Asymptomatic atherosclerosis and myocardial infarction: Risk modified by ability to adapt to stressful situations. Results from prospective cohort study "Men born in 1914", Malmo, Sweden

Background: The purpose of this study was to investigate whether different behaviors in a stressful situation modify the risk of atherosclerosis in association with a myocardial infarction, cardiovascular mortality, and all-cause mortality. Many individuals have atherosclerotic changes in their arteries but may never experience any symptoms nor develop cardiovascular disease. A myocardial infarction is caused by a disruption of a vulnerable atherosclerotic plaque. The mechanisms that trigger these events are not fully understood, but among the proposed agents is psychological stress. A differential in risk exposure could be expected since individuals differ in their ability to cope with stressful situations. Materials/Methods: In the prospective cohort study "Men born in 1914", atherosclerosis was noninvasively studied in the peripheral, carotid, and coronary arteries at a baseline examination in 1982/83. The serial Color Word Test, which is a semi-experimental way to assess how individuals adapt in a stressful situation, was administered at the same examination. Participants were followed-up regarding incidence of myocardial infarction and mortality until December 31 1996. Results: Atherosclerosis was associated with an increased risk of myocardial infarction (relative risk (RR) 2.96; 95% confidence interval (CI) 1.52 to 5.74) and cardiovascular mortality (RR 3.31; 95% Cl 2.08 to 5.28) during follow-up only among the men who showed maladaptive behavior. No excess risk could be established in men with an adaptive behavior pattern. Conclusions: The serial Color Word Test can assist in identifying men at high cardiovascular risk