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Psychosocial Factors and Coronary Calcium in Adults without Clinical Cardiovascular Disease

Ana V. Diez Roux, MD, PhD; Nalini Ranjit, PhD; Lynda Powell, PhD; Sharon Jackson, PhD; Tené T. Lewis, PhD; Steven Shea, MD; and Colin Wu, PhD
[+] Article and Author Information

From University of Michigan, Ann Arbor, Michigan; Rush University Medical Center, Chicago, Illinois; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Columbia University, New York, New York; and National Institutes of Health, Bethesda, Maryland.


Note: Drs. Diez Roux and Ranjit had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

Acknowledgments: The authors thank the other investigators, the staff, and the participants of MESA for their valuable contributions, and Sarah Burgard for assistance with initial data analyses.

Grant Support: By the National Heart, Lung, and Blood Institute (contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169) (Multiethnic Study of Atherosclerosis) and in part by R01 HL076831 (Dr. Diez Roux).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Ana V. Diez Roux, MD, PhD, Department of Epidemiology, School of Public Health, University of Michigan, 1214 South University, 2nd Floor, Ann Arbor, MI 48103; e-mail, adiezrou@umich.edu.

Current Author Addresses: Drs. Diez Roux and Ranjit: Department of Epidemiology, School of Public Health, University of Michigan, 1214 South University, 2nd Floor, Ann Arbor, MI 48103.

Dr. Powell: Department of Preventive Medicine and Department of Behavioral Sciences, Rush University Medical Center, Suite 470, 1700 West Van Buren, Chicago, IL 60612.

Dr. Jackson: Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.

Dr. Lewis: Department of Preventive Medicine, Rush University Medical Center, Suite 470, 1700 West Van Buren, Chicago, IL 60612.

Dr. Shea: Departments of Medicine and Epidemiology, Columbia University, 630 West 168th Street, New York, NY 10032.

Dr. Wu: National Heart, Lung, and Blood Institute, National Institutes of Health, 2 Rockledge Center, Room 8218, 6701 Rockledge Drive, Bethesda, MD 20892-7938.

Author Contributions: Conception and design: A.V. Diez Roux, N. Ranjit, L. Powell, S. Jackson, S. Shea.

Analysis and interpretation of the data: A.V. Diez Roux, N. Ranjit, L. Powell, S. Jackson, C. Wu.

Drafting of the article: A.V. Diez Roux, N. Ranjit.

Critical revision of the article for important intellectual content: A.V. Diez Roux, N. Ranjit, L. Powell, S. Jackson, T.T. Lewis, S. Shea, C. Wu.

Final approval of the article: A.V. Diez Roux, N. Ranjit, L. Powell, S. Jackson, T.T. Lewis, S. Shea, C. Wu.

Provision of study materials or patients: A.V. Diez Roux, S. Shea, S. Jackson.

Statistical expertise: A.V. Diez Roux, N. Ranjit, C. Wu.

Obtaining of funding: A.V. Diez Roux, S. Shea.

Collection and assembly of data: A.V. Diez Roux, S. Jackson, S. Shea.


Ann Intern Med. 2006;144(11):822-831. doi:10.7326/0003-4819-144-11-200606060-00008
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The MESA is a longitudinal study supported by the National Heart, Lung, and Blood Institute (NHLBI); its goal is identifying risk factors for subclinical atherosclerosis. Details of the study design have been published elsewhere (33). Between July 2000 and August 2002, 6814 men and women 45 to 84 years of age who identified themselves as white, black, Hispanic, or Chinese and were free of clinically apparent cardiovascular disease were recruited from 6 U.S. communities: Baltimore City and Baltimore County, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan and the Bronx, New York; and St. Paul, Minnesota. Each field site recruited participants from locally available sources, which included lists of residents, lists of dwellings, and telephone exchanges. In the last few months of the recruitment period, supplemental sources, such as lists of Medicare beneficiaries from the Centers for Medicare & Medicaid Services and referrals by participants, were used to ensure adequate numbers of minority and elderly participants. The age distribution of the final sample was as follows: 45 to 54 years (27%), 55 to 64 years (28%), 65 to 74 years (30%), and 75 years or older (16%). Percentages do not sum to 100 because of rounding. Coronary calcium was assessed by using chest computed tomography (CT) with a cardiac-gated electron-beam CT scanner (34) (Chicago, Los Angeles, and New York field centers) or a multidetector CT system (35) (Baltimore, Forsyth County, and St. Paul field centers) (36). All participants had scanning over phantoms of known physical calcium concentration. A cardiologist read all scans at the Harbor-UCLA Research and Education Institute in Torrance, California, to identify and quantify coronary calcification, calibrated according to the readings of the calcium phantom. Scans were read blindly with respect to scan pairs and to other participant data by using a computerized interactive scoring system similar to that described by Yaghoubi and colleagues (37). The score of Agatston and colleagues (38) was used in all analyses. The Agatston score and the volumetric calcium score were very highly correlated in this sample (r = 0.99). The presence of calcification was defined as an average Agatston score greater than 0.

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Figure.
Log Agatston score plotted against anger, anxiety, depression, and chronic burden in men and women in the Multiethnic Study of Atherosclerosis, 2000–2002.(53)

One point was added to all Agatston scores before taking the logarithm so that the 0 score could be included in the figure. Smooth lines were fitted by using a cubic spline . Points for women were offset slightly to the right to induce separation between both sexes.

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Summary for Patients

Psychosocial Factors and Coronary Calcium

The summary below is from the full report titled “Psychosocial Factors and Coronary Calcium in Adults without Clinical Cardiovascular Disease.” It is in the 6 June 2006 issue of Annals of Internal Medicine (volume 144, pages 822-831). The authors are A.V. Diez Roux, N. Ranjit, L. Powell, S. Jackson, T.T. Lewis, S. Shea, and C. Wu.

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