Psychosocial Factors and Cardiovascular Disease Risk: An Opportunity in Women's Health.
Psychosocial Factors and Cardiovascular Disease Risk: An Opportunity in Women's Health.
复制标题
心理社会因素和心血管疾病风险：女性健康的机会。
DOI：
10.1161/circresaha.117.311113
复制
发表时间：
2017
影响因子：
20.1
通讯作者：
Manson,JoAnnE
中科院分区：
文献类型：
--
作者：
Okereke,OliviaI;Manson,JoAnnE
1856循环研究2017年6月9日这可能解释了作者观察到的发现。然而，对于非致命性事件，在考虑了吸烟和体育活动等生活方式和健康行为后，社会融合似乎与结果无关。值得注意的是，社会融合可能会影响患者的行为，包括对保健预约和血管风险治疗(例如，抗高血压药物、他汀类/降胆固醇药物等)的遵从性，这些行为在目前的研究中没有被测量到，这会影响发生心血管事件的可能性。尽管在分析中有许多潜在的协变量，但治疗依从性并未被明确测量或纳入。最后，Chang等人的文章指出了未来研究活动的领域。首先，正如作者和其他人在其他地方所说的那样，公共卫生需要解决对女性心血管疾病风险因素和女性心血管结果差异的长期认识差距。应对心理社会压力的潜在不利影响，特别是对妇女发生致命心血管事件的风险，是一个重要的公共卫生研究方向和预防机会。例如，未来需要开展工作，以了解诸如通过改善社会融合等方式优化应对压力和心理痛苦的复原力的努力是否能对降低妇女的心血管疾病风险产生益处。其次，文章提醒我们，在考虑心理社会因素与心血管疾病风险的关系时，充分描述潜在的解释性生活方式和健康行为变量的重要性，包括治疗依从性。最后，继续研究的目标必须是区分个体和风险因素--遗传、生物、环境、心理、社会和行为--对致命性和非致命性心血管疾病事件的共同贡献，重要的是这种努力将性别视为生物变量，同时解决社会经济因素和种族/族裔的差异。
1856 Circulation Research June 9, 2017 this may explain findings observed by the authors. However, with regard to nonfatal events, social integration may seem unrelated to the outcome, after accounting for lifestyle and health behaviors, such as smoking and physical activity. Notably, social integration may influence patients’ behaviors that were unmeasured in the current study, including compliance with healthcare appointments and vascular risk treatments (eg, antihypertensive agents, statins/cholesterol-lowering medications, etc) that affect the likelihood of CVD events. Although many potential covariates were available in the analyses, treatment compliance was not explicitly measured or included. Finally, the article by Chang et al3 points to areas of future research activity. First, as has been stated by the authors and others elsewhere, there is a public health need to address persistent gaps in knowledge of women’s CVD risk factors and disparities in women’s cardiovascular outcomes. Addressing potential adverse impacts of psychosocial stress, especially on the risk of fatal CVD events in women, is an important public health research direction and opportunity for prevention. For example, future work is needed to understand whether efforts to optimize resilience to stress and psychological distress, such as through improved social integration, can yield benefits for CVD risk reduction in women. Second, the article reminds us of the importance of adequate characterization of potential explanatory lifestyle and health behavior variables, including treatment compliance, when considering relations of psychosocial factors to CVD risk. Finally, a continued target of research must be the differentiation of the individual and joint contributions of risk factors—genetic, biological, environmental, psychological, social, and behavioral—for fatal versus nonfatal CVD events, and it is important for such efforts to consider sex as a biological variable and concurrently to address disparities by socioeconomic factors and race/ethnicity.