Coping strategies and risk of cardiovascular disease incidence and mortality: the Japan Public Health Center-based prospective Study
Coping strategies and risk of cardiovascular disease incidence and mortality: the Japan Public Health Center-based prospective Study
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DOI：
10.1093/eurheartj/ehv724
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发表时间：
2016-03-14
影响因子：
39.3
通讯作者：
Tsugane, Shoichiro
中科院分区：
文献类型：
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作者：
Svensson, Thomas;Inoue, Manami;Tsugane, Shoichiro
应对策略可能与健康结果显著相关。这是第一项研究，调查基线应对策略和心血管疾病（CVD）的发病率和死亡率之间的关联在一般人群coherent.Methods和结果日本公共卫生中心为基础的前瞻性研究提出的问题，应对在其第三次随访调查（200004）。对CVD发病率和死亡率的分析包括57017名年龄在50-79岁的受试者，他们没有CVD病史，并提供了关于接近和回避导向的应对行为和策略的完整答案。根据应对方式，采用考克斯回归模型，调整混杂因素，以确定风险比（HR）。发病率平均随访时间为7.9年，死亡率平均随访时间为8.0年。发病前使用以接近为导向的应对策略与卒中发生率（HR = 0.85; 95%CI，0.73-1.00）和CVD死亡率（HR = 0.74; 95%CI，0.55-0.99）呈负相关。卒中亚型分析显示，以方法为导向的应对策略与缺血性卒中的发生率呈负相关（HR = 0.79; 95%CI，0.64-0.98），而联合应对策略与脑实质内出血的发生率呈正相关（HR = 2.03; 95%CI，1.01-4.10）。仅在高血压患者中，使用回避应对策略与缺血性心脏病（IHD）死亡率增加相关（HR = 3.46; 95%CI，1.07-11.18）。幻想和积极重评的应对行为与心血管病发病风险增加有关（HR = 1.24; 95% CI，1.03-1.50）和IHD死亡风险降低（HR = 0.63;结论以应对方式为导向的应对策略，即积极应对压力源，可能与日本人群队列中卒中发病率和CVD死亡率显著降低相关。
Aims Coping strategies may be significantly associated with health outcomes. This is the first study to investigate the association between baseline coping strategies and cardiovascular disease (CVD) incidence and mortality in a general population cohort.Methods and results The Japan Public Health Center-based prospective Study asked questions on coping in its third follow-up survey (200004). Analyses on CVD incidence and mortality included 57 017 subjects aged 50-79 without a history of CVD and who provided complete answers on approach-and avoidance-oriented coping behaviours and strategies. Cox regression models, adjusted for confounders, were used to determine hazard ratios (HRs) according to coping style. Mean follow-up time was 7.9 years for incidence and 8.0 years for mortality. The premorbid use of an approach-oriented coping strategy was inversely associated with incidence of stroke (HR = 0.85; 95% CI, 0.73-1.00) and CVD mortality (HR = 0.74; 95% CI, 0.55-0.99). Stroke subtype analyses revealed an inverse association between the approach-oriented coping strategy and incidence of ischaemic stroke (HR = 0.79; 95% CI, 0.64-0.98) and a positive association between the combined coping strategy and incidence of intra-parenchymal haemorrhage (HR = 2.03; 95% CI, 1.01-4.10). Utilizing an avoidance coping strategy was associated with increased mortality from ischaemic heart disease (IHD) only in hypertensive individuals (HR = 3.46; 95% CI, 1.07-11.18). The coping behaviours fantasizing and positive reappraisal were associated with increased risk of CVD incidence (HR = 1.24; 95% CI, 1.03-1.50) and reduced risk of IHD mortality (HR = 0.63; 95% CI, 0.40-0.99), respectively.Conclusion An approach-oriented coping strategy, i.e. proactively dealing with sources of stress, may be associated with significantly reduced stroke incidence and CVD mortality in a Japanese population-based cohort.