Gender and cardiovascular disease: a psychobiological and integrative approach

Coronary artery disease is the most common cause of morbidity, mortality, and economic loss in all industrialized countries. Although there are gender differences in the prevalence, causes, symptoms, treatment, and outcome of heart disease, the differences are complex and often misunderstood. These gender differences are a function of psychological influences, physiological influences, and an interaction of the two. Understanding these complex interactions and how they differentially influence the development and progression of heart disease will ultimately contribute to a greater understanding of how to integrate information from medicine and epidemiology with that from psychology and behavioral medicine. Ultimately, it is this integrated approach that will allow us to better understand heart disease in both men and women.     

Science,atherosclerosis and the “age of unreason”: A review

Research in atherosclerosis has been dominated by the lipid hypothesis. The pathology of both the cholesterol-fed animal and of familial hypercholesterolemia has been misrepresented. The vascular lesions of these disorders are not atherosclerotic but manifestations of fat storage. There has been undue faith in the epidemiology of coronary heart disease and atherosclerosis. Fundamental defects in the epidemiological approach to the cause of atherosclerosis include: (1) misuse of cause and risk factors; (2) misuse of coronary heart disease as an imprecise and inappropriate surrogate endpoint in clinical and mortality studies; (3) use of fallacious monocausal death certificates and mortality rates; (4) assumed causal role of risk factors; (5) use of fallacious dietary data; (6) ecological fallacies; (7) nonspecificity of statistical correlations and selection bias; (8) failure to take note of inconsistencies; (9) inappropriate use of the blood cholesterol level as a surrogate of atherosclerosis (substitution game) without demonstration of any such effect on arteries; and (10) misplaced faith in pathological and experimental corroborative evidence. The epidemiology of atherosclerosis is based on unscientific methodology and the lipid hypothesis as currently envisaged is invalid. There is need to review the cholesterol-lowering campaign especially for normolipidemic subjects.     

Sex differences in mortality rates among long-stay psychiatric inpatients

Study of the sex ratio of mortality rates among three categories of long-term psychiatric inpatients suggests a trend toward equalization of death rates between the sexes by specific cause of death, given the constant inpatient environment. The most dramatic example of this equalization was the virtual parity of death rates for ischemic heart disease among younger schizophrenic patients of both sexes in contrast to a three- to fourfold male excess in the general population. An exception to this equalization was seen for neoplasm deaths, which showed a female excess in all three patient groups in contrast to the male excess seen in the general population. Further study of chronically hospitalized psychiatric patients seems indicated to delineate patterns of death associated with biologic variation in a relatively constant environment.     

Marital status integration, suicide disapproval, and societal integration as explanations of marital status differences in female age-specific suicide rates

Sociological analyses of suicide have often neglected female suicide rates. Three competing explanations are tested to determine why the suicide rates of married women are, typically, lower than the suicide rates of women who are not married: (1) marital status integration, (2) societal integration, and (3) a nation's normative order about disapproval of suicide. Data refer to age and marital status-specific female suicide rates from 12 developed countries. The results provide the strongest support for the marital status integration theory and consistent support for the social integration perspective. There is also mixed support for the cultural disapproval of suicide hypothesis.     

Is Work Conducive to Self-Destruction?

ABSTRACT: While the current literature contains numerous studies and even more numerous assumptions linking aspects of the work setting, stress, and mortality; no systematic investigation has been made of possible patterns of stress-induced self-destructive behaviors among the work settings per se. This research paper attempts to help fill that gap by reporting on an analysis of data on industry, age and mortality rates for seven stress-related causes of death (suicide, homocide, hypertensive heart disease, cirrhosis of the liver, arteriosclerotic heart disease, ulcer of the stomach, and hypertension). Using available United States' mortality statistics, a consistent pattern is found for all of the stress-related types of deaths by industry and age. A suggested explanation of this pattern is based on status integration theory.     

Alzheimer's disease in Down syndrome: neurobiology and risk

Down syndrome (DS) is characterized by increased mortality rates, both during early and later stages of life, and age-specific mortality risk remains higher in adults with DS compared with the overall population of people with mental retardation and with typically developing populations. Causes of increased mortality rates early in life are primarily due to the increased incidence of congenital heart disease and leukemia, while causes of higher mortality rates later in life may be due to a number of factors, two of which are an increased risk for Alzheimer's disease (AD) and an apparent tendency toward premature aging. In this article, we describe the increase in lifespan for people with DS that has occurred over the past 100 years, as well as advances in the understanding of the occurrence of AD in adults with DS. Aspects of the neurobiology of AD, including the role of amyloid, oxidative stress, Cu/ZN dismutase (SOD-1), as well as advances in neuroimaging are presented. The function of risk factors in the observed heterogeneity in the expression of AD dementia in adults with DS, as well as the need for sensitive and specific biomarkers of the clinical and pathological progressing of AD in adults with DS is considered.     

Exploration of Environmental and Genetic Risk Factors for Alzheimer’s Disease: The Value of Cross-Cultural Studies

Advances in molecular genetics have revolutionized epidemiological research. It is now possible to combine the techniques of population genetics with research on risk factors to construct genetic-environmental interactive models that explain geographic-ethnic variations in disease rates. Cross-cultural studies involving populations from developing and developed countries offer a unique opportunity for constructing these models by providing a wide diversity of environmental exposures. Results from a comparative Indianapolis-Ibadan study suggest that Alzheimer’s disease incidence rates are lower in Yoruba than in African Americans and that these lower rates may be due to a combination of genetic and environmental, primarily dietary, influences.     

Depression in Women with Heart Disease: The Importance of Social Role Performance and Spirituality

Compared with men, women are more likely to experience depression, and depression increases risk of morbidity and mortality in individuals with heart disease. Psychosocial interventions have been developed for depressed patients with heart disease; however, women's experience of chronic disease differs from men's and women may benefit from interventions tailored to address their difficulties. Spirituality and social roles have been related to depressive symptoms in other populations. To identify the relationship between depression and spirituality and social role performance (i.e., role concerns, role rewards and confidence in ability to fulfill roles) in women with heart disease, we assessed depressive symptoms, spirituality, social role functioning and medical history in 125 women with heart disease. After controlling for age and severity of medical conditions, spirituality, role confidence and role concerns were significantly associated with depressive symptoms. Consideration of spirituality and aspects of social role performance may be important when developing psychosocial interventions for depressed women with heart disease.     

National differences in intelligence,crime, income,and skin color

National differences in murder, rape, and serious assault were examined in 113 countries in relation to national IQ, income, skin color, birth rate, life expectancy, infant mortality, and HIV/AIDS. Data were collated from the 1993–1996 International Crime Statistics published by INTERPOL. Violent crime was found to be lower in countries with higher IQs, higher life expectancies, lighter skin color, and lower rates of HIV/AIDS, although not with higher national incomes or higher rates of infant mortality. A principal components analysis found the first general factor accounted for 52% of the variance. Moreover, the correlations were significantly higher with skin color, a more biologically influenced variable, than with measures of national income, a more culturally influenced variable. When the 19 sub-Saharan African countries were excluded from analysis the crime/IQ relation held but the crime/skin color relation did not.     

The association between change in cognitive ability and cause-specific mortality in a community sample of older adults

While there is consistent evidence that initial levels of cognitive ability predict mortality, there is mixed evidence for a relationship between changes in cognition and mortality. There have been few studies that have examined whether the level and slope of cognitive performance is predictive of subsequent mortality from all causes or from cardiovascular disease, stroke, heart disease, respiratory disease, or cancer. This study aimed to assess whether the level and slope of cognitive ability were associated with all-cause or cause-specific mortality. A cohort of 896 community-based elderly people in Australia was interviewed four times over 12 years, with vital status followed for up to 17 years. Of these, 592 participants completed two or more interviews and were included in survival models of six mortality outcomes. Cognitive change in five domains of ability was estimated using latent growth models. Poorer initial processing speed or verbal fluency was significantly associated with greater all-cause and/or cardiovascular mortality. In addition, declines in global ability were associated with greater all-cause, cardiovascular, and heart disease mortality. Vocabulary and episodic memory were not associated with mortality, and none of the cognitive tests significantly predicted respiratory or cancer mortality. Initial levels of cognitive ability tended to be better predictors of subsequent mortality than were changes in ability. The results suggest that vascular events may be largely responsible for the overall relationship between cognition and mortality.     

抑郁和焦虑与心律失常

焦虑抑郁广泛存在于各种心血管疾病中已成共识。心律失常患者合并心理问题在临床上十分常见,焦虑抑郁导致的自主神经对心脏的调节失衡会进一步促使心律失常的发生与发展。对于非器质性心脏病,β受体阻滞剂与抗焦虑药物合用有很好的疗效;器质性心脏病患者并发心律失常时患者的焦虑抑郁会进一步加重,甚至导致恶性室性心律失常的发生,增加器质性心脏病患者的病死率;心律失常介入治疗引起的焦虑抑郁更为常见。临床上对焦虑抑郁症状要有充分的重视,积极识别并诊断,以期进一步提高心律失常患者的生活质量,减少病死率。     

The perceived vulnerability to disease scale: Cross-cultural measurement invariance and associations with fear of COVID-19 across 16 countries

Using cross-sectional data from N = 4274 young adults across 16 countries during the COVID-19 pandemic, we examined the cross-cultural measurement invariance of the perceived vulnerability to disease (PVD) scale and tested the hypothesis that the association between PVD and fear of COVID-19 is stronger under high disease threat [that is, absence of COVID-19 vaccination, living in a country with lower Human Development Index (HDI) or higher COVID-19 mortality]. Results supported a bi-factor Exploratory Structural Equation Modeling model where items loaded on a global PVD factor, and on the sub-factors of Perceived Infectability and Germ Aversion. However, cross-national invariance could only be obtained on the configural level with a reduced version of the PVD scale (PVD-r), suggesting that the concept of PVD may vary across nations. Moreover, higher PVD-r was consistently associated with greater fear of COVID-19 across all levels of disease threat, but this association was especially pronounced among individuals with a COVID-19 vaccine, and in contexts where COVID-19 mortality was high. The present research brought clarity into the dimensionality of the PVD measure, discussed its suitability and limitations for cross-cultural research, and highlighted the pandemic-related conditions under which higher PVD is most likely to go along with psychologically maladaptive outcomes, such as fear of COVID-19.     

Why people engage in parasuicide: a cross-cultural study of intentions

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.     

The effects of changes in the World Health Organization's International Classification of Diseases on suicide rates in 71 countries, 1950-1999

The World Health Organization (WHO) provides annual mortality statistics from 1950 onward based on the International Classification of Diseases (ICD). In this paper we evaluate the effects of ICD form revisions on suicide rates for 71 countries. The changes between ICD-6, ICD-7, ICD-8, and ICD-9 did not have an overall effect on reported suicide rates. The transitions to ICD-8 and ICD-9 were, however, associated with country-specific changes in the suicide rate in some countries. The change from ICD-9 to ICD-10 was associated with an overall change of -.73 suicides per 100,000 inhabitants. It is recommended that researchers using the WHO mortality data for longitudinal cross-national studies control for the ICD form used at different time points.     

Interactive effects of behavior and reproductive hormones on sex differences in risk for coronary heart disease

It is well known that women in the United States, as in most industrialized countries in the world, are protected from coronary heart disease (CHD), relative to men. It is thought that this protection is by and large due to the effects of female reproductive hormones (i.e., estrogens) on lipid and lipoprotein metabolism and blood pressure, although women's relatively low rates of cigarette smoking are also thought to play a role. However, epidemiological studies that statistically adjust for sex differences in lipids, blood pressure, and smoking status cannot explain sex differences in CHD morbidity and mortality. Also, inconsistent with a simple main-effect model of reproductive hormones are data showing elevated risk of myocardial infarction and stroke among women who use oral contraceptives. Men who are prescribed estrogens have elevated risk of CHD, and case-control studies show that male CHD patients have elevated estradiol, compared to controls. This article suggests that simple main-effect models of female protection from CHD are inadequate. It argues that reproductive hormones are important determinants of protection from CHD, in interaction with behavioral characteristics. It also demonstrates that reproductive hormones can influence behavioral characteristics and that behavioral characteristics can influence the effects of reproductive hormones on CHD risk factors.     

Social Relationships and Health: The Toxic Effects of Perceived Social Isolation

Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad‐based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum – the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well‐being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.     

Is There a Backlash Against Immigration From Richer Countries? International Hierarchy and the Limits of Group Threat

Why do immigrants from particular countries systematically face more opposition? To resolve inconsistencies of prevailing group‐threat theories, I reintroduce a long‐standing hypothesis stipulating that people have a disposition for maintaining status hierarchy between ethnic groups. Accordingly, independent of perceived economic or cultural threat, natives are more likely to prefer immigrant groups of higher status based on the development level of the group's national origin. To test this argument, I exploit a substantial provincial variation of immigration flows and attitudes in Spain—one of the only countries that has received immigrants from both less and more developed countries. Consistent with my hypothesis, I demonstrate that anti‐immigration attitudes are more widespread in areas with immigrants from less developed countries regardless of their economic and cultural characteristics. I further document that many voters perceive stable group hierarchies and that these preferences are more predictive of anti‐immigration attitudes in lower‐status immigration contexts. Overall, these results suggest that even culturally similar and economically beneficial immigrant groups from poorer countries can face public opposition due to their lower‐status national origin, highlighting the independent role of group‐status perceptions in politics.     

Suicide and Homicide Rates in Canada and the United States

Suicide and homicide rates by age were analyzed for Canada and the United States, indicating that suicide is higher in Canada and that homicide is higher in the United States. Results indicated a positive association between homicide and suicide rates in the United States but these two rates of death were not significantly associated in Canada. Holinger (1987) had associated the relative size of the cohort to the rates of suicide and homicide in young people in the United States. The more current data in both countries did not support Holinger's results. Using the measure devised by Easterlin (1980) and Ahlburg and Schapiro (1984) –that is, the proportion of youths aged 15–24 relative to adults aged 25–64–the correlation between the size of the youth cohort and the suicide rate of youths aged 15–24 was negative. It is concluded that the two patterns in these two countries may be explained from a historical perspective.     

An assessment of community suicide risk

The contributions of several core variables to the white suicide rates in 24 Florida counties were examined, and a prediction equation, using multiple linear regression, was developed. Age was found to be about 50% more important than divorce. With both age and divorce controlled, loneliness and insanity were found to be significant core variables (p less than .05). A prediction equation including age, crime rate, insanity, and alcoholism was found that accounted for 79% of the variation in the suicide rates across counties. The observed rates were divided by predicted rates to yield standardized mortality ratios. It is proposed that these ratios may serve to assess both the need for and the impact of community suicide prevention services by placing suicide rates in the context of relevant social conditions.     

Home country national intelligence and self-employment rates among immigrants in Norway

The level of self-employment varies significantly among immigrants from different countries of origin. The objective of this research is to examine the relationship between home-country national intelligence and self-employment rates among first generation immigrants in Norway. Empirical secondary data on self-employment among immigrants from 117 countries residing in Norway in 2008 was used. The relevant hypothesis was tested using hierarchical regression analysis. The immigrants’ national intelligence was found to be significantly positively associated with self-employment. However, the importance of national IQ for self-employment among immigrants decreases with the duration of residence in Norway. The study concludes with practical implications and suggestions for future research.