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Patients with a history of spontaneous coronary artery dissection (SCAD) have high levels of perceived stress and fatigue, whereas levels of anxiety and depression are relatively low.
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Several chronic conditions that do not reflect ischaemic or non-ischaemic cardiovascular disease (including tinnitus, chronic pain and burnout) are frequently reported precursors or comorbidities of SCAD.
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Psychological factors, in addition to fibromuscular dysplasia, migraine, tinnitus, and non-ischaemic pain conditions, may contribute to the development of SCAD and its subsequent clinical course.
Introduction
Methods
Participants and setting
Procedure
Measures
SCAD-related characteristics
Psychological factors
Clinical characteristics and covariates
Statistical analyses
Results
Participant characteristics
Characteristics | Women (n = 172)a |
---|---|
Demographic factors | |
Age (years) | 52.0 ± 7.5 |
European descent | 169 (98%) |
Married or in a relationship | 154 (90%) |
Employment status | |
– Employed, working full time | 31 (18%) |
– Employed, working part time | 98 (57%) |
– Other (e.g. unemployed, retired, homemaker) | 43 (25%) |
Education level | |
– University education or higher professional education | 96 (56%) |
– Secondary vocational education | 62 (36%) |
– Secondary education | 12 (7%) |
– Primary education | 2 (1%) |
Cardiovascular risk factors | |
Hypertension | 54 (31%) |
Hypercholesterolaemia | 15 (9%) |
Diabetes mellitus | 2 (1%) |
Family history of heart disease <60 years | 80 (47%) |
Current smoker | 4 (2%) |
Ever smoker (previous or current) | 31 (18%) |
Body mass index (kg/m2) | 24.9 ± 4.4 |
Physical inactivityb | 29 (17%) |
Alcohol (>1 glass per day) | 16 (9%) |
Women-specific factors | |
Age at first menarche | 13 ± 1.5 |
Fertility problems | 24 (14%) |
Ever pregnant | 156 (91%) |
– Ever had a miscarriage | 53 (34%) |
– Children | 153 (98%) |
– Gestational diabetes | 3 (2%) |
– Gestational hypertension | 32 (21%) |
– HELLP syndrome and/or pre-eclampsia | 14 (9%) |
– Multiparous (≥4 births) | 7 (4%) |
Polycystic ovary syndrome | 3 (2%) |
1 or 2 ovaries removed | 6 (3%) |
Uterus removed | 10 (6%) |
On hormonal therapyc | 34 (20%) |
Postmenopausald | 63 (37%) |
Psychological factors
Psychological factors | Women (n = 172) |
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Psychological stress | |
Perceived stress in the last month (PSS-10) | 14.7 ± 6.8 |
– Moderate or high perceived stress (PSS-10, cutoff ≥14)a | 85 (50%) |
Anxiety symptoms (GAD‑7, mean ± SD) | 4.9 ± 4.2 |
– Moderate/severe anxiety (GAD‑7, cutoff ≥10) | 21 (12%) |
Depressive symptoms (PHQ‑9, mean ± SD) | 4.9 ± 3.9 |
– Moderate/severe depressive symptoms (PHQ‑9 cutoff ≥10) | 16 (9%) |
Fatigue (FAS-10, mean ± SD) | 23.4 ± 6.7 |
– Substantial or extreme fatigue (FAS-10, cutoff ≥22) | 96 (56%) |
Sensitivity to physical symptoms (BVS‑3, mean ± SD) | 14.3 ± 6.3 |
Positive mental well-being (MHC-SF, mean ± SD) | 3.2 ± 0.8 |
Burnout | 43 (25%) |
Personality characteristics | |
Type D personality (DS14 ≥10 for both NA and SI) | 32 (19%) |
Neuroticism (BFI-NL neuroticism scale, mean ± SD) | 2.8 ± 0.7 |
Comorbidities of SCAD
Comorbidities | Women (n = 172) |
---|---|
No comorbid condition reported | 16 (9%) |
Fibromuscular dysplasia (FMD) | |
Tested on FMD | 130 (76%) |
– Confirmed diagnosis FMDa | 38 (29%) |
Other medical conditions | |
Mixed connective tissue diseases (e.g. Marfan syndrome, Ehlers-Danlos syndrome) | 5 (3%) |
Rheumatoid arthritis | 15 (9%) |
Vasculitis | 4 (2%) |
Hypo- or hyperthyroidism | 20 (12%) |
Allergies | 64 (37%) |
Migrainea | 89 (52%) |
Medically chronic symptoms | |
Fibromyalgia | 13 (8%) |
Chronic fatigue syndrome | 9 (5%) |
Irritable bowel syndrome | 23 (13%) |
Tinnitus | 48 (28%) |
At least one of the above | 64 (37%) |
Current pain conditions | |
Chronic pain | 50 (29%) |
Pain between the shoulder blades | 73 (42%) |
Stomach pain | 39 (23%) |
Pain in the jaws or neck | 46 (27%) |
Chest pain | 117 (68%) |