Type D personality is not associated with coronary heart disease risk in a North American sample of retirement-aged adults.

BACKGROUND: Type D personality is associated with recurrent coronary heart disease (CHD) risk but there is limited and inconsistent evidence regarding incident risk among persons free of clinical CHD. PURPOSE: We examined the association between Type D personality and coronary heart disease (CHD) risk in apparently healthy adults. We also explored the association of these traits with waist circumference, body mass index (BMI), and inhibited physician consultation behavior. METHODS: Cross-sectional study of North American retirement-aged residents (N = 303). The primary outcome variable was a modified 10-year absolute CHD risk score from the Framingham Heart Study. Secondary outcomes included adiposity and a 5-item measure of patient/provider interaction inhibition. We regressed CHD risk on negative affect (NA), social inhibition (SI), and the NAxSI interaction (i.e., the Type D personality) and repeated these analyses for adiposity and for patient/provider interaction inhibition. We also contrasted CHD risk across Type D and non-Type D categories. RESULTS: None of the personality variables were associated with CHD risk for the whole sample (regression coefficients from −0.11 to .10, Ps > 0.29) or in gender-specific analyses. For adiposity, NA was positively associated and SI was negatively associated with BMI in women (Ps < 0.05), but there were no other personality associations. Patient/provider interaction inhibition was associated with SI (P < 0.001) but not NA or the NAxSI interaction (P = 0.42). The contrast between Type D and non-Type D personality revealed no differences in CHD risk (P = 0.93). CONCLUSIONS: Neither Type D nor its constituent NA and SI traits were associated with absolute incident CHD risk in retirement-aged adults free of reported CHD. Optimal analytic practices and attention to patient/provider interaction behavior will improve our understanding of the association between Type D personality traits and health.

Demographic variables are associated with knowledge, attitudes, and preventive behaviors related to environmental tobacco smoke.

INTRODUCTION: Environmental tobacco smoke (ETS) is the third leading preventable cause of death in the United States. Few biopsychosocial studies have addressed knowledge of specific ETS health effects, attitudes toward ETS, and personal preventive efforts related to ETS. METHOD: We surveyed a diverse U.S. community sample of convenience (N = 328) in Flagstaff, Arizona, to examine the following: (a) Does ETS knowledge measured using two response formats, open-ended (OPEF) versus closed-ended (CLEF), result in differences in apparent knowledge? and (b) what are demographic predictors of ETS knowledge, attitudes, and preventive behaviors? RESULTS: Participants scored significantly higher on the ETS knowledge CLEF than OPEF. In regression analyses, predictors of ETS knowledge on the OPEF scale included ethnicity, age, and smoking status; the model predicting knowledge using the CLEF scale was not significant. Knowledge and smoking status, as measured on both the CLEF and the OPEF, were significant predictors of negative attitudes. Additional predictors of attitudes included income for the model using the OPEF and gender for the model using the CLEF. Predictors of preventive behaviors included attitudes and age (OPEF and CLEF models). DISCUSSION: Differences in apparent ETS knowledge of specific ETS health effects by varying response format suggest that open-ended surveys may be useful in identifying specific content areas to address in public health education efforts. Various demographic variables predicted ETS knowledge, attitudes, and preventive behaviors, highlighting specific populations to target in public health interventions relating to ETS, such as non-White and younger populations.

Depression Is Associated With Reduced Outpatient Cardiac Rehabilitation Completion Rates: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS.

PURPOSE: Depression is associated with recurrent cardiac events and death in patients with coronary heart disease and congestive heart failure. Furthermore, depression may be associated with reduced completion of outpatient cardiac rehabilitation (CR), an empirically supported treatment for patients with coronary heart disease and congestive heart failure that reduces recurrent coronary events and cardiac mortality. The goal of the current systematic review and meta-analysis was to explore the association between depression and outpatient CR completion. METHOD: A systematic literature review cross-referenced 3 electronic databases (PsycINFO, MEDLINE, and Dissertation Abstracts International) from inception through February 15, 2015. Studies quantifying an association between depression and outpatient CR completion were identified for review. A random-effects model was used to pool quantitative data, moderators were tested, and publication bias was analyzed. RESULTS: Seventeen studies with 19 independent samples consisting of 30 586 cardiac patients were included in the meta-analysis. A moderate inverse relationship between depression and outpatient CR completion was observed (g = -0.44; 95% CI, -0.59 to -0.29), indicating that depressed CR patients were significantly less likely to complete their prescribed CR programs. No significant moderator variables were identified. A minor amount of publication bias was detected. CONCLUSION: Depression is associated with reduced outpatient CR completion rates. Future research should focus on attendance interventions for depressed CR patients, as completion of outpatient CR reduces cardiac and all-cause mortality.

Prescribing exercise at varied levels of intensity and frequency: a randomized trial.

BACKGROUND: Regular physical activity produces beneficial effects on health, but the exercise prescription needed to improve cardiovascular disease risk factors in free-living sedentary individuals remains unclear. METHODS: Sedentary adults (N = 492, 64.0% women) were randomized to 1 of 4 exercise-counseling conditions or to a physician advice comparison group. The duration (30 minutes) and type (walking) of exercise were held constant, while exercise intensity and frequency were manipulated to form 4 exercise prescriptions: moderate intensity-low frequency, moderate intensity-high frequency (HiF), hard intensity (HardI)-low frequency, and HardI-HiF. Comparison group participants received physician advice and written materials regarding recommended levels of exercise for health. Outcomes included 6- and 24-month changes in cardiorespiratory fitness (maximum oxygen consumption), high-density lipoprotein cholesterol (HDL-C) level, and the total cholesterol-HDL-C ratio. RESULTS: At 6 months, the HardI-HiF, HardI-low-frequency, and moderate-intensity-HiF conditions demonstrated significant increases in maximum oxygen consumption (P < .01 for all), but only the HardI-HiF condition showed significant improvements in HDL-C level (P < .03), total cholesterol-HDL-C ratio (P < .04), and maximum oxygen consumption (P < .01) compared with physician advice. At 24 months, the increases in maximum oxygen consumption remained significantly higher than baseline in the HardI-HiF, HardI-low-frequency, and moderate-intensity-HiF conditions and in the HardI-HiF group compared with physician advice (P < .01 for all), but no significant effects on HDL-C level (P = .57) or total cholesterol-HDL-C ratio (P = .64) were observed. CONCLUSIONS: Exercise counseling with a prescription for walking at either a HardI or a HiF produced significant long-term improvements in cardiorespiratory fitness. More exercise or the combination of HardI plus HiF exercise may provide additional benefits, including larger fitness changes and improved lipid profiles.

Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder?

BACKGROUND: Anxiety symptoms are associated with elevated coronary heart disease (CHD) risk, but it is not known whether such associations extend to anxiety disorders or if they are independent of depression. We sought to determine if generalized anxiety disorder is associated with elevated CHD risk, and whether this association is independent of or interacts with major depressive disorder. METHODS: Generalized anxiety and major depressive disorders were assessed in a cross-sectional survey of a representative sample of U.S. adults aged 25-74 (N=3032). Coronary heart disease risk was determined by self-reported smoking status, body mass index, and recent medication use for hypertension, hypercholesterolemia, and diabetes. RESULTS: Generalized anxiety disorder independently predicted increased CHD risk (F(1,3018)=5.14; b=0.39; 95% confidence interval (0.05-0.72)) and tended to denote the greatest risk in the absence of major depressive disorder. LIMITATIONS: The cross-sectional design cannot determine the causal direction of the association. CONCLUSIONS: Generalized anxiety disorder appears to be associated with elevated CHD risk in the general population. It may denote excess CHD risk relative to major depressive disorder, and clinicians should consider CHD risk when treating generalized anxiety disorder.

Adherence to exercise prescriptions: effects of prescribing moderate versus higher levels of intensity and frequency.

Sedentary adults (N = 379) were randomly assigned in a 2 x 2 design to walk 30 min per day at a frequency of either 3-4 or 5-7 days per week, at an intensity of either 45%-55% or 65%-75% of maximum heart rate reserve. Analyses of exercise accumulated over 6 months showed greater amounts completed in the higher frequency (p = .0001) and moderate intensity (p = .021) conditions. Analyses of percentage of prescribed exercise completed showed greater adherence in the moderate intensity(p = .02) condition. Prescribing a higher frequency increased the accumulation of exercise without a decline in adherence, whereas prescribing a higher intensity decreased adherence and resulted in the completion of less exercise.