Role of the central autonomic nervous system intrinsic functional organisation and psychosocial factors in primary microvascular angina and Takotsubo syndrome.

INTRODUCTION AND OBJECTIVE: Dysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns. METHODS: Patients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI). RESULTS: We evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI. CONCLUSIONS: The study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists ('Neuro-psycho-heart Team'). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies. TRIAL REGISTRATION NUMBER: NCT02759341.

Level of Anxiety and Depression in Cardiac Syndrome X.

OBJECTIVE: Cardiac syndrome X (CSX) is defined as angina-like symptoms, abnormalities on stress testing, and normal epicardial coronary arteries on coronary angiography. The aim of this study was to determine the Hospital Anxiety and Depression scores of patients with CSX and to compare with healthy controls. Materials/Subjects and Methods: Patients undergoing coronary angiography between January 2015 and December 2016 because of clinical indications, including abnormal noninvasive test results were examined. Two hundred and 10 subjects (110 patients with CSX, 100 controls) were enrolled. Demographic characteristics including age, education level, marriage status, and history of stressful life events were recorded. The Turkish version of the Hospital Anxiety and Depression scale was evaluated in the study population. RESULTS: Anxiety, depression, and total scores in the patients with CSX were significantly higher than those in the control group (p < 0.001, p < 0.003, p < 0.001, respectively). Among women, anxiety, depression, total scores, and stressful life events were significantly higher in the CSX group (p = 0.006, p = 0.015, p = 0.001, p < 0.001, respectively). Patients with lower educational status had higher anxiety scores (p = 0.03), stressful life events, and HAD-A > 10 were the only independent predictors of CSX in logistic regression analysis with comparable ORs 2.256 (95% CI 1.057-4.817, p = 0.03) and 2,399 (95% CI 1.248-4.613, p = 0.009) respectively. CONCLUSION: The results of our research suggest that patients with CSX have a high prevalence of stress and psychiatric disturbances. Interventions targeted toward improving the quality of life and to give psychological support may have the potential benefits especially for women and individuals with lower education.

Anxiety Level and Cardiac Autonomic Modulations in Coronary Artery Disease and Cardiac Syndrome X Patients.

BACKGROUND: Anxiety and cardiac autonomic modulations (CAM) were thoroughly investigated in coronary artery disease (CAD) and cardiac syndrome X (CSX) patients worldwide, but not among Sudanese with similar pathology. AIMS: To compare levels of anxiety and CAM between Sudanese patients with CSX and CAD. MATERIALS AND METHODS: Anxiety was evaluated in 51 CAD and 26 CSX patients using Taylor Manifest anxiety score (TMAS) questionnaire while heart rate variability derived indices were used to assess CAM, namely natural logarithm of low frequency (LnLF), high frequency (LnHF) and LF/HF ratio (LnLF/HF). RESULTS: Low anxiety levels were achieved by 6 (23.1%) and 9 (17.6%) patients with CSX and CAD respectively. High anxiety level was achieved by only one (3.8%) patient, who was suffering from CSX. TMAS was significantly higher in CSX (31.27 (21.97)) compared to CAD (21.86 (12.97), P = 0.021). However, abnormally increased anxiety was not associated with higher risk of CSX. LnLF, LnHF and LnLF/HF were comparable in CAD and CSX patients. CONCLUSION: CSX and CAD patients showed comparable CAM. Although anxiety levels were higher in CSX compared to CAD, TMAS ≥ 35 failed to show significant association with CSX.

Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy.

BACKGROUND: Recurrent chest pain in the absence of coronary artery disease is a common problem which sometimes leads to excess use of medical care. Although many studies have examined the causes of pain in these patients, few clinical trials have evaluated treatment. This is an update of a Cochrane review originally published in 2005 and last updated in 2010. The studies reviewed in this paper provide an insight into the effectiveness of psychological interventions for this group of patients. OBJECTIVES: To assess the effects of psychological interventions for chest pain, quality of life and psychological parameters in people with non-specific chest pain. SEARCH METHODS: We searched the Cochrane Library (CENTRAL, Issue 4 of 12, 2014 and DARE Issue 2 of 4, 2014), MEDLINE (OVID, 1966 to April week 4 2014), EMBASE (OVID, 1980 to week 18 2014), CINAHL (EBSCO, 1982 to April 2014), PsycINFO (OVID, 1887 to April week 5 2014) and BIOSIS Previews (Web of Knowledge, 1969 to 2 May 2014). We also searched citation lists and contacted study authors. SELECTION CRITERIA: Randomised controlled trials (RCTs) with standardised outcome methodology that tested any form of psychotherapy for chest pain with normal anatomy. Diagnoses included non-specific chest pain (NSCP), atypical chest pain, syndrome X or chest pain with normal coronary anatomy (as either inpatients or outpatients). DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted data and assessed quality of studies. We contacted trial authors for further information about the included RCTs. MAIN RESULTS: We included two new papers, one of which was an update of a previously included study. Therefore, a total of 17 RCTs with 1006 randomised participants met the inclusion criteria, with the one new study contributing an additional 113 participants. There was a significant reduction in reports of chest pain in the first three months following the intervention: random-effects relative risk = 0.70 (95% CI 0.53 to 0.92). This was maintained from three to nine months afterwards: relative risk 0.59 (95% CI 0.45 to 0.76). There was also a significant increase in the number of chest pain-free days up to three months following the intervention: mean difference (MD) 3.00 (95% CI 0.23 to 5.77). This was associated with reduced chest pain frequency (random-effects MD -2.26, 95% CI -4.41 to -0.12) but there was no evidence of effect of treatment on chest pain frequency from three to twelve months (random-effects MD -0.81, 95% CI -2.35 to 0.74). There was no effect on severity (random-effects MD -4.64 (95% CI -12.18 to 2.89) up to three months after the intervention. Due to the nature of the main interventions of interest, it was impossible to blind the therapists as to whether the participant was in the intervention or control arm. In addition, in three studies the blinding of participants was expressly forbidden by the local ethics committee because of issues in obtaining fully informed consent . For this reason, all studies had a high risk of performance bias. In addition, three studies were thought to have a high risk of outcome bias. In general, there was a low risk of bias in the other domains. However, there was high heterogeneity and caution is required in interpreting these results. The wide variability in secondary outcome measures made it difficult to integrate findings from studies. AUTHORS' CONCLUSIONS: This Cochrane review suggests a modest to moderate benefit for psychological interventions, particularly those using a cognitive-behavioural framework, which was largely restricted to the first three months after the intervention. Hypnotherapy is also a possible alternative. However, these conclusions are limited by high heterogeneity in many of the results and low numbers of participants in individual studies. The evidence for other brief interventions was less clear. Further RCTs of psychological interventions for NSCP with follow-up periods of at least 12 months are needed.

Pilot study testing the effect of physical training over the myocardial perfusion and quality of life in patients with primary microvascular angina.

BACKGROUND: Primary microvascular angina (PMA) is a common clinical condition associated to negative impact on quality of life (QOL) and reduced physical capacity. This study aimed at evaluating the effects of aerobic physical training (APT) on myocardial perfusion, physical capacity, and QOL in patients with PMA. METHODS: We investigated 12 patients (53.8 ± 9.7 years old; 7 women) with PMA, characterized by angina, angiographycally normal coronary arteries, and reversible perfusion defects (RPDs) detected on (99m)Tc-sestamibi-SPECT myocardial perfusion scintigraphy (MPS). At baseline and after 4 month of APT, the patients underwent MPS, cardiopulmonary test, and QOL questionnaire. Stress-rest MPS images were visually analyzed by attributing semi-quantitative scores (0 = normal; 4 = absent uptake), using a 17-segment left ventricular model. Summed stress, rest, and difference scores (SDS) were calculated. RESULTS: In comparison to the baseline, in the post-training we observed a significant increase in peak-VO2 (19.4 ± 4.8 and 22.1 ± 6.2 mL·kg(-1)·minute(-1), respectively, P = .01), reduction of SDS (10.1 ± 8.8 and 2.8 ± 4.9, P = .008), and improvement in QOL scores. CONCLUSIONS: Physical training in patients with PMA is associated with reduction of myocardial perfusion abnormalities, increasing of physical capacity, and improvement in QOL. The findings of this hypothesis-generating study suggest that APT can be a valid therapeutic option for patients with PMA.

Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy.

BACKGROUND: Recurrent chest pain in the absence of coronary artery disease is a common problem that sometimes leads to excess use of medical care. Although many studies examine the causes of pain in these patients, few clinical trials have evaluated treatment. The studies reviewed in this paper provide an insight into the effectiveness of psychological interventions for this group of patients. OBJECTIVES: To update the previously published systematic review. SEARCH METHODS: We searched the Cochrane LIbrary (CENTRAL and DARE) (Issue 3 of 4 2011), MEDLINE (1966 to August Week 5, 2011), CINAHL (1982 to Sept 2011) EMBASE (1980 to Week 35 2011), PsycINFO (1887 to Sept Week 1, 2011), and Biological Abstracts (January 1980 to Sept 2011). We also searched citation lists and approached authors. SELECTION CRITERIA: Randomised controlled trials (RCTs) with standardised outcome methodology that tested any form of psychotherapy for chest pain with normal anatomy. Diagnoses included non-specific chest pain (NSCP), atypical chest pain, syndrome X, or chest pain with normal coronary anatomy (as either inpatients or outpatients). DATA COLLECTION AND ANALYSIS: Two authors independently selected studies for inclusion, extracted data and assessed quality of studies. The authors contacted trial authors for further information about the RCTs included. MAIN RESULTS: Six new RCTs were located and added to the existing trials, therefore, a total of 15 RCTs (803 participants) were included. There was a significant reduction in reports of chest pain in the first three months following the intervention; fixed-effect relative risk = 0.68 (95% CI 0.57 to 0.81). This was maintained from three to nine months afterwards; relative risk = 0.59 (95% CI 0.45 to 0.76). There was also a significant increase in the number of chest pain free days up to three months following the intervention; mean difference = 2.81 (95% CI 1.28 to 4.34). This was associated with reduced chest pain frequency (random-effects mean difference = -2.26 95% CI -4.41 to -0.12) but there was no evidence of effect of treatment on chest pain frequency from three to twelve months (random-effects mean difference -0.81 95% CI -2.35, 0.74). There was no effect on severity (random-effects mean difference = -4.64 (95% CI -12.18 to 2.89) up to three months after the intervention. Overall there was generally a low risk of bias, however, there was high heterogeneity and caution is required in interpreting these results. Wide variability in outcome measures made integration of studies for secondary outcome measures difficult to report on. AUTHORS' CONCLUSIONS: This review suggests a modest to moderate benefit for psychological interventions, particularly those using a cognitive-behavioural framework, which was largely restricted to the first three months after the intervention. Hypnotherapy is also a possible alternative. The evidence for brief interventions was less clear. Further RCTs of psychological interventions for NSCP with follow-up periods of at least 12 months are needed.

Group support to improve psychosocial well-being and primary-care demands among women with cardiac syndrome X.

BACKGROUND: Women with angina pectoris, a positive exercise electrocardiogram (ECG) for myocardial ischemia and angiographically smooth coronary arteries (cardiac syndrome X), are often characterized by unresolved symptomatology and a poor quality of life. Psychological morbidity and quality of life appear to be related to social support and social isolation. An investigation of group support as an aid to treatment for cardiac syndrome X was therefore undertaken. METHODS: Forty-nine women with cardiac syndrome X (mean ± standard deviation 61.8 ± 8 years) were randomized to 12 monthly support group meetings or usual care control. The Health Anxiety Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), SF-36, York Angina Beliefs scale, ENRICHD Social Support Instrument (ESSI) and a demographic information scale, along with hospital admissions, general practitioner (GP) or cardiologist appointments were measured at baseline, 6 months and 12 months. RESULTS: Support group participants maintained higher levels of social support than controls (ESSI score, 17.18 ± 5.35 vs. 14.45 ± 6.98, p = 0.008). Near significant improvements in health beliefs total score (p = 0.068) and threat perception (p = 0.062) were found among the support group compared to the control; 29% of support patients had made one or more GP visits over the duration of the study, compared with 54% of the control group (p = 0.06). CONCLUSION: Support group participation maintains social support and may reduce health-care demands and misconceived health beliefs among patients with cardiac syndrome X.

Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy.

BACKGROUND: Recurrent chest pain in the absence of coronary artery disease is a common problem that sometimes leads to excess use of medical care. Although many studies examine the causes of pain in these patients, few clinical trials have evaluated treatment. The studies reviewed in this paper provide an insight into the effectiveness of psychological interventions for this group of patients. OBJECTIVES: To investigate psychological treatments for non-specific chest pain (NSCP) with normal coronary anatomy. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2008, Issue 4), MEDLINE (1966 to December 2008), CINAHL (1982 to December 2008) EMBASE (1980 to December 2008), PsycINFO (1887 to December 2008), the Database of Abstracts of Reviews of Effectiveness (DARE) and Biological Abstracts (January 1980 to December 2008). We also searched citation lists and approached authors. SELECTION CRITERIA: Randomised controlled trials (RCTs) with standardised outcome methodology that tested any form of psychotherapy for chest pain with normal anatomy. Diagnoses included non-specific chest pain, atypical chest pain, syndrome X, or chest pain with normal coronary anatomy (as either inpatients or outpatients). DATA COLLECTION AND ANALYSIS: Two authors independently selected studies for inclusion, extracted data and assessed quality of studies. The authors contacted trial authors for further information about the RCTs included. MAIN RESULTS: Ten RCTs (484 participants) were included. There was a significant reduction in reports of chest pain in the first three months following the intervention; fixed effects relative risk = 0.68 (95% CI 0.57 to 0.81). This was maintained from 3 to 9 months afterwards; relative risk = 0.59 (95% CI 0.45 to 0.76). There was also a significant increase in the number of chest pain free days up to three months following the intervention; mean difference = 2.81 (95% CI 1.28 to 4.34). This was associated with reduced chest pain frequency (mean difference = -1.73 (95% CI -2.21 to -1.26)) and severity (mean difference = -6.86 (95% CI -10.74 to -2.97)). However, there was high heterogeneity and caution is required in interpreting these results. Wide variability in outcome measures made integration of studies for secondary outcome measures difficult to report on. AUTHORS' CONCLUSIONS: This review suggests a modest to moderate benefit for psychological interventions, particularly those using a cognitive-behavioural framework, which was largely restricted to the first three months after the intervention. Hypnotherapy is also a possible alternative. The evidence for brief interventions was less clear. Further RCTs of psychological interventions for NSCP with follow-up periods of at least 12 months are needed.

Autogenic training to manage symptomology in women with chest pain and normal coronary arteries.

OBJECTIVES: To explore autogenic training (AT) as a treatment for psychological morbidity, symptomology, and physiological markers of stress among women with chest pain, a positive exercise test for myocardial ischemia, and normal coronary arteries (cardiac syndrome X). DESIGN: Fifty-three women with cardiac syndrome X (mean +/- SD age, 57.1 +/- 8 years) were randomized to an 8-week AT program or symptom diary control. Symptom severity and frequency, Hospital Anxiety and Depression Scale, Spielberger State-Trait Anxiety Inventory, Cardiac Anxiety Questionnaire (CAQ), and Ferrans and Powers Quality of Life Index (QLI), blood pressure, heart rate, electrocardiogram, and plasma catecholamines were measured before and after intervention and at the 8-week follow-up. RESULTS: Women who underwent AT had improved symptom frequency (8.04 +/- 10.08 vs 1.66 +/- 2.19, P < 0.001) compared with control women and reduced symtom severity (2.08 +/- 1.03 vs 1.23 +/- 1.36, P = 0.02) and frequency (6.11 +/- 3.17 vs 1.66 +/- 2.19, P < G 0.001) post-AT compared with baseline within group. Within-group improvements among women who underwent AT include QLI health functioning (17.80 +/- 5.74 vs 19.41 +/- 5.19, P = 0.04) and CAQ fear (1.53 +/- 0.61 vs 1.35 +/- 0.56, P = 0.02) post-AT and QLI health functioning (17.80 +/- 5.74 vs 20.09 +/- 5.47, P = 0.01), CAQ fear (1.53 +/- 0.61 vs 1.30 +/- 0.67, P = 0.002), CAQ total (1.42 +/- 0.54 vs 1.29 +/- 0.475, P = 0.04), Spielberger State-Trait Anxiety Inventory trait anxiety (42.95 +/- 11.19 vs 38.68 +/- 11.47, P = 0.01), and QLI quality of life (20.67 +/- 5.37 vs 21.9 +/- 4.89, P = 0.02) at follow-up. CONCLUSION: An 8-week AT program improves symptom frequency, with near-significant improvements in symptom severity in women with cardiac syndrome X.

Cardiac rehabilitation for the treatment of women with chest pain and normal coronary arteries.

OBJECTIVE: To explore cardiac rehabilitation (CR) as a treatment for psychological and physiological morbidity in women with chest pain and normal coronary arteries (cardiac syndrome X). DESIGN: Sixty-four women aged 57.3+/-8.6 years (mean +/- SD) with cardiac syndrome X were randomly assigned to an 8-week phase III CR exercise program or symptom monitoring control. All women completed the Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, and Short Form-36 before and after intervention and at the 8-week follow-up. CR patients underwent physical assessment before and after CR. RESULTS: After CR, patients demonstrated improved symptom severity (2.0+/-0.8 vs 1.26+/-1.1, P=0.009), Hospital Anxiety and Depression Scale depression score (8.0+/-3.4 vs 6.4+/-3.1, P=0.04), total Health Anxiety Questionnaire score (12.0+/-5.5 vs 9.5+/-6.0, P=0.008), health worry (4.5+/-3.1 vs 3.52+/-2.4, P=0.025) and interference (2.4+/-1.8 vs 1.6+/-1.8, P=0.004), SF-36 physical functioning (53.1+/-20.4 vs 62.3+/-23.9, P = 0.006), energy (36.3+/-20.7 vs 49.8+/-19.1, P<0.001), pain (49.9+/-20.7 vs 58.1+/-22.9, P=0.028), and general health (48.8+/-17.9 vs 57.6+/-17.0, P=0.01) not found among the control women. Improvements were maintained at follow-up. CR patients showed significant improvements in Shuttle Walk Test performance (326.8+/-111.0 vs 423.6+/-133.2 m, P<0.001), diastolic blood pressure (84.7+/-9.4 vs 79.7+/-7.3 mm Hg, P=0.007), and body mass index (29.1+/-6.0 vs 28.4+/-6.17 kg/m2, P=0.003). CONCLUSIONS: An 8-week phase III CR program improves exercise tolerance, quality of life, psychological morbidity, symptom severity, and cardiovascular risk factors in women with cardiac syndrome X.

[Cardiac syndrome X from a psychosomatic point of view]. / Kardiologiczny zespól X w ujeciu psychosomatycznym.

The aim of this paper was to explain the idea of cardiac syndrome X, particularly the association between emotional disturbances, somatoform disorder and syndrome X. Cardiac syndrome X is defined by the presence of angina-like chest pain, a positive response to stress testing and angiographically normal coronary arteriogram. It has been shown to occur in approximately 20 - 30 percent of angina patients undergoing cardiac catheterization. Most of the patients with normal angiograms are women especially in perimenopausal age. Syndrome X patients reported more depression, anxiety and somatic concerns than positive angiographic patients. They have high scores on psychological inventories that measure anxiety and depression, and are very prone to somatization. They have better prognosis with death from cardiac causes than patients with coronary heart disease. With regard to female chest pain patients, somatoform disorder can be assumed. At the present time, there is no common agreement on the exact cause of the symptoms associated with syndrome X.

Cardiac syndrome X.

Cardiac syndrome X, the triad of angina pectoris, a positive exercise electrocardiogram for myocardial ischaemia and angiographically smooth coronary arteries, is frequently associated with debilitating symptomology, increased psychological morbidity and a poor quality of life. While various avenues of research have been undertaken, there are as yet no definitive conclusions regarding the exact pathogenesis of the condition. A number of physiological mechanisms have been explored, including the existence of underlying myocardial ischaemia, suggested endothelial dysfunction, abnormal pain perception, hormonal irregularities and insulin resistance, while the psychological impact of the condition has also been explored. Various treatment regimens have also been the subject of research with varying degrees of success. The heterogeneous nature of the patient population suggests that the mechanistic pathway may be multifactorial, while a comprehensive treatment regimen including both psychosocial and pharmacological interventions may offer the best outcome for patients with cardiac syndrome X.

Platelet reactivity in response to mental stress in syndrome X and in stable or unstable coronary artery disease.

INTRODUCTION: Previous studies showed differences in platelet reactivity in response to exercise in patients with syndrome X (SX) and those with obstructive coronary artery disease (CAD). In this study, we investigated whether similar differences could be detectable in response to a mental stressful stimulus. MATERIALS AND METHODS: We studied 30 SX patients (60+/-8 years, 8 men), 20 patients with stable angina and angiographically documented CAD (SA, 66+/-8 years, 14 men), and 11 patients with unstable angina (UA, 67+/-8 years, 6 men). A control group of 22 healthy controls (50+/-7 years, 5 men) was also studied. All subjects underwent a mathematical mental stress test (MST) consisting of rapid consecutive subtractions of number 7 for a period of 5 min. A venous blood sample was collected at baseline and immediately after MST. Platelet reactivity was measured on flowing blood as time necessary to occlude a ring coated with collagen-adenosine diphosphate (ADP; closure time, CT), using the platelet function analyzer (PFA-100) system. RESULTS: At rest, CT was lower in UA patients (87+/-19 s) compared to controls (109+/-24 s, p=0.02) and SA patients (105+/-37 s, p=0.055), and also tended to be lower in SX patients (96+/-18 s) compared to controls (p=0.07). The CT response to MST differed significantly among groups (p=0.0009). At peak MST, CT did not change in controls (110+/-27 s, p=0.88), whereas it decreased in SA patients (96+/-29 s, p=0.003) and tended to decrease in UA patients (82+/-15 s, p=0.25). In contrast, a significant increase in CT with MST was shown in SX patients (103+/-21 s, p=0.007). CONCLUSIONS: Platelet reactivity is increased by MST in patients with CAD, whereas it paradoxically decreases in SX patients, which may constitute a protective effect against stress-induced events in these patients.

Psychosocial factors associated with noncardiac chest pain and cardiac syndrome X.

Cardiac syndrome X, the triad of angina pectoris, positive exercise electrocardiogram (ECG) for myocardial ischemia and angiographically smooth coronary arteries, is associated with increased psychological morbidity, debilitating symptomatology and a poor quality of life. Patients with noncardiac chest pain (NCCP) are often similarly affected. The psychological morbidity noted among this patient population has been linked with a number of psychosocial factors, including impaired social support, traumatic life events, the negative impact of menopause among female sufferers, and an awareness of a family history of coronary heart disease (CHD). Cognitive behavioral therapy (CBT), group support, physical activity and relaxation techniques have been investigated as treatments for psychological morbidity among this patient group with varying degrees of success. While clinicians should be aware of the psychological aspect of patients with NCCP and cardiac syndrome X, further research is needed in order to establish a comprehensive physiological and psychological treatment regimen.

Distinct psychosocial differences between women with coronary heart disease and cardiac syndrome X.

AIMS: To compare the impact of oestrogen, gynaecological history, social support, life events and family history of CHD on psychosocial morbidity in syndrome X, CHD patients and healthy controls. METHODS AND RESULTS: 100 female syndrome X (60 +/- 9 years), 100 female CHD (65 +/- 9 years) and 100 healthy female volunteers (61 +/- 10 years) completed the hospital anxiety and depression scale (HADS), health anxiety questionnaire (HAQ), a demographic information scale, life events scale, family history of CHD, menopausal, menstrual and gynaecological history. A 17beta-oestradiol sample was taken. Syndrome X patients had higher levels of life interference (p < 0.05) and HADS anxiety (p < 0.05) than CHD patients, and higher levels of all HADS and HAQ scales than controls (p < 0.01). Syndrome X patients with a large social network had lower HADS anxiety (p < 0.05), health worry (p < 0.05), life interference (p < 0.01) and total HAQ (p < 0.01). Social network (p = 0.003), divorced/separated or widowed status (p = 0.005), HRT (p = 0.008) and HADS anxiety score (p < 0.001) accounted for 41.9% of the variance in HAQ scores in syndrome X. Oestrogen was unrelated to the HADS or HAQ for any group. CONCLUSION: Syndrome X patients suffered higher levels of psychological morbidity in comparison to CHD patients and controls. Life events and social network size were related to health anxiety, general anxiety and depression in women with syndrome X.