The incidence of non-fatal myocardial infarction in Swedish women below age 60 has been found to increase during the past 15 years. Standard risk factor change includes a decrease in average systolic blood pressure and S-cholesterol but a moderate increase in smoking and diabetes prevalence. During the same time period Swedish women have """"""""moved"""""""" into the labor market, so that employment rates are now similar in Swedish men and women. However, women have kept the main responsibilities for household and child care. In spite of generous legislation as concerns maternity leave and child care, the strains from multiple roles and responsibilities have probably increased in Swedish women. We intend to study the role of social strain within a broader psychosocial context including social networks, social supports, social skills, reciprocity, coping, stressors, chronic work strain, family structure, personality and behavior characteristics. These aspects will be related to possible physiologic cardiovascular mechanisms including reactivity of and persistent elevated heart rates and blood pressure, on ambulatory monitoring as well as cardiac dysrhythmia and silent or symptomatic ischemia. Also psychoneuroendocrine pathways will be investigated. These include catecholamines, cortisol, prolactine, estrogen, testosterone, gastrin, somatostatin. Other biochemical measures include lipid profile, coagulation, thrombolysis and immune function. These examinations will be applied to all women below age 60, living in the greater Stockholm area, with signs or symptoms of CHD. 4-500 women are anticipated. They will be followed and reexamined (including angiograms) after 2 to 2.5 years. They will be compared to an equal number of age matched men and to an equal number of age matched healthy women from the same catchment area. The study will provide an answer to: 1) which factors - biological and behavioral - influence both the extent of and progress of coronary artery disease, 2) which physiological, biochemical, or neuroendocrine mechanisms are participating in the process. In addition to conventional statistical methods, canonical correlations analyses will be used to describe direct and indirect pathways of the pathogenesis. Furthermore, by means of the two comparison groups, information will be obtained about the specific characteristics of the female psychosocial and behavioral CHD risk profile.
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