Coronary artery disease (CAD), one of the most common cardiovascular diseases (CVD), poses a serious threat to physical and mental health, resulting in a severe disease burden. Psychocardiology medicine focuses on the vital role of psychological factors in the development, diagnosis, and treatment of CVD. The prevalence of depression and anxiety is high in patients with CAD. Furthermore, there is a vital interplay among depression, anxiety, mental stress-induced myocardial ischemia, cognitive impairment, and delirium. Both cognitive impairment and delirium adversely impact the prognosis of patients with CAD, warranting increasing attention and the development of interventions. To further direct the clinic diagnosis and treatment of cognitive impairment in patients with CAD complicated with depression and anxiety, and to thus improve the prognosis of such patients, the Psychocardiology Medicine Branch of Chinese Medical Association Beijing Branch, and Psychocardiology Education Professional Committee of China Medical Education Association, together with over 40 other organizations, including more than 50 experts from several related fields, have developed the association standards on guidelines for the cognitive clinical diagnosis and treatment of CAD complicated with depression and anxiety under the framework of the China standard association (No.T/CAS 812-2024).
Humans ; Depression/diagnosis* ; Coronary Artery Disease/psychology* ; Anxiety/diagnosis* ; Practice Guidelines as Topic

PURPOSE: To evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores. MATERIALS AND METHODS: The 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD. RESULTS: In the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02−1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82−5.34, p<0.001), and CAC 1−9 (OR 1.80, 95% CI 1.08−3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02−1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93−0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14−5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model. CONCLUSION: Smoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.
Angiography ; Asymptomatic Diseases ; Body Mass Index ; Calcium ; Cholesterol, HDL ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Creatinine ; Discrimination (Psychology) ; Dyslipidemias ; Humans ; Hypertension ; Lipoproteins ; Risk Factors ; Smoke ; Smoking

OBJECTIVES: This study identifies associated factors of ischemic heart disease (IHD) among post-menopausal Korean women at the biomedical (age, family history of hypertension, dyslipidemia, type 2 diabetes mellitus, or cerebro-cardiovascular disease, body mass index, and metabolic syndrome), biosocial (socioeconomic status and educational level), and psychosocial levels (stress, depression, smoking, binge alcohol consumption, and physical activity). METHODS: This study used a cross-sectional design with secondary data analysis of the 2013–2016 Korean National Health and Nutrition Examination Survey. Data from 3,636 women were analyzed by logistic regression analysis using a complex sample procedure. RESULTS: Of the biomedical factors, older age [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.87–4.80, p < 0.001], family history (OR: 2.29, 95% CI: 1.44–3.65, p = 0.001), and metabolic syndrome (OR: 1.93, 95% CI: 1.27–2.95, p = 0.002) were associated with IHD in post-menopausal women. Of the psychosocial factors, depression (OR: 2.56, 95% CI: 1.66–3.96, p < 0.001) and smoking (OR: 1.92, CI: 1.04–3.55, p = 0.038) were associated with IHD in post-menopausal women. CONCLUSION: These findings suggest that healthcare providers need to consider the contributing adverse effects of older age, family history, metabolic syndrome, depression and smoking when evaluating risk factors for IHD in post-menopausal women.
Alcohol Drinking ; Body Mass Index ; Coronary Artery Disease ; Depression ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Female ; Health Personnel ; Humans ; Hypertension ; Logistic Models ; Myocardial Ischemia ; Nutrition Surveys ; Postmenopause ; Psychology ; Risk Factors ; Smoke ; Smoking ; Statistics as Topic

PURPOSE: The purpose of this descriptive study was to identify the influence of health literacy and health empowerment on health behavior practice in elderly patients with coronary artery disease. METHODS: 239 elderly outpatients older than 65 years of age were included. The data were analyzed with descriptive statistics including independent t-test, ANOVA, and hierarchical regression. RESULTS: Major factors having a significant impact on health behavior practice were health literacy (β=.26, p<.001) and health empowerment (β=.32, p<.001). Health literacy was increased by 4.7% after controlling for general and health-related characteristics. Health empowerment increased by 5.9% after controlling for general and health-related characteristics, and health literacy. The two variables explained 35% of the variance in health behavior practice (F=7.74, p<.001). CONCLUSION: The main findings of this study can be utilized as the foundation for developing programs to promote health empowerment and health behavior practice of the elderly population. Furthermore, the results of the study can also be used to establish health-related strategies.
Aged ; Coronary Artery Disease ; Coronary Vessels ; Health Behavior ; Health Literacy ; Humans ; Outpatients ; Power (Psychology)

BACKGROUND AND OBJECTIVES: A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. SUBJECTS AND METHODS: Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. RESULTS: Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). CONCLUSION: No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.
Cardiology ; Checklist ; Chest Pain* ; Coronary Artery Disease ; Coronary Disease ; Dyspnea ; Exercise Test ; Humans ; Hypochondriasis ; Linear Models ; Outpatients* ; Psychology ; Thorax*

BACKGROUND/AIMS: This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain. METHODS: Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death. RESULTS: The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant. CONCLUSIONS: CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.
Angina, Unstable ; Calcium ; Chest Pain ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Death ; Discrimination (Psychology) ; Electrocardiography* ; Follow-Up Studies ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Odds Ratio ; Prognosis

PURPOSE: Soluble ST2 (sST2) is an emerging prognostic biomarker in patients with cardiovascular disease (CVD). A recent study showed that sST2 predicted incident hypertension. High sensitive C-reactive protein (hsCRP) has been a widely-used biomarker for risk-stratifying in CVD. We compared the abilities of sST2 and hsCRP to predict high risk coronary artery calcium score (CACS). MATERIALS AND METHODS: The CACS was assessed by cardiac computed tomography, and sST2 was measured in 456 subjects enrolled in the Mapo-gu community cohort. In accordance with the 2013 ACC/AHA guidelines, we defined the high risk CACS group as individuals with a CACS ≥300 Agatston units (AU). RESULTS: There were 99 (21.7%) subjects with a CACS ≥300 AU. There was a strong correlation between log sST2 and log hsCRP (r=0.128, p=0.006), and both log sST2 and log hsCRP showed significant associations with CACS (r=0.101, p=0.031 for sST2, r=0.101, p=0.032 for hsCRP). In net reclassification improvement (NRI) analysis, the NRI for hsCRP over sST2 was significant [continuous NRI 0.238, 95% confidence interval (CI) 0.001–0.474, integrated discrimination index (IDI) 0.022, p=0.035], while the NRI for sST2 over hsCRP was not significant (continuous NRI 0.212, 95% CI -0.255–0.453, IDI 0.002, p=0.269). CONCLUSION: sST2 does not improve net reclassification for predicting a high risk CACS. Using hsCRP provides superior discrimination and risk reclassification for coronary atherosclerosis, compared with sST2.
Atherosclerosis ; C-Reactive Protein* ; Calcium* ; Cardiovascular Diseases ; Cohort Studies* ; Coronary Artery Disease ; Coronary Vessels* ; Discrimination (Psychology) ; Humans ; Hypertension

PURPOSE: The project was to test a structural equation model in which self-efficacy, self-care health behaviors, and modifiable risk factors predict the quality of life (QOL) of individuals with coronary artery disease. METHODS: The data set from the intervention study with 130 patients with coronary artery disease before the intervention was included in the secondary analysis for this study. The following parameters were measured: self-efficacy, self-care health behaviors with the subscales of health responsibility, exercise, consumption of a healthy diet, stress management, and smoking cessation; modifiable risk score; and QOL (assessed using the 36-item Short-Form Health Survey instrument). RESULTS: The mean age of the participants was 66.1 years. The following evaluation parameters indicated that the proposed model provided a good fit to the data: comparative fit index at .87, goodness of fit index at .91, adjusted goodness of fit index at .84, standardized root mean square residual at .06, root mean square error of estimation at .09, and confidence interval at 0.06-0.13. Self-efficacy, self-care health behaviors, and modifiable risk factors had significant effects on QOL and explained 64.0% of the variance, with modifiable risk factors mediating between self-care health behaviors and QOL. CONCLUSIONS: The findings indicate that self-efficacy, self-care health behaviors, and modifiable risk factors play an important role in QOL in adults with coronary artery disease. Patients could be more confident in performing self-care health behaviors, leading to a better QOL, by more effectively managing their cardiovascular risk factors. Nursing strategies to improve QOL in this population should include motivating them to perform self-care health behaviors.
Adult ; Aged ; Cardiovascular Diseases/etiology ; Coronary Artery Disease/psychology/*therapy ; Cross-Sectional Studies ; Female ; *Health Behavior ; Humans ; Male ; Middle Aged ; Models, Theoretical ; *Quality of Life ; Risk Factors ; Self Care/*methods/psychology ; Self Efficacy

BACKGROUND AND OBJECTIVES: Increasing evidence supports that psychological factors may be related to development of coronary artery disease (CAD). Although psychological well-being, ill-being, and control strategy factors may play a significant role in CAD, rarely have these factors been simultaneously examined previously. We assessed comprehensive psychological factors in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: A total of 85 ACS patients (56 unstable angina, 29 acute myocardial infarction; 52.6+/-10.2 years; M/F=68/17) and 63 healthy controls (48.7+/-6.7 years, M/F=43/20) were included. Socio-demographic information, levels of psychological maladjustment, such as anxiety, hostility, and job stress, health-related quality of life (HRQoL), and primary and secondary control strategy use were collected through self-report questionnaires. RESULTS: There was no significant difference between the ACS group and control group in levels of anxiety, hostility, and job stress. However, ACS patients had significantly lower scores on the general health perception and bodily pain subscales of HRQoL than the control group. The ACS group, as compared with the controls, tended to use primary control strategies more, although not reaching statistical significance by univariate analysis. Multivariate logistic regression analysis after adjusting age and gender identified the physical domain of HRQoL {odds ratio (OR)=0.40}, primary control strategy (OR=1.92), and secondary control strategy (OR=0.53) as independent predictors of ACS. CONCLUSION: Poor HRQoL and primary control strategy, proactive behaviors in achieving ones' goal, may act as risk factors for ACS, while secondary control strategy to conform to current situation may act as a protective factor for ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Anxiety ; Coronary Artery Disease ; Hostility ; Humans ; Logistic Models ; Myocardial Infarction ; Psychology ; Quality of Life* ; Risk Factors* ; Stress, Psychological ; Surveys and Questionnaires

PURPOSE: Prediction of the proximal right coronary artery (pRCA) through electrocardiography (ECG) is very important because pRCA occlusion has frequently been suspected in right ventricular infarction, which has a high mortality rate. The aim of this study is to investigate characteristic ECG finding of pRCA occlusion distinguishable from mid or distal RCA. METHODS: A review was conducted retrospectively of 630 patients with chest pain in the ED who underwent coronary angiography (CAG) from June 2007 to December 2013 and CAG of 89 among them resulted in only RCA occlusion exempting other coronary vessels. The patients were divided into two groups: subjects with pRCA (n=32) occlusion and below the mid RCA (n=57) occlusion. In each subset, features of ECG were searched and analyzed. RESULTS: ECG of patients with occlusion of the pRCA showed more prominent ST depression in lead I (-0.68 mm vs -0.22 mm, p=0.027) and ST elevation in V1 (0.94 mm vs 0.09 mm, p=0.001) than in the below portion. Both ST depression (< or =0 mm) in I and ST elevation (>0.5 mm) in V1 classified according to cutoff value using Youden index J were closely related to pRCA occlusion other than mid or distal RCA (OR 7.16, p<0.001). CONCLUSION: Discrimination of pRCA occlusion from mid or distal RCA in ECG through ST depression in lead I and ST elevation in lead V1 might be valid as a sentinel of right ventricular infarction.
Chest Pain ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Depression ; Discrimination (Psychology) ; Electrocardiography* ; Humans ; Infarction ; Mortality ; Myocardial Infarction ; Retrospective Studies