Abstract

Background: Cardiovascular disease (CVD) is the major cause of mortality and morbidity among the adult USA population. Major cardiovascular risk factors include age, obesity, hypertension, hypercholesterolemia, diabetes, and chronic kidney disease (CKD) with both diabetes and CKD being considered CVD risk equivalent. Psychological distress is known to be associated with diverse health outcomes. We aim to assess the relationship between psychological distress and cardiovascular disease among adult USA population.
Materials & Methods: Data was analyzed from National Health Interview Survey (NHIS) administered by the CDC’s National Center for Health Statistics (NCHS). The NHIS samples non-institutionalized American civilians by household following a multi-stage area probability design. The survey included Kessler 6, a standardized psychological distress scale. SPSS^® version 26 was used for analysis which included utilizing both the t-test and ANOVA for continuous variables and the Chi-squared analysis for categorical variables. A logistic regression model was developed to estimate the odds ratio and the strength of association between psychological distress and cardiovascular risk factors, coronary heart disease and stroke. Data is presented as the mean value ±SEM unless otherwise specified.
Results: The analysis included 284,497 respondents with 3.6% of the US representative sample reporting psychological distress with a mean age of 48.09 ±0.16. Psychological distress was more common among age group 45-64 years, women, Hispanics and Blacks, alcoholic drinkers, those without a high school diploma, and those below the poverty level. The unadjusted odds ratio for myocardial infarction among those with psychological distress was 2.6 (2.45-2.83 95% CI), p<0.01. The unadjusted odds ratio for stroke among those with psychological distress was 3.1 (2.88-3.34 95% CI), p<0.01. After adjusting for age, BMI, diabetes, hypertension, hypercholesterolemia, smoking and chronic kidney disease, the odds ratio of myocardial infarction among the psychologically distressed was 1.96 (1.66-2.31 95% CI), p<0.01. The adjusted odds ratio for stroke was 2.56 (2.18-3.01 95% CI) p<0.01.
Conclusion: Psychological distress is associated with a substantially higher risk of myocardial infarction and stroke independent of the traditional cardiovascular disease risk factors and is highly prevalent among ethnic minorities and disadvantaged socioeconomic groups. Further research is needed to develop effective interventions to manage psychological distress and decrease the disproportionately higher rates of cardiovascular disease among vulnerable populations.