A Moderator-mediator Analysis of Coronary Heart Disease Mortality

Overview

Journal J Psychosom Res

Specialty Psychiatry

Date 2010 Nov 27

PMID 21109042

Citations 2

Authors

Robert D Keeley

Margaret Driscoll

Affiliations

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Abstract

Objective: The purpose of this study is to better understand how risk factors for coronary heart disease (CHD) mortality may interact.

Methods: We conducted a moderator-mediator analysis of a representative national sample of 5027 and 2902 community-dwelling women and men in the first National Health and Nutrition Examination Survey free of CHD in 1982. The outcome was 10-year CHD mortality.

Results: Two hundred sixty-seven subjects experienced CHD mortality. In the complete sample, gender moderated the effect of depressive symptoms, and among women, race-ethnicity moderated the effect of nonleisure activity on CHD mortality, defining three subgroups for further analysis: men, white women, and black/other women. Among men, baseline differences from median age (55 to 64 years), systolic blood pressure (129 to 158 mmHg), or self-rated general health ("good" to "poor") were associated with equivalent increases in 10-year CHD mortality from 2.3% to 5.3% [area-under-the-curve effect size (ES)=0.53]. These factors appeared to mediate the effect of education on CHD mortality. Severe depression in men was associated with higher 10-year CHD mortality than less or no depression, 10.0% vs. 2.5% (ES=0.55). Among white women, baseline differences from median age (51 to 65 years) was also associated with 10-year mortality (1.2 to 13.4%, ES=0.56), as was higher blood pressure (125 to 151 mmHg) or worse self-rated health ("very good" to "fair") to a lesser extent (1.2% to 3.5%, ES=0.51).

Conclusion: Moderators (gender, race-ethnicity) defined possible pathways to CHD mortality characterized by varying factors and interactions between factors, highlighting potential utility for targeted interventions among community-dwelling persons.

Citing Articles

Does poorer self-rated health mediate the effect of Roma ethnicity on mortality in patients with coronary artery disease after coronaro-angiography?.

Sudzinova A, Rosenberger J, Stewart R, van Dijk J, Reijneveld S Int J Public Health. 2015; 61(3):375-82.

PMID: 26659588 DOI: 10.1007/s00038-015-0771-y.

Effects of emotional response on adherence to antihypertensive medication and blood pressure improvement.

Keeley R, Driscoll M Int J Hypertens. 2013; 2013:358562.

PMID: 23431420 PMC: 3575667. DOI: 10.1155/2013/358562.

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