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Significant financial stress associated with 13-fold higher odds of having a heart attack
Significant financial stress is associated with a 13-fold
higher odds of having a heart attack, according to research
presented at the 18th Annual Congress of the South African
Heart Association.
‘The role of psychosocial factors in causing disease is a
neglected area of study in South Africa, perhaps because
there are so many other pressing health challenges such
as tuberculosis and HIV,’ said lead author Dr Denishan
Govender, associate lecturer, University of theWitwatersrand,
Johannesburg.
‘The INTERHEART study showed that psychosocial
factors are independently associated with acute myocardial
infarction (heart attack) in Africa but as far as we are aware
there are no other published local data,’ said last author
Professor Pravin Manga, professor of cardiology, University
of the Witwatersrand.
This study included 106 patients with acute myocardial
infarction who presented to a large public hospital in
Johannesburg. A control group of 106 patients without cardiac
disease was matched for age, gender and race. All participants
completed a questionnaire about depression, anxiety, stress,
work stress and financial stress in the previous month. The
Likert scale was used to grade the experience of each condition.
Regarding financial stress, patients were graded with no
financial stress if they were coping financially; mild financial
stress if they were coping financially but needed added support;
moderate financial stress if they had an income but were in
financial distress; and significant financial stress if they had no
income and at times struggled to meet basic needs. Levels of
psychosocial conditions were compared between groups and
used to calculate associations with having a heart attack.
Self-reported stress levels were common, with 96% of
heart attack patients reporting any level of stress, and 40%
reporting severe stress levels. There was a three-fold increased
risk of myocardial infarction if a patient had experienced
any level of depression (from mild to extremely severe) in the
previous month compared to those with no depression.
Both work stress and financial stress were associated
with a higher risk of acute myocardial infarction. The odds
of myocardial infarction was 5.6 times higher in patients
with moderate or severe work stress compared to those with
minimal or no stress. Patients with significant financial stress
had a 13-fold higher odds of having a myocardial infarction.
Dr Govender said: ‘Our study suggests that psychosocial
aspects are important risk factors for acute myocardial
infarction. Often patients are counselled about stress after
a heart attack but there needs to be more emphasis prior to
an event. Few doctors ask about stress, depression or anxiety
during a general physical and this should become routine
practice, like asking about smoking. Just as we provide advice
on how to quit smoking, patients need information on how
to fight stress.’
continued on page 335…