{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T22:39:48Z","timestamp":1788734388557,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,10,23]],"date-time":"2017-10-23T00:00:00Z","timestamp":1508716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004330","name":"GlaxoSmithKline","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004330","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006513","name":"Duke Clinical Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006513","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Assess the risk of ischaemic events associated with psychosocial stress in patients with stable coronary heart disease (<jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Psychosocial stress was assessed by a questionnaire in 14\u00a0577 patients (median age 65.0, <jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 59, 71; 81.6% males) with stable <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> on optimal secondary preventive therapy in the prospective randomized <jats:styled-content style=\"fixed-case\">STABILITY<\/jats:styled-content> clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 3.7\u00a0years of follow\u2010up, depressive symptoms, loss of interest and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> death (1.21, 1.09\u20131.34; 1.15, 1.05\u20131.27; and 1.19, 1.08\u20131.30, respectively) and the primary composite end\u2010point of <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> death, nonfatal <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content> or nonfatal stroke (1.21, 1.13\u20131.30; 1.19, 1.11\u20131.27; and 1.17, 1.10\u20131.24, respectively). Living alone was related to higher risk of <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> death (1.68, 1.38\u20132.05) and the primary composite end\u2010point (1.28, 1.11\u20131.48), whereas being married as compared with being widowed, was associated with lower risk of <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> death (0.64, 0.49\u20130.82) and the primary composite end\u2010point (0.81, 0.67\u20130.97).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Psychosocial stress, such as depressive symptoms, loss of interest, living alone and\u00a0financial stress, were associated with increased <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content>\u00a0mortality in patients with stable <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> despite optimal medical secondary prevention treatment. Secondary prevention of <jats:styled-content style=\"fixed-case\">CHD<\/jats:styled-content> should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.12692","type":"journal-article","created":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T16:28:51Z","timestamp":1506616131000},"page":"83-92","source":"Crossref","is-referenced-by-count":77,"title":["Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease"],"prefix":"10.1111","volume":"283","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3221-0144","authenticated-orcid":false,"given":"E.","family":"Hagstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Medical Sciences Uppsala University Uppsala Sweden"},{"name":"Uppsala Clinical Research Center Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Norlund","sequence":"additional","affiliation":[{"name":"Department of Women\u2032s and Children\u2032s Health Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Stebbins","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Duke University Medical Center Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. W.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Chiswell","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Duke University Medical Center Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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