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Abstract：
BACKGROUND: Cardiovascular disease (CVD) is a major global health issue, primarily caused by atherosclerosis. Psychological factors may play a role in the development and progression of CVD. However, the relationship between psychological factors and atherosclerosis is complex and poorly understood. This study, therefore, aimed to examine the association of psychological factors with (i) coronary and carotid atherosclerosis and (ii) cardiovascular health according to Life\'s Essential 8, in a large Swedish cohort.
METHODS: This study utilized data from the Swedish CArdioPulmonary bioImage Study (SCAPIS), a large population-based project including individuals aged 50 to 65 years. Several psychological factors were analysed: general stress, stress at work, financial stress, major adverse life events, locus of control, feeling depressed, and depression. Coronary atherosclerosis was assessed as the degree of stenosis by coronary computed tomography angiography (CCTA) and coronary artery calcification (CAC) scores. Carotid atherosclerosis was examined using ultrasound. In addition, cardiovascular health was examined using the Life\'s Essential 8 concept created by the American Heart Association, which includes four health behaviors and four health factors. Associations were examined through binomial logistic regression (atherosclerosis variables) and linear regression (Life\'s Essential 8).
RESULTS: A total of 25,658 participants were included in the study. The presence of financial stress, higher locus of control, and depression was weakly associated with increased odds of CCTA stenosis, CAC ≥ 1 and the presence of carotid plaques (all odds ratios: 1.10-1.21, 95% CI: 1.02-1.32) after adjusting for sex, age, and study site. However, these associations were attenuated and not statistically significant after additional adjustments for socioeconomic factors and health behaviors. Conversely, we observed inverse associations between the worst category for all psychological factors and cardiovascular health according to Life\'s Essential 8 score (all standardized β-Coefficient ≤-0.033, p < 0.001).
CONCLUSIONS: While there were no strong and consistent associations between psychological factors and atherosclerosis, the consistent associations of psychological factors with cardiovascular health by Life\'s Essential 8 may have relevance for future CVD risk. However, further studies are needed to elucidate the long-term effects of psychological factors on atherosclerosis development and cardiovascular health.
METHODS: This study utilized data from the Swedish CArdioPulmonary bioImage Study (SCAPIS), a large population-based project including individuals aged 50 to 65 years. Several psychological factors were analysed: general stress, stress at work, financial stress, major adverse life events, locus of control, feeling depressed, and depression. Coronary atherosclerosis was assessed as the degree of stenosis by coronary computed tomography angiography (CCTA) and coronary artery calcification (CAC) scores. Carotid atherosclerosis was examined using ultrasound. In addition, cardiovascular health was examined using the Life\'s Essential 8 concept created by the American Heart Association, which includes four health behaviors and four health factors. Associations were examined through binomial logistic regression (atherosclerosis variables) and linear regression (Life\'s Essential 8).
RESULTS: A total of 25,658 participants were included in the study. The presence of financial stress, higher locus of control, and depression was weakly associated with increased odds of CCTA stenosis, CAC ≥ 1 and the presence of carotid plaques (all odds ratios: 1.10-1.21, 95% CI: 1.02-1.32) after adjusting for sex, age, and study site. However, these associations were attenuated and not statistically significant after additional adjustments for socioeconomic factors and health behaviors. Conversely, we observed inverse associations between the worst category for all psychological factors and cardiovascular health according to Life\'s Essential 8 score (all standardized β-Coefficient ≤-0.033, p < 0.001).
CONCLUSIONS: While there were no strong and consistent associations between psychological factors and atherosclerosis, the consistent associations of psychological factors with cardiovascular health by Life\'s Essential 8 may have relevance for future CVD risk. However, further studies are needed to elucidate the long-term effects of psychological factors on atherosclerosis development and cardiovascular health.
摘要：
背景：心血管疾病（CVD）是一个主要的全球健康问题，主要由动脉粥样硬化引起。心理因素可能在CVD的发生和发展中起作用。然而,心理因素和动脉粥样硬化之间的关系是复杂的和知之甚少。这项研究,因此,旨在根据瑞典大型队列中的《生活要点8》，检查心理因素与（i）冠状动脉和颈动脉粥样硬化以及（ii）心血管健康的关联。
方法：本研究利用了来自瑞典CARdioLumonic生物影像研究（SCAPIS）的数据，一个以人口为基础的大型项目，包括50至65岁的个人。分析了几个心理因素：一般压力，工作压力,财务压力，主要不良生活事件，控制源，感到沮丧，和抑郁症。通过冠状动脉计算机断层扫描血管造影（CCTA）和冠状动脉钙化（CAC）评分评估冠状动脉粥样硬化的狭窄程度。使用超声检查颈动脉粥样硬化。此外,使用美国心脏协会创建的“生命本质8”概念检查心血管健康，其中包括四种健康行为和四种健康因素。通过二项逻辑回归（动脉粥样硬化变量）和线性回归（生命要素8）检查相关性。
结果：共有25,658名参与者被纳入研究。财务压力的存在，更高的控制源，抑郁与CCTA狭窄的几率增加弱相关，CAC≥1和颈动脉斑块的存在（所有比值比：1.10-1.21，95％CI：1.02-1.32）后调整性别，年龄,和研究网站。然而,在对社会经济因素和健康行为进行额外调整后,这些关联减弱,且无统计学意义.相反，我们观察到所有心理因素的最差类别与心血管健康之间的负相关(所有标准化β系数≤-0.033,p<0.001)。
结论：虽然心理因素与动脉粥样硬化之间没有强烈且一致的关联，《生活要点8》显示,心理因素与心血管健康的一致关联可能与未来心血管疾病风险相关.然而,需要进一步的研究来阐明心理因素对动脉粥样硬化发展和心血管健康的长期影响.
方法：本研究利用了来自瑞典CARdioLumonic生物影像研究（SCAPIS）的数据，一个以人口为基础的大型项目，包括50至65岁的个人。分析了几个心理因素：一般压力，工作压力,财务压力，主要不良生活事件，控制源，感到沮丧，和抑郁症。通过冠状动脉计算机断层扫描血管造影（CCTA）和冠状动脉钙化（CAC）评分评估冠状动脉粥样硬化的狭窄程度。使用超声检查颈动脉粥样硬化。此外,使用美国心脏协会创建的“生命本质8”概念检查心血管健康，其中包括四种健康行为和四种健康因素。通过二项逻辑回归（动脉粥样硬化变量）和线性回归（生命要素8）检查相关性。
结果：共有25,658名参与者被纳入研究。财务压力的存在，更高的控制源，抑郁与CCTA狭窄的几率增加弱相关，CAC≥1和颈动脉斑块的存在（所有比值比：1.10-1.21，95％CI：1.02-1.32）后调整性别，年龄,和研究网站。然而,在对社会经济因素和健康行为进行额外调整后,这些关联减弱,且无统计学意义.相反，我们观察到所有心理因素的最差类别与心血管健康之间的负相关(所有标准化β系数≤-0.033,p<0.001)。
结论：虽然心理因素与动脉粥样硬化之间没有强烈且一致的关联，《生活要点8》显示,心理因素与心血管健康的一致关联可能与未来心血管疾病风险相关.然而,需要进一步的研究来阐明心理因素对动脉粥样硬化发展和心血管健康的长期影响.
