Association of chronophysiological and psychological risk factors among patients with acute coronary syndromes

Introduction. Coronary risk factors (CRF) and acute coronary syndromes are decreasing in developed countries but have become a major health problem in most middle-income countries. The increased risk of acute coronary syndromes (ACS) in South Asians is not accounted for by conventional risk factors alone. This study examines the association of chronobehavioral risk factors with ACS. Subjects and Methods. We used a case-control study design including 435 patients with ACS who were compared with 495 age- and gender-matched control subjects. Clinical, electrocardiographic, radiological and laboratory data were obtained in all the patients for confirmation of diagnosis by WHO and AHA criteria. Chronobiological and psychological risk factors were assessed by validated questionnaires. Psychological risk factors, such as psychosocial stress, was assessed by stress at work and at home, financial stress, and major life events in the past year. Other questions assessed locus of control and presence of depression. Multivariate logistic regression analysis was conducted after adjustment of age, gender, and body mass index (BMI) to determine the association of risk factors with ACS. Results. Risk factors: all psychological risk factors (40.0% vs. 12.7%, n = 174 vs. 63, P < 0.001), including psychosocial stress, depression, type A behavior, acute emotional stress were significantly more common among ACS cases compared to the control group. All chronobiological risk factors (24.1% vs. 10.5%, n = 105 vs. 52, P < 0.001), including late-night eating, large meals, hot and cold weather, as well as sleep deprivation due to any cause (24.4% vs. 10.5%, n = 106 vs. 52, P < 0.001) were significantly more common among ACS patients as compared to the control group. After adjustment for age and BMI, sleep deprivation and psychological risk factors were positively and strongly associated with ACS (P < 0.001), as shown by odds ratios and their 95% confidence intervals. Total psychosocial stress (males: 3.15 [2.75-3.32]; females: 3.06 [2.79-3.21]) and sleep deprivation (males: 2.68 [2.55-2.82]; females: 2.75 [2.56-2.89]) were significantly and strongly associated with ACS (P < 0.001). Large meals in both males (1.45 [1.27-1.64]) and females (1.38 [1.27-1.52]), and late-night eating (males: 1.12 [1.01-1.24]; females: 1.09 [1.02-1.18]) were weakly associated with ACS (P < 0.02), indicating the possible involvement of circadian disruption in the etiology of ACS. A weaker positive association (P < 0.02) of cold weather (males: 1.18 [1.11-1.31]; females: 1.15 [1.09-1.27]) and hot weather (>40°C) (males: 1.14 [1.05-1.23]; females: 1.11 [1.02-1.19]) with ACS was also found. Conclusions. This study shows that psychological risk factors, sleep deprivation, and chronobiological risk factors (late-night eating, large meals, hot and cold weather) were significant risk factors of ACS. © 2017 Nova Science Publishers, Inc.