Healthy psychological functioning and incident coronary heart disease: the importance of self-regulation.

CONTEXT Studies have documented effects of positive and negative emotion on the risk of developing coronary heart disease (CHD), leading investigators to speculate about the importance of effective self-regulation for good health. Little work has directly assessed the role of self-regulation in risk of incident CHD. OBJECTIVE To examine whether self-regulation is associated with reduced risk of coronary heart disease (CHD). Secondary aims were to consider whether the effects are independent of other measures of psychological functioning and how they may occur. DESIGN A prospective population-based cohort study. SETTING The Normative Aging Study, an ongoing cohort study of community-dwelling men in the Boston area. PARTICIPANTS One thousand one hundred twenty-two men aged 40 to 90 years without CHD or diabetes mellitus at baseline, followed up for an average of 12.7 years. MAIN OUTCOME MEASURES Measures of incident CHD obtained from hospital records, medical history, physical examination, and death certificates. During follow-up, 168 cases of incident CHD occurred, including 56 cases of incident nonfatal myocardial infarction (MI), 44 cases of fatal CHD, and 68 cases of angina pectoris. RESULTS In 1986, 1122 men completed the revised Minnesota Multiphasic Personality Inventory, from which we derived a measure of self-regulation. Compared with men with lower levels, those reporting higher levels of self-regulation had an age-adjusted hazard ratio of 0.38 (95% confidence interval, 0.22-0.64) for combined nonfatal MI and CHD death. Moreover, a dose-response relation was evident, as each 1-SD increase in self-regulation level was associated with a 20% decreased risk of combined angina, nonfatal MI, and CHD death. Significant associations were also found after adjusting for anxiety, anger, or depression and after controlling for positive affect. The association could not be explained by known demographic factors, health behaviors, or biological factors. CONCLUSION Findings suggest that self-regulation may protect against risk of CHD in older men.

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