Smaardijk,Veerle RMaas,Angela H E MLodder,PaulKop,Willem JMommersteeg,Paula M C2025-02-012025-02-012020Smaardijk, V R, Maas, A H E M, Lodder, P, Kop, W J & Mommersteeg, P M C 2020, 'Sex and gender-stratified risks of psychological factors for adverse clinical outcomes in patients with ischemic heart disease : A systematic review and meta-analysis', International Journal of Cardiology, vol. 302, pp. 21-29. https://doi.org/10.1016/j.ijcard.2019.12.0140167-5273ORCID: /0000-0002-8458-866X/work/82469861ORCID: /0000-0003-1300-7853/work/16632103210.1016/j.ijcard.2019.12.014https://hdl.handle.net/20.500.14602/73996This work was supported by ZonMw and the Dutch Heart Foundation (De Hartstichting) ‘Gender and Health’ program to Dr. Mommersteeg [Grant number #849100001].Background:  Psychological factors are associated with adverse prognosis in patients with ischemic heart disease (IHD). However, it is unknown whether these risk factors differ between women and men. Methods:  PubMed, EMBASE, and PsycINFO were searched to identify studies assessing the risk of psychological factors for major adverse cardiovascular events (MACE) in samples with IHD. Psychological factors included anger/hostility, anxiety, depression, psychological distress, social support, Type A behavior pattern, Type D personality, and Posttraumatic Stress Disorder (PTSD). Results:  A total of 44 articles (64 separate reports) including 227,647 women and 321,894 men reporting confounder-adjusted hazard ratios (HRs) or relative risks (RRs) were included in the primary analysis. Results based on random-effects models showed that the association between psychological factors (all combined) and MACE was stronger in men (n = 321,236; 57 reports; HR = 1.37, 95%CI 1.27-1.48) than in women (n = 226,886; 56 reports; HR = 1.21, 95%CI 1.12-1.30; p = .017). A subset of the studies focusing on women showed significant associations between anger/hostility, depression, and distress with MACE. For men, statistically significant associations were found for anxiety, depression, and distress with MACE. Conclusions:  Psychological factors are associated with MACE in samples with IHD in both women and men, with a small, but significant higher risk for men. Because of the limited number of studies on other psychological factors than depression and anxiety and the current major focus on MACE reflecting lesions in the major coronary arteries which is more typical in men than women, more research is needed to better identify sex and gender differences in IHD.enginfo:eu-repo/semantics/openAccessANXIETYASSOCIATIONCORONARY-ARTERY-DISEASEDEPRESSIVE SYMPTOMSEVENTSGenderIschemic heart diseaseMANAGEMENTMORTALITYMYOCARDIAL-INFARCTIONMajor adverse cardiovascular eventsPsychological factorsSexWOMENWomenSDG 3 - Good Health and Well-beingArticleGeneral rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. - Users may download and print one copy of any publication from the public portal for the purpose of private study or research. - You may not further distribute the material or use it for any profit-making activity or commercial gain - You may freely distribute the URL identifying the publication in the public portal" Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.https://www.scopus.com/pages/publications/85077677607open43361548899350https://research.tilburguniversity.edu/en/publications/c81c219a-b543-4886-a4d1-f4d0ddea747a(c) Universiteit van TilburgSmaardijk, Veerle RMaas, Angela H E MLodder, Paul§0000-0003-1300-7853Kop, Willem J§0000-0003-3141-4815Mommersteeg, Paula M C§0000-0002-8458-866X