The Role of Emotional Regulation and Affective Balance on Health Perception in Cardiovascular Disease Patients According to Sex Differences

Bárbara Luque, Rosario Castillo-Mayén, Esther Cuadrado, Tamara Gutiérrez-Domingo, Sebastián J Rubio, Alicia Arenas, Javier Delgado-Lista, Pablo Pérez Martínez, Carmen Tabernero, Bárbara Luque, Rosario Castillo-Mayén, Esther Cuadrado, Tamara Gutiérrez-Domingo, Sebastián J Rubio, Alicia Arenas, Javier Delgado-Lista, Pablo Pérez Martínez, Carmen Tabernero

Abstract

One of the challenges of aging is the increase of people with chronic diseases, such as cardiovascular disease (CVD). Men and women experience the disease differently. Therefore, it has an impact on how CVD is treated and its outcomes. This research analyzed the relationship between psychosocial variables and health promotion among cardiovascular patients, paying special attention to sex differences. A longitudinal study with cardiovascular patients (747 in phase 1 (122 women) and 586 in phase 2 (83 women)) was carried out. Participants were evaluated based on their sociodemographic characteristics, affective balance, regulatory negative affect self-efficacy, stress and anxiety regulation strategies, and perceived global health. Results showed that men presented significantly higher scores in positive affect, affective balance, and self-efficacy to regulate negative emotions, while women presented significantly higher scores in negative affect and the use of passive strategies to cope with stressful situations. Regression analyses showed that all psychological variables studied in phase 1 were significant predictors of health perception in phase 2. According to the results, it is necessary to include strategies to improve cardiovascular health through education and emotional regulation, with a gender focus.

Keywords: Gender; cardiovascular health; emotional regulation; women’s health.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

References

    1. Naghavi M., Abajobir A.A., Abbafati C., Abbas K.M., Abd-Allah F., Abera S.F., Aboyans V., Adetokunboh O., Afshin A., Agrawal A., et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–1210. doi: 10.1016/S0140-6736(17)32152-9.
    1. Wilkins E., Wilson L., Wickramasinghe K., Bhatnagar P., Leal J., Luengo-Fernandez L., Burns R., Rayner M., Townsend N. European Cardiovascular Disease Statistics 2017. European Heart Network; Brussels, Belgium: 2017.
    1. Grazzi G., Mazzoni G., Myers J., Caruso L., Sassone B., Pasanisi G., Guerzoni F., Napoli N., Pizzolato M., Zerbini V., et al. Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease. J. Clin. Med. 2020;9:1755. doi: 10.3390/jcm9061755.
    1. Chandrasekhar J., Mehran R. Sex-Based Differences in Acute Coronary Syndromes. JACC Cardiovasc. Imaging. 2016;9:451–464. doi: 10.1016/j.jcmg.2016.02.004.
    1. Chandrasekhar J., Dangas G., Yu J., Vemulapalli S., Suchindran S., Vora A.N., Baber U., Mehran R. Sex-Based Differences in Outcomes With Transcatheter Aortic Valve Therapy. J. Am. Coll. Cardiol. 2016;68:2733–2744. doi: 10.1016/j.jacc.2016.10.041.
    1. Gao Z., Chen Z., Sun A., Deng X. Gender differences in cardiovascular disease. Med. Nov. Technol. Devices. 2019;4:100025. doi: 10.1016/j.medntd.2019.100025.
    1. Maas A.H.E.M., Appelman Y. Gender differences in coronary heart disease. Neth. Heart J. 2010;18:598–602. doi: 10.1007/s12471-010-0841-y.
    1. Maas A.H.E.M., Van Der Schouw Y.T., Regitz-Zagrosek V., Swahn E., Appelman Y.E., Pasterkamp G., Cate H.T., Nilsson P.M., Huisman M.V., Stam H.C., et al. Red alert for women’s heart: The urgent need for more research and knowledge on cardiovascular disease in women: Proceedings of the Workshop held in Brussels on Gender Differences in Cardiovascular disease, 29 September 2010. Eur. Heart J. 2011;32:1362–1368. doi: 10.1093/eurheartj/ehr048.
    1. Shah A.S.V., Griffiths M., Lee K.K., McAllister D.A., Hunter A.L., Ferry A.V., Cruikshank A., Reid A., Stoddart M., Strachan F., et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: Prospective cohort study. BMJ. 2015;350:g7873. doi: 10.1136/bmj.g7873.
    1. McQuillan B.M., Thompson P.L. Acute coronary syndromes in women: Different presentation and poorer outcomes. Med. Today. 2016;7:16–20.
    1. Melloni C., Berger J.S., Wang T.Y., Gunes F., Stebbins A., Pieper K.S., Dolor R., Douglas P.S., Mark D.B., Newby L.K. Representation of Women in Randomized Clinical Trials of Cardiovascular Disease Prevention. Circ. Cardiovasc. Qual. Outcomes. 2010;3:135–142. doi: 10.1161/CIRCOUTCOMES.110.868307.
    1. Stramba-Badiale M. Women and research on cardiovascular diseases in Europe: A report from the European Heart Health Strategy (EuroHeart) project. Eur. Heart J. 2010;31:1677–1681. doi: 10.1093/eurheartj/ehq094.
    1. Piepoli M.F., Hoes A.W., Agewall S., Albus C., Brotons C., Catapano A.L., Cooney M.-T., Corra U., Cosyns B., Deaton C. European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2016: Web Addenda. [(accessed on 9 January 2020)]; Available online: .
    1. Low C.A., Thurston R.C., Matthews K.A. Psychosocial Factors in the Development of Heart Disease in Women: Current Research and Future Directions. Psychosom. Med. 2010;72:842–854. doi: 10.1097/PSY.0b013e3181f6934f.
    1. Sirois F.M. A self-regulation resource model of self-compassion and health behavior intentions in emerging adults. Prev. Med. Rep. 2015;2:218–222. doi: 10.1016/j.pmedr.2015.03.006.
    1. Oyanguren J., García P.M.L., Laguna J.T., Goya I.L., Martín S.R., Lafuente E.M., Grandes G. Effectiveness and Factors Determining the Success of Management Programs for Patients with Heart Failure: A Systematic Review and Meta-analysis. Rev. Española Cardiol. 2016;69:900–914. doi: 10.1016/j.recesp.2016.05.008.
    1. Ashgar R.I. Relationships Between Personal Satisfaction, Cardiovascular Disease Risk, and Health Promoting Behavior Among Arab American Middle-Aged Women. J. Cardiovasc. Nurs. 2020;8 doi: 10.1097/JCN.0000000000000690.
    1. World Health Organization . Global Status Report on Noncommunicable Diseases 2014 (No. WHO/NMH/NVI/15.1) World Health Organization; Geneva, Switzerland: 2014.
    1. Araujo-Soares V., Hankonen N., Presseau J., Rodrigues A., Sniehotta F.F. Developing Behavior Change Interventions for Self-Management in Chronic Illness. Eur. Psychol. 2019;24:7–25. doi: 10.1027/1016-9040/a000330.
    1. Lee K.S., Feltner F.J., Bailey A.L., Lennie T.A., Chung M.L., Smalls B.L., Schuman D.L., Moser D.K. The relationship between psychological states and health perception in individuals at risk for cardiovascular disease. Psychol. Res. Behav. Manag. 2019;12:317–324. doi: 10.2147/PRBM.S198280.
    1. Graven L.J., Grant J.S. Social support and self-care behaviors in individuals with heart failure: An integrative review. Int. J. Nurs. Stud. 2014;51:320–333. doi: 10.1016/j.ijnurstu.2013.06.013.
    1. Backholer K., Peters S.A.E., Bots S.H., Peeters A., Huxley R.R., Woodward M. Sex differences in the relationship between socioeconomic status and cardiovascular disease: A systematic review and meta-analysis. J. Epidemiol. Community Health. 2016;71:550–557. doi: 10.1136/jech-2016-207890.
    1. Bruthans J., Mayer O., De Bacquer D., De Smedt D., Reiner Ž., Kotseva K., Cífková R. Educational level and risk profile and risk control in patients with coronary heart disease. Eur. J. Prev. Cardiol. 2015;23:881–890. doi: 10.1177/2047487315601078.
    1. De Smedt D., De Bacquer D., De Sutter J., Dallongeville J., Gevaert S., De Backer G., Bruthans J., Kotseva K., Reiner Ž., Tokgözoğlu L., et al. The gender gap in risk factor control: Effects of age and education on the control of cardiovascular risk factors in male and female coronary patients. The EUROASPIRE IV study by the European Society of Cardiology. Int. J. Cardiol. 2016;209:284–290. doi: 10.1016/j.ijcard.2016.02.015.
    1. Albus C. Psychosocial risk factors: Time for action in the lifelong prevention of coronary heart disease. Eur. J. Prev. Cardiol. 2017;24:1369–1370. doi: 10.1177/2047487317715770.
    1. Jenkins K.R., Ofstedal M.B. The association between socioeconomic status and cardiovascular risk factors among middle-aged and older men and women. Women Health. 2014;54:15–34. doi: 10.1080/03630242.2013.858098.
    1. MacKenbach J., Cavelaars A., Kunst A., Groenhof F. Socioeconomic inequalities in cardiovascular disease mortality. An international study. Eur. Heart J. 2000;21:1141–1151. doi: 10.1053/euhj.1999.1990.
    1. Thurston R.C., Kubzansky L.D. Women, Loneliness, and Incident Coronary Heart Disease. Psychosom. Med. 2009;71:836–842. doi: 10.1097/PSY.0b013e3181b40efc.
    1. Stewart A.L., Kathawalla U.-K., Wolfe A.G., Everson-Rose S.A. Women’s heart health at mid-life: What is the role of psychosocial stress? Women’s Midlife Health. 2018;4:11. doi: 10.1186/s40695-018-0041-2.
    1. Richards S.H., Anderson L., Jenkinson C.E., Whalley B., Rees K., Davies P., Bennett P., Liu Z., West R., Thompson D.R., et al. Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. Eur. J. Prev. Cardiol. 2017;25:247–259. doi: 10.1177/2047487317739978.
    1. Pool L., Ning H., Huffman M.D., Reis J.P., Lloyd-Jones N.M., Allen N.B. Association of cardiovascular health through early adulthood and health-related quality of life in middle age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Prev. Med. 2019;126:105772. doi: 10.1016/j.ypmed.2019.105772.
    1. Pinheiro L.C., Reshetnyak E., Sterling M.R., Richman J., Kern L.M., Safford M.M. Using health-related quality of life to predict cardiovascular disease events. Qual. Life Res. 2019;28:1465–1475. doi: 10.1007/s11136-019-02103-1.
    1. Karademas E.C., Barouxi E., Mavroeides G. Positive and negative affect and well-being in cardiac patients and their spouses: The mediating role of illness representations. Psychol. Health. 2018;34:289–305. doi: 10.1080/08870446.2018.1525490.
    1. Peleg S., Drori E., Banai S., Finkelstein A., Shiloh S. The Dynamic Nature of Self-Assessed Health (SAH) as a Function of Negative and Positive Affects among Cardiac Patients. Appl. Psychol. Heal. Well-Being. 2017;9:370–386. doi: 10.1111/aphw.12099.
    1. Huber A., Oldridge N., Höfer S. International SF-36 reference values in patients with ischemic heart disease. Qual. Life Res. 2016;25:2787–2798. doi: 10.1007/s11136-016-1316-4.
    1. Sin N.L., Moskowitz J.T., Whooley M.A. Positive Affect and Health Behaviors Across 5 Years in Patients with Coronary Heart Disease. Psychosom. Med. 2015;77:1058–1066. doi: 10.1097/PSY.0000000000000238.
    1. Boehm J.K., Kubzansky L.D. The heart’s content: The association between positive psychological well-being and cardiovascular health. Psychol. Bull. 2012;138:655–691. doi: 10.1037/a0027448.
    1. Meyer F.A., Von Känel R., Saner H., Schmid J.-P., Stauber S. Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation. Eur. J. Prev. Cardiol. 2014;22:1247–1253. doi: 10.1177/2047487314549745.
    1. Mommersteeg P.M., Arts L., Zijlstra W., Widdershoven J.W., Aarnoudse W., Denollet J. Impaired Health Status, Psychological Distress, and Personality in Women and Men with Nonobstructive Coronary Artery Disease. Circ. Cardiovasc. Qual. Outcomes. 2017;10:e003387. doi: 10.1161/CIRCOUTCOMES.116.003387.
    1. Chauvet-Gelinier J.-C., Bonin B. Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation. Ann. Phys. Rehabil. Med. 2017;60:6–12. doi: 10.1016/j.rehab.2016.09.002.
    1. Caprara G.V., Steca P. Affective and Social Self- Regulatory Efficacy Beliefs as Determinants of Positive Thinking and Happiness. Eur. Psychol. 2005;10:275–286. doi: 10.1027/1016-9040.10.4.275.
    1. Alessandri G., Vecchione M., Caprara G.V. Assessment of regulatory emotional self-efficacy beliefs: A review of the status of the art and some suggestions to move the field forward. J. Psychoeduc. Assess. 2015;33:24–32. doi: 10.1177/0734282914550382.
    1. Chaves C., Park C.L. Differential pathways of positive and negative health behavior change in congestive heart failure patients. J. Health Psychol. 2016;21:1728–1738. doi: 10.1177/1359105314564812.
    1. Phillips A.C., Carroll U., Der G. Negative life events and symptoms of depression and anxiety: Stress causation and/or stress generation. Anxiety Stress Coping. 2015;28:357–371. doi: 10.1080/10615806.2015.1005078.
    1. Vaccarino V., Bremner J.D. Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci. Biobehav. Rev. 2017;74:297–309. doi: 10.1016/j.neubiorev.2016.04.023.
    1. Nolen-Hoeksema S. Emotion Regulation and Psychopathology: The Role of Gender. Annu. Rev. Clin. Psychol. 2012;8:161–187. doi: 10.1146/annurev-clinpsy-032511-143109.
    1. Svensson T., Inoue M., Sawada N., Yamagishi K., Charvat H., Saito I., Kokubo Y., Iso H., Kawamura N., Shibuya K., et al. Coping strategies and risk of cardiovascular disease incidence and mortality: The Japan Public Health Center-based prospective Study. Eur. Heart J. 2016;37:890–899. doi: 10.1093/eurheartj/ehv724.
    1. Delgado-Lista J., Perez-Martinez P., Garcia-Rios A., Díaz J.F.A., Perez-Caballero A.I., Delgado-Lista J., Fuentes F., Quintana-Navarro G., Lopez-Segura F., Ortiz-Morales A.M., et al. CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (the CORDIOPREV study): Rationale, methods, and baseline characteristics. Am. Heart J. 2016;177:42–50. doi: 10.1016/j.ahj.2016.04.011.
    1. Watson D., Clark L.A., Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J. Personal. Soc. Psychol. 1988;54:1063. doi: 10.1037/0022-3514.54.6.1063.
    1. López-Gómez I., Hervás G., Vázquez C. Adaptación de la “Escala de afecto positivo y negativo” (PANAS) en una muestra general española. Psicol. Conduct. 2015;23:529–548.
    1. Caprara G.V., Di Giunta L., Eisenberg N., Gerbino M., Pastorelli C., Tramontano C. Assessing regulatory emotional self-efficacy in three countries. Psychol. Assess. 2008;20:227–237. doi: 10.1037/1040-3590.20.3.227.
    1. Vilagut G., Valderas J.M., Ferrer M., Garín O., López-García E., Alonso J. Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: Componentes físico y mental. Med. Clínica. 2008;130:726–735. doi: 10.1157/13121076.
    1. Kubota Y., Heiss G., MacLehose R.F., Roetker N.S., Folsom A.R. Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study. JAMA Intern. Med. 2017;177:1165–1172. doi: 10.1001/jamainternmed.2017.1877.
    1. Manfredini R., De Giorgi A., Tiseo R., Boari B., Cappadona R., Salmi R., Gallerani M., Signani F., Manfredini F., Mikhailidis D.P., et al. Marital Status, Cardiovascular Diseases, and Cardiovascular Risk Factors: A Review of the Evidence. J. Women’s Health. 2017;26:624–632. doi: 10.1089/jwh.2016.6103.
    1. Shih M.-L., Tsai S.-T., Chen H.-M., Chou F.-H., Liu Y. Gender differences? Factors related to quality of life among patients with Heart failure. Women Health. 2019;60:382–395. doi: 10.1080/03630242.2019.1662868.
    1. Allman E., Berry D.C., Nasir L. Depression and Coping in Heart Failure Patients. J. Cardiovasc. Nurs. 2009;24:106–117. doi: 10.1097/JCN.0b013e318197a985.
    1. Eisenberg S.A., Shen B.-J., Schwarz E.R., Mallon S. Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients. J. Behav. Med. 2011;35:253–261. doi: 10.1007/s10865-011-9358-0.
    1. Goldberg M., Chastang J.F., Leclerc A., Zins M., Bonenfant S., Bugel I., Kaniewski N., Schmaus A., Niedhammer I., Piciotti M., et al. Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: A prospective study of the French GAZEL cohort and its target population. Am. J. Epidemiol. 2001;154:373–384. doi: 10.1093/aje/154.4.373.
    1. Cervone D. Personality Architecture: Within-Person Structures and Processes. Annu. Rev. Psychol. 2005;56:423–452. doi: 10.1146/annurev.psych.56.091103.070133.
    1. Raeisi-Giglou P., Volgman A.S., Patel H., Campbell S., Villablanca A., Hsich E.M. Advances in Cardiovascular Health in Women over the Past Decade: Guideline Recommendations for Practice. J. Women’s Health. 2018;27:128–139. doi: 10.1089/jwh.2016.6316.
    1. Prata J., Ramos S., Martins A.Q., Rocha-Gonçalves F., Coelho R. Women with Coronary Artery Disease. Cardiol. Rev. 2014;22:25–29. doi: 10.1097/CRD.0b013e31829e852b.
    1. Pogosova N.V., Kotseva K., De Bacquer D., Von Känel R., De Smedt D., Bruthans J., Dolzhenko M. Psychosocial risk factors in relation to other cardiovascular risk factors in coronary heart disease: Results from the EUROASPIRE IV survey. A registry from the European Society of Cardiology. Eur. J. Prev. Cardiol. 2017;24:1371–1380. doi: 10.1177/2047487317711334.
    1. Anderson L., Brown J.P., Clark A.M., Dalal H., Rossau H.K., Bridges C., Taylor R. Patient education in the management of coronary heart disease. Cochrane Database Syst. Rev. 2017;2017:CD008895. doi: 10.1002/14651858.CD008895.pub3.
    1. Orth-Gomér K., Schneiderman N., Wang H.-X., Walldin C., Blom M., Jernberg T. Stress Reduction Prolongs Life in Women with Coronary Disease. Circ. Cardiovasc. Qual. Outcomes. 2009;2:25–32. doi: 10.1161/CIRCOUTCOMES.108.812859.
    1. Freixas A., Luque B., Reina A. Critical Feminist Gerontology: In the Back Room of Research. J. Women Aging. 2012;24:44–58. doi: 10.1080/08952841.2012.638891.
    1. Fitzpatrick M., Thakor A.S. Advances in Precision Health and Emerging Diagnostics for Women. J. Clin. Med. 2019;8:1525. doi: 10.3390/jcm8101525.

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