Health  Vol.6 No.20 , December 2014
Life before Myocardial Infarction
—A Qualitative Study of Middle-Aged Women
Abstract: The health burden of myocardial infarction is rising for middle-aged women and they are underrepresented in research of cardiovascular diseases. The aim of this qualitative study was to explore how life had been for middle-aged women before they suffered a myocardial infarction (MI). Through a health care register, we identified all women (n = 46) under 65 years of age in a defined region in southeast Sweden who had suffered an MI the past 2 years and a strategic selection of n = 16 women from these was made. These selected women were interviewed and their narratives were interpreted by qualitative content analysis. The qualitative interviews generated five general themes: “Serious life events”, “Negative affectivity”, “Loneliness”, “Being a good girl” and “Lack of control”. The interviews revealed that many of these women had been exposed to extreme and repeated traumatic life events in their lives. Many had a cynical attitude towards others, felt lonely and experienced a lack of social support. Many of these women endeavored to “be a good girl”, which was a special psychosocial phenomenon found. This study uncovered that these women before they suffered an MI were affected by a variety of psychosocial factors. The study stresses the importance of psychosocial risk factors in the assessment of middle-aged women’s risk profile for MI. A general conclusion for clinical practice is that in the assessment of the individual risk for myocardial infarction for middle-aged women, potential psychosocial factors might also be considered.
Cite this paper: Wennerholm, C. , Jern, M. , Honkasalo, M. and Faresjö, T. (2014) Life before Myocardial Infarction
—A Qualitative Study of Middle-Aged Women. Health, 6, 2765-2774. doi: 10.4236/health.2014.620316.

[1]   Maas, A.H., van der Schouw, Y.T., Regitz-Zagrosek, V., Swahn, E., Appelman, Y.E., Pasterkamp, G., Ten Cate, H., Nilsson, P.M., Huisman, M.V., Stam, H.C., Eizema, K. and Stramba-Badiale, M. (2011) 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, 9 September 2010. European Heart Journal, 32, 1362-1368.

[2]   Wenger, N.K. (2010) The Female Heart Is Vulnerable to Cardiovascular Disease: Emerging Prevention Evidence for Women Must Inform Emerging Prevention Strategies for Women. Circulation: Cardiovascular Quality and Outcomes, 3, 118-119.

[3]   Hallman, T., Burell, G., Setterlind, S., Odén, A. and Lisspers, J. (2001) Psychosocial Risk Factors for Coronary Heart Disease, Their Importance Compared with Other Risk Factors and Gender Differences in Sensitivity. Journal of Cardiovascular Risk, 8, 39-49.

[4]   Mendis, S., Puska, P. and Norrving, B. (2011) Global Atlas on Cardiovascular Disease Prevention and Control. World Health Organisation, Geneva.

[5]   Perk, J., De Backer, G., Gohlke, H., Graham, I., Reinr, Z., Verschuren, W.M., Albus, C., Benlian, P., Boysen, G., Cifkova, R., Deaton, C., Ebrahim, S., Fisher, M., Germanò, G., Hobbs, R., Hoes, A., Karadeniz, S., Mezzani, A., Prescott, E., Ryden, L., Scherer, M., Syvanne, M., Scholte, Op Reimer, W.J., Vrints, C., Wood, D., Zamorano, J.L. and Zannad, F. (2012) European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Atherosclerosis, 223, 1-68.

[6]   Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J. and Lisheng, J., INTERHEART Study Ivestigators (2004) Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (The INTERHEART Study)—Case Control Study. The Lancet, 364, 937-952.

[7]   Kop, W.J. (1997) Acute and Chronic Psychological Risk Factors for Coronary Syndromes: Moderating Effects of Coronary Artery Disease Severity. Journal of Psychosomatic Research, 43, 167-181.

[8]   Gonzalez, A., Jenkins, J.M., Steiner, M. and Flemming, A.S. (2009) The Relation between Early Life Adversity, Cortisol Awakening Response and Diurnal Salivary Cortisol Levels in Postpartum Women. Psychoneuroendocrinology, 34, 76-86.

[9]   Reinier, K., Thomas, E., Andrusiek, D.L., Aufderheide, T.P., Brooks, S.C., Callaway, C.W., Pepe, P.E., Rea, T.D., Schmicker, R.H., Vaillancourt, C. and Chugh, S.S. (2011) Resuscitation Outcomes Consortium Investigators. Socioeconomic Status and Incidence of Sudden Cardiac Arrest. Canadian Medical Association Journal, 183, 1705-1712.

[10]   Wennerholm, C., Grip, B., Johansson, A.K., Nilsson, H., Honkasalao, M.L. and Faresjo, T. (2011) Cardiovascular Disease Occurrence in Two Close but Different Social Environments. International Journal of Health Geographics, 10, 5.

[11]   Kivimaki, M., Virtanen, M., Elovainio, M., Kouvonen, A., Vaananen, A. and Vahtera, J. (2006) Work Stress in the Etiology of Coronary Heart Disease—A Meta-Analysis. Scandinavian Journal of Work, Environment & Health, 32, 431-442.

[12]   Johnson, J.V., Stewart, W., Hall, E.M., Fredlund, P. and Theorell, T. (1996) Long-Term Psychosocial Work Environment and Cardiovascular Mortality among Swedish Men. American Journal of Public Health, 86, 324-331.

[13]   Low, C.A., Thurston, R.C. and Matthews, K.A. (2010) Psychosocial Factors in the Development of Heart Disease in Women: Current Research and Future Direction. Psychosomatic Medicine, 72, 843-854.

[14]   Suinn, R.M. (2001) The Terrible Twos—Anger and Anxiety. American Psychologist, 56, 27-36.

[15]   Sapolsky, R. (1994) Why Zebras Don’t Get Ulcers: A Guide to Stress, Stress-Related Diseases and Coping. WH Freeman, New York.

[16]   Denollet, J., Schiffer, A.A. and Spek, V. (2010) A General Propensity to Psychological Distress Affects Cardiovascular Outcomes: Evidence from Research on the Type D (Distressed) Personality Profile. Circulation: Cardiovascular Quality and Outcomes, 3, 546-557.

[17]   Tindle, H.A., Chang, Y.F., Kuller, L.H., Manson, J.E., Robinson, J.G., Rosal, M.C., Siegle, G.J. and Matthews, K.A. (2009) Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women’s Health Initiative. Circulation, 120, 656-662.

[18]   Lawler, K.A., Younger, J.W., Piferi, R.L., Billington, E., Jobe, R., Edmondson, K. and Jones, W.H. (2003) A Change of Heart: Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict. Journal of Behavioral Medicine, 26, 373-393.

[19]   Andersen, I., Diderichsen, F., Kornerup, H., Prescott, E. and Rod, N.H. (2011) Major Life Events and the Risk of Ischaemic Heart Disease: Does Accumulation Increase the Risk? International Journal of Epidemiology, 40, 904-913.

[20]   Aioki, T., Fukumoto, Y., Yasuda, S., Sakata, Y., Ito, K., Takahashi, J., Miyata, S., Tsuji, I. and Shimokawa, H. (2012) The Great East Japan Earthquake Disaster and Cardiovascular Diseases. European Heart Journal, 33, 2796-2803.

[21]   Idris, N., Aznal, SS., Chin, SP., Ahmad, W.A., Rosman, A., Jeyaindran, S., Ismail, O., Zambahari, R. and Sim, K.H. (2011) Acute Coronary Syndrome in Women of Reproductive Age. International Journal of Women’s Health, 3, 375-380.

[22]   Claesson, M., Burell, G., Slunga Birgander, L., Lindahl, B. and Asplund, K. (2003) Psychosocial Distress and Impaired Quality of Life—Targets Neglected in the Secondary Prevention in Women with Ischemic Heart Disease. European Journal of Preventive Cardiology, 10, 258-266.

[23]   Wiréhn, AB., Karlsson, HM. and Carstensen, JM. (2007) Estimating Disease Prevalence Using a Population-Based Administrative Health Care Database. Scandinavian Journal of Public Health, 35, 424-431.

[24]   Guest, G., Bunce, A. and Johnson, L. (2006) How Many Interviews Are Enough? An Experiment with Data Saturation and Variability. Field Methods, 18, 59-82.

[25]   Graneheim, U.H. and Lundman, B. (2004) Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112.

[26]   Tong, A., Sainsbury, P. and Craig, J. (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-Item Checklist for Interviews and Focus Groups. International Journal for Quality in Health Care, 19, 349-357.

[27]   Albus, C., Jordan, J. and Herrmann-Lingen, C. (2004) Screening for Psychosocial Risk Factors in Patients with Coronary Heart Disease-Recommendations for Clinical Practice. European Journal of Preventive Cardiology, 11, 75-79.

[28]   Johnson, M. and Forsman, L. (1995) Competence Strivings and Self-Esteem: An Experimental Study. Personality and Individual Differences, 19, 417-430.

[29]   Forsman, L. and Johnson, M. (1996) Dimensionality and Validity of Two Scales Measuring Different Aspects of Self-Esteem. Scandinavian Journal of Psychology, 37, 1-15.

[30]   Koivula, N., Hassmén, P. and Fallby, J. (2002) Self-Esteem and Perfectionism in Elite Athletes: Effects on Competitive Anxiety and Self-Confidence. Personality and Individual Differences, 32, 865-875.

[31]   Blom, V. (2011) Striving for Self-Esteem—Conceptualization and Role in Burnout. PhD Thesis, Stockholm University, Department of Psychology, Stockholm.