Hans K. Ury

Mortality in middle-aged smokers and nonsmokers.

We assessed the relation of cigarette smoking to mortality in an 11-year follow-up study of 4004 men and women, 35 to 54 years of age, who responded to urging to have multiphasic health checkups. Accounting for 48 other characteristics, both individually and in combination, failed to eliminate the association of smoking with mortality from all causes or with mortality from coronary heart disease. The smoker-to-nonsmoker mortality ratios, crude and adjusted respectively, were 2.6 and 2.1 for all causes and 4.7 and 3.6 for coronary heart disease. This analysis did not support the counterhypothesis that the association of cigarette smoking with mortality is secondary to some underlying characteristic.

A Psychological Questionnaire Predictive of Myocardial Infarction: Results from the Kaiser-Permanente Epidemiologic Study of Myocardial Infarction

&NA; A 155‐item psychological questionnaire was given to 330 multiphasic examinees who subsequently developed a well‐documented first myocardial infarction (MI). Two age‐sex‐race‐matched control groups remaining free of MI were selected from multiphasic examinees; one group was additionally matched to the cases for standard coronary risk factors. Responses to several questionnaire items were associated with subsequent MI to a statistically significant degree, and a further test indicated that the questionnaire as a whole contained more associated items than would be expected by chance. Outside experts selected items to represent certain psychological traits that have been hypothesized as predicting MI. Items representing “emotional drain” and “somatization” proved to be associated with subsequent MI, but these relationships were no longer apparent when persons with coronary symptoms and diagnoses at the time of testing were removed from the study group. Sets of items representing certain other traits were not significantly predictive, except for those representing “anxietyneuroticism,” in the symptom‐free subgroup. In studying factors predicting MI, care should be taken that psychological traits are not confused with symptoms of coronary heart disease.

Cigarette Smoking Habits and Urine Characteristics

Voided urines of 53,000 white and 9,300 black cigarette smokers and nonsmokers were studied. Proteinuria was found to be commoner in smokers of both races and sexes. Heavy smokers showed proteinuria m

Psychological questionnaire score, cigarette smoking, and myocardial infarction: A continuing enigma☆

The ability of a group of 94 psychological questions to discriminate between men in whom cigarette smoking was associated with increased risk of myocardial infarction and men in whom smoking was not so associated remains puzzling. Further analyses, controlling for reported alcohol consumption and for a questionnaire item that might reflect physical activity, failed to alter this finding. This interaction of the questionnaire responses with smoking was not found with two other major coronary risk factors, serum cholesterol and systolic blood pressure. Believing that these observations may provide (a) a clue to how cigarette smoking affects risk of myocardial infarction, or (b) some means of identifying greater or lesser susceptibility to the effects of smoking, we invite other investigators to join in the pursuit of this matter. A list of ten selected yes-or-no questions with strong interaction with smoking is provided to assist others in studying this phenomenon; these are similar to ten items on the Minnesota Multiphasic Personality Inventory.

Is the increased risk of myocardial infarction in cigarette smokers due to psychological traits? An attempted exploration using psychological questionnaire responses.

Abstract Cigarette smoking assessed in a multiphasic health checkup was almost twice as frequent in 222 men who subsequently developed a first myocardial infarction as in 228 controls. Responses to many items in a psychological questionnaire, also given at the checkup, were associated with both smoking and subsequent infarction. Subdividing the study group according to their responses to such items, individually and in combination, failed to eliminate the apparent relation of smoking to subsequent infarction in most subjects. However, in one-quarter of subjects giving the highest number of those responses that were more frequent both in smokers and in infarction cases, the relation of smoking to infarction was not evident. Although smoking remained a risk factor in most subjects, the data suggest that the importance of smoking as a coronary risk factor may vary with psychological status.