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July 8, 1992

Social and Economic Factors in Patients With Coronary Disease-Reply

Author Affiliations

St Luke's-Roosevelt Hospital and Columbia University College of Physicians and Surgeons New York, NY
University of Rochester (NY) School of Medicine and Dentistry
North Shore University Hospital— Cornell University Medical College Manhasset, NY

JAMA. 1992;268(2):197. doi:10.1001/jama.1992.03490020039017

In Reply.  —In reply to the letter of Dr Burke, all conclusions and figures were based on the prestated primary end point of the occurrence of either nonfatal recurrent infarction or cardiac death, whichever came first. Data on cardiac death were included for completeness. As we stated, the lack of independent risk for cardiac death may imply either a differential effect of psychosocial factors on recurrent cardiac events, or a reduced statistical power for cardiac death (123 vs 226 events).We certainly agree with Drs Frasure-Smith, Lespérance, Hojat, Morris, and Robinson that negative emotions such as depression, loneliness, anxiety, and emotional distress may bear an important relationship to the observed increase in major recurrent events. At the same time, we are not sure of the specific mechanisms that would initiate either an acute MI or cardiac death in this group; further studies are needed to explore the mechanism. The fact