Perceived vulnerability to serious heart disease and persistent pain in patients with minimal or no coronary disease.

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Abstract
A hypochondriacal personality has been shown to be a major determinant of continued pain in patients with chest pain, both in the presence and absence of significant (less than 75%) coronary stenosis. We investigated preoccupation with cardiac illness among 106 patients (63 women, 43 men) within a few days after coronary angiography, carried out for evaluation of chest pain, showed no significant stenosis. Thirteen questions were used in a structured interview to assess patients' beliefs, behaviors, and expectations pertaining to their cardiac health. Information about persistence of pain was obtained 1 year later by telephone interview. A composite variable, called Self-Label of Coronary Vulnerability, was determined by factor analysis; it accounted for 65% of the variance in the responses. In a multivariable regression analysis, a high score on Self-Label showed the strongest association (p less than 0.005) with continued, unimproved chest pain 1 year later even after adjusting for other variables. As a result, perhaps of a self-labeling process a set of beliefs about vulnerability to serious heart disease helps explain persistence of pain, despite the absence of significant coronary disease.