Doctors have long known that hostility, depression, anxiety and anger have a negative effect on heart health. Now, a long-term study finds that the combined presence of these traits makes it more likely that a veteran will experience coronary heart disease.
The study, published in the November/December issue of Psychosomatic Medicine, followed 2,105 Air Force veterans who served in the Vietnam War, with researchers tracking their cardiovascular health over 17 years, from 1985 to 2002. At the start of the study, none of the vets showed evidence of coronary heart disease.
Researchers assessed participants’ hostility, anxiety and depression when the study began. The men then underwent periodic physical examinations until 2002.
When researchers evaluated each psychological trait individually, all were significantly associated with an increased risk of coronary heart disease, a finding supportive of previous research.
However, in a new twist, they discovered that the combination of these factors more strongly predicted which participants would experience coronary heart disease events.
“The unique aspect of this study is that it examined multiple, related psychological attributes that have individually predicted heart disease in previous studies,†said Stephen Boyle, Ph.D., and Edward Suarez, Ph.D., researchers at Duke University Medical Center.
“The co-occurrence of anger, hostility, anxiety and depression was the best predictor,†Boyle said. “It appears that a more general disposition to experience psychological distress,†and negative affect — how a person displays emotions to others — increases heart disease risk, he said.
This increased risk persisted even after researchers took into account other coronary heart disease risk factors, such as smoking, diabetes and high blood pressure.
“We can predict most coronary heart disease with the classic risk factors of cholesterol, diabetes, smoking and gender,†said Michael Farkouh, M.D., an associate professor of medicine and cardiology at the Mount Sinai School of Medicine in New York.
“The question is, are there other factors at play? Why does someone with risk factors have a cardiac incident and someone else does not? These findings help us understand the precipitants of the incident, not necessarily the development,†Farkouh added.
The next step for researchers is evaluating how these factors increase heart disease risk.
“We are currently exploring the possibility that chronic psychological distress and negative affect increase the risk for heart disease by elevating levels of other risk factors, such as inflammation and lipids, over time,†Boyle said.
Sources:
Boyle SH, Michalek JE, Suarez EC. Covariation of psychological attributes and incident coronary heart disease in U.S. Air Force veterans of the Vietnam War. Psychosomatic Medicine 68(6), 2006.
Thanks to Amy Sutton, Contributing Writer, Health Behavior News Service and to HBNS.
