Mental Health, Alzheimer's, & Dementia
Angry Men, Depressed Women May be Headed to Heart
Trouble Say New Studies
Clinicians should take symptoms of anger and
hostility seriously; Research links depression to cardiac death in women
without known heart disease
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Depression |
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March 16, 2009 - Men are much more likely to suffer
coronary heart disease from anger and hostility, while women are much
more likely to have increased risk of cardiac events if severely
depressed, according to two studies reported in tomorrow’s issue of the
Journal of the American College of Cardiology.
Anger and Hostility Harmful to the Heart,
Especially Among Men
Anger and hostility are significantly associated
with both a higher risk for coronary heart disease (CHD) in healthy
individuals and poorer outcomes in patients with existing heart disease,
according to this first quantitative review and meta-analysis of related
studies, which appears in the March 17 issue of the American College of
Cardiology journal.
Management of anger and hostility may be an
important strategy in preventing CHD in the general public and treating
CHD patients, according to authors.
“Anger and hostility were found to predict a 19
percent and 24 percent increase in CHD events among initially healthy
people and those with pre-existing CHD, respectively,” says Yoichi Chida,
M.D., Ph.D., Department of Epidemiology & Public Health, University
College, London, UK.
“The harmful association of anger and hostility
with CHD events in healthy people was greater in men than women. This
suggests that the accumulation of stress responses in daily life might
have a greater impact on future CHD in men.”
Authors extensively reviewed the literature on the
longitudinal associations of anger and hostility with CHD events, and
identified 25 studies of initially healthy populations and 18 studies of
patients with CHD. While the damaging effects of these emotions have
been widely asserted, previous reviews have been inconclusive.
“This review provides further evidence that
psychological factors do matter in the development and progression of
CHD,” says Johan Denollet, Ph.D., CoRPS research center, Tilburg
University, The Netherlands, and co-author of the accompanying
editorial.
“Clinicians should take symptoms of anger and
hostility seriously, and may consider referring their patient for
behavioral intervention. We need to closely monitor and study these
personality traits in order to do a better job at identifying high-risk
patients who are more liable to future fatal and non-fatal coronary
events.”
Interestingly, there was no longer a significant
association of anger and hostility with CHD when researchers performed a
subgroup analysis of the studies that controlled for behavioral
covariates (e.g., smoking, physical activity or body mass index,
socioeconomic status) and disease treatment, suggesting that the major
pathway between anger and hostility and CHD might be behavioral risk
factors.
In addition, a direct physiological pathway should
be considered in future studies; this might involve autonomic nervous
dysregulation, increases in inflammatory or coagulation factors such as
C-reactive protein, interleukin 6 and fibrinogen, and higher cortisol
levels.
Future research should also focus on the interplay
between negative emotions and emotion regulation strategies as a
determinant of major coronary events, according to Denollet.
Feeling Down and Out Could Break a Woman’s
Heart, Literally
New data published in the March 17, 2009, issue of
the Journal of the American College of Cardiology suggest that
relatively healthy women with severe depression are at increased risk of
cardiac events, including sudden cardiac death (SCD) and fatal coronary
heart disease (CHD).
Researchers found that much of the relationship
between depressive symptoms and cardiac events was mediated by
cardiovascular disease risk factors, such as high blood pressure, high
cholesterol and smoking.
“It’s important for women with depression to be
aware of the possible association between depression and heart disease,
and work with their health care providers to manage their risk for
coronary heart disease,” says William Whang, M.D., M.S., Division of
Cardiology, Columbia University Medical Center, and lead investigator of
the study.
“A significant part of the heightened risk for cardiac events
seems to be explained by the fact that coronary heart disease risk
factors such as high blood pressure, diabetes, elevated cholesterol, and
smoking were more common among women with more severe depressive
symptoms.”
Dr. Whang and his colleagues prospectively studied
63,469 women from the Nurses Health Study who had no evidence of prior
heart disease or stroke during follow-up between 1992 and 2004.
Self-reported symptoms of depression and use of antidepressant
medication were used as measures of depression. To best identify those
with clinical depression, researchers specifically examined women with
the most severe symptoms defined by a validated 5-point mental health
index score of less than 53 or regular antidepressant use.
The study found that women with more severe
depressive symptoms or those who reported taking antidepressants were at
higher risk for SCD and fatal CHD. In particular, women with clinical
depression were more than twice as likely to experience sudden cardiac
death. Surprisingly, this risk was associated more strongly with
antidepressant use than with depressive symptoms.
“These data indicate the link between depression
and serious heart rhythm problems may be more complex than previously
thought,” says Sanjiv M. Narayan, M.D., F.A.C.C., University of
California, San Diego, who co-authored the accompanying editorial with
colleague, Murray Stein, M.D. “It raises the question of whether this
association may have something to do with the antidepressant drugs used
to treat depression.”
Both Drs. Whang and Narayan stress that although
the relationship between antidepressant medicines and SCD merits further
investigation to determine whether antidepressant medications directly
increase the risk for heart rhythm disorders, at present the benefits of
appropriately prescribed antidepressants outweigh the risk of sudden
cardiac death. There was no relationship between antidepressant use and
fatal CHD or nonfatal heart attack.
“We can’t say antidepressant medications were the
cause of higher risk of sudden cardiac death. It may well be that use of
antidepressants is a marker for worse depression,” adds Dr. Whang. “Our
data raise more questions about the mechanisms by which depression is
associated with arrhythmia and cardiac death.”
Plausible explanations for the link between
depression and SCD may include autonomic dysfunction, higher resting
heart rates and reduced heart rate variability, according to Dr. Whang.
Researchers also found an association with nonfatal MI, but this became
borderline non-significant when adjusted for multiple other CHD risk
factors.
Still, these study findings reinforce the need for
patients with depression to be monitored closely for risk factors for
coronary heart disease, since management of these risk factors can
reduce the risk for mortality from coronary heart disease and sudden
cardiac death.
Dr. Whang reports no conflict of interest.
Background information:
The American College of Cardiology is leading the
way to optimal cardiovascular care and disease prevention. The College
is a 36,000-member nonprofit medical society and bestows the credential
Fellow of the American College of Cardiology upon physicians who meet
its stringent qualifications. More information about the association is
available online at www.acc.org.
