More recent investigations suggest that these emotions influence both the development and recovery from CHD. Several population studies have demonstrated a relationship between high levels of the negative emotion of anxiety and an increased incidence of heart disease. The Normative Aging Study followed 2,271 men for 32 years and found that men reporting two or more symptoms of anxiety at baseline were three times more likely to have a fatal coronary event than men without symptoms of anxiety. Similar associations have been reported for phobic anxiety symptoms and for high levels of chronic worry. In a community study of Danish men and women, a high score for depressive symptoms was associated with an increased risk of acute MI and CHD death during the 27-year follow-up period. Although there is little evidence that depression leads to the development of CHD, it is considerably more prevalent in CHD populations. Depression is found in approximately 6% of the overall population, but its incidence ranges from 16% to 25% in CHD populations.
Negative emotions have also been linked to a worse prognosis once heart disease is established. During recovery from an acute MI, high levels of anxiety were associated with increased in-hospital complications, including acute ischemia, arrhythmias, reinfarction, and cardiac death. After controlling for indicators of disease severity, patients with major depression have been reported to be three to four times more likely to die in the first year after infarction compared with those with little or no depression. When the negative emotions of depression, anger, and anxiety were simultaneously evaluated in the same group of patients with MI, both depression and anxiety were significant independent predictors of subsequent cardiac events. In this study, the authors divided events into thrombogenic events (infarction or unstable angina) or arrhythmic events, and found that anxiety and a past history of depression were associated with thrombogenic events, whereas current depression and anger were associated with arrhythmic events. The study authors speculate that mechanisms such as enhanced platelet adhesion leading to plaque instability and thrombosis might account for these results. These biologic pathways have yet to be tested, however. Nevertheless, the aforementioned studies suggested that negative emotions adversely influence recovery.
Coming up: Psychosocial interventions during recovery from coronary events.
