2006 Heart-Brain summit proceedings
Sick at heart:
The pathophysiology
of
negative emotions
ARTICLE INTRODUCTION
The notion that emotional states can influence health is an enduring idea. In 1628, William Harvey noted that a mental disturbance can affect the heart and impair its function. However, it is only in the past several decades that rigorous and methodologically sound epidemiologic research has begun to provide compelling evidence of the link between emotions and cardiovascular diseases, with relative risk estimates that are comparable to those for known risk factors such as smoking. As a result, negative psychological states are beginning to be recognized as risk factors for the development of cardiovascular disease, believed to adversely affect cardiovascular health through multiple pathways.
This article reviews the epidemiologic evidence supporting the role of negative emotion in the development of one form of cardiovascular disease—coronary heart disease (CHD)—and briefly discusses the mechanisms that may help us to understand this relationship. It is worth noting, however, that there is evidence of similar relationships between negative emotions and other cardiovascular outcomes (eg, stroke), as well as between the related experience of chronic stress (eg, caregiver burden, work stress, marital stress) and a range of cardiovascular diseases.
CITATIONS
- Everson-Rose SA, Lewis TT.
Psychosocial factors and cardiovascular diseases. Annu Rev Public Health 2005; 26:469–500.
http://www.ncbi.nlm.nih.gov/pubmed/15760298 - Kubzansky LD, Kawachi I.
Going to the heart of the matter: do negative emotions cause coronary heart disease? J Psychosom Res 2000; 48:323–337.
http://www.ncbi.nlm.nih.gov/pubmed/10880655 - Rozanski A, Blumenthal JA, Davidson KW, Saab P, Kubzansky LD.
The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005; 45:637–651.
http://www.ncbi.nlm.nih.gov/pubmed/15734605 - Yusuf S, Hawken S, Ounpuu S, et al.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937–952.
http://www.ncbi.nlm.nih.gov/pubmed/15364185 - Albert CM, Chae CU, Rexrode KM, Manson JE, Kawachi I.
Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation 2005; 111:480–487.
http://www.ncbi.nlm.nih.gov/pubmed/15687137 - Eaker ED, Pinsky J, Castelli WP.
Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol 1992; 135:854–864.
http://www.ncbi.nlm.nih.gov/pubmed/1585898 - Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB Sr, Benjamin EJ.
Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom Med 2005; 67:692–696.
http://www.ncbi.nlm.nih.gov/pubmed/16204425 - Haines A, Cooper J, Meade TW.
Psychological characteristics and fatal ischemic heart disease. Heart 2001; 85:385–389.
http://www.ncbi.nlm.nih.gov/pubmed/11250959 - Haines AP, Imeson JD, Meade TW.
Phobic anxiety and ischaemic heart disease. BMJ (Clin Res Ed) 1987; 295:297–299.
http://www.ncbi.nlm.nih.gov/pubmed/3115417 - Kawachi I, Colditz GA, Ascherio A, et al.
Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation 1994; 89:1992–1997.
http://www.ncbi.nlm.nih.gov/pubmed/8181122 - Kawachi I, Sparrow D, Vokonas PS, Weiss ST.
Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 1994; 90:2225–2229.
http://www.ncbi.nlm.nih.gov/pubmed/7955177 - Kubzansky LD, Kawachi I, Spiro A 3rd, Weiss ST, Vokonas PS, Sparrow D.
Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the Normative Aging Study. Circulation 1997; 95:818–824.
http://www.ncbi.nlm.nih.gov/pubmed/9054737 - Nicholson A, Fuhrer R, Marmot M.
Psychological distress as a predictor of CHD events in men: the effect of persistence and components of risk. Psychosom Med 2005; 67:522–530.
http://www.ncbi.nlm.nih.gov/pubmed/16046363 - Ringback Weitoft G, Rosen M.
Is perceived nervousness and anxiety a predictor of premature mortality and severe morbidity? A longitudinal follow up of the Swedish survey of living conditions. J Epidemiol Community Health 2005; 59:794–798.
http://www.ncbi.nlm.nih.gov/pubmed/16100319 - Thurston R, Kubzansky LD, Kawachi I, Berkman L.
Do depression and anxiety mediate the link between educational attainment and coronary heart disease? Psychosom Med 2006; 68:25–32.
http://www.ncbi.nlm.nih.gov/pubmed/16449408 - Rugulies R.
Depression as a predictor for coronary heart disease. Am J Prev Med 2002; 23:51–61.
http://www.ncbi.nlm.nih.gov/pubmed/12093424 - Egede LE, Nietert PJ, Zheng D.
Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care 2005; 28:1339–1345.
http://www.ncbi.nlm.nih.gov/pubmed/15920049 - Empana JP, Jouven X, Lemaitre RN, et al.
Clinical depression and risk of out-of-hospital cardiac arrest. Arch Intern Med 2006; 166:195–200.
http://www.ncbi.nlm.nih.gov/pubmed/16432088 - Empana JP, Sykes DH, Luc G, et al.
Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Circulation 2005; 111:2299–2305.
http://www.ncbi.nlm.nih.gov/pubmed/15867179 - Kamphuis MH, Kalmijn S, Tijhuis MA, et al.
Depressive symptoms as risk factor of cardiovascular mortality in older European men: the Finland, Italy and Netherlands Elderly (FINE) study. Eur J Cardiovasc Prev Rehabil 2006; 13:199–206.
http://www.ncbi.nlm.nih.gov/pubmed/16575273 - Marzari C, Maggi S, Manzato E, et al.
Depressive symptoms and development of coronary heart disease events: the Italian longitudinal study on aging. J Gerontol A Biol Sci Med Sci 2005; 60:85–92.
http://www.ncbi.nlm.nih.gov/pubmed/15741288 - Rowan PJ, Haas D, Campbell JA, Maclean DR, Davidson KW
. Depressive symptoms have an independent, gradient risk for coronary heart disease incidence in a random, population-based sample. Ann Epidemiol 2005; 15:316–320.
http://www.ncbi.nlm.nih.gov/pubmed/15780780 - Sundquist J, Li X, Johansson SE, Sundquist K.
Depression as a predictor of hospitalization due to coronary heart disease. Am J Prev Med 2005; 29:428–433.
http://www.ncbi.nlm.nih.gov/pubmed/16376706 - Williams SA, Kasl SV, Heiat A, Abramson JL, Krumholz HM,
Vaccarino V.
Depression and risk of heart failure among the elderly: a prospective community-based study. Psychosom Med 2002; 64:6–12.
http://www.ncbi.nlm.nih.gov/pubmed/11818580 - Wulsin LR, Evans JC, Vasan RS, Murabito JM, Kelly-Hayes M,
Benjamin EJ.
Depressive symptoms, coronary heart disease, and overall mortality in the Framingham Heart Study. Psychosom Med 2005; 67:697–702.
http://www.ncbi.nlm.nih.gov/pubmed/16204426 - Kubzansky LD, Koenen KC, Spior A, Vokonas PS, Sparrow D.
A distressed heart: a prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Arch Gen Psychiatry. In press.
http://www.ncbi.nlm.nih.gov/pubmed/17199060 - Chang PP, Ford DE, Meoni LA, Wang NY, Klag MJ.
Anger in young men and subsequent premature cardiovascular disease: the precursors study. Arch Intern Med 2002; 162:901–906.
http://www.ncbi.nlm.nih.gov/pubmed/11966341 - Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB Sr, Benjamin EJ.
Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation 2004; 109:1267–1271.
http://www.ncbi.nlm.nih.gov/pubmed/14993133 - Kawachi I, Sparrow D, Spiro A, Vokonas P, Weiss ST.
A prospective study of anger and coronary heart disease. The Normative Aging Study. Circulation 1996; 94:2090–2095.
http://www.ncbi.nlm.nih.gov/pubmed/8901656 - Williams JE, Nieto FJ, Sanford CP, Tyroler HA.
Effects of an angry temperament on coronary heart disease risk: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 2001; 154:230–235.
http://www.ncbi.nlm.nih.gov/pubmed/11479187 - Williams JE, Paton CC, Siegler IC, Eigenbrodt ML, Nieto FJ, Tyroler HA.
Anger proneness predicts coronary heart disease risk: prospective analysis from the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2000; 101:2034–2039.
http://www.ncbi.nlm.nih.gov/pubmed/10790343 - Mittleman MA, Maclure M, Sherwood JB, et al.
Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators [see comments]. Circulation 1995; 92:1720–1725.
http://www.ncbi.nlm.nih.gov/pubmed/7671353 - Kawachi I, Sparrow D, Vokonas PS, Weiss ST.
Decreased heart rate variability in men with phobic anxiety (data from the Normative Aging Study). Am J Cardiol 1995; 75:882–885.
http://www.ncbi.nlm.nih.gov/pubmed/7732994 - Paterniti S, Zureik M, Ducimetiere PJT, Feve JM, Alperovitch A.
Sustained anxiety and 4-year progression of carotid atherosclerosis. Arterioscler Thromb Vasc Biol 2001; 21:136–141.
http://www.ncbi.nlm.nih.gov/pubmed/11145945 - Todaro JF, Shen BJ, Niaura R, Spiro A, Ward KD.
Effect of negative emotions on frequency of coronary heart disease (the Normative Aging Study). Am J Cardiol 2003; 92:901–906.
http://www.ncbi.nlm.nih.gov/pubmed/14556863 - Kubzansky LD, Cole SR, Kawachi I, Vokonas PS, Sparrow D.
Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the Normative Aging Study. Ann Behav Med 2006; 31:21–29.
http://www.ncbi.nlm.nih.gov/pubmed/16472035 - Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R.
Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Ann Rev Psychol 2002; 53:83–107.
http://www.ncbi.nlm.nih.gov/pubmed/11752480 - Bierhaus A, Wolf J, Andrassy M, et al.
A mechanism converting psychosocial stress into mononuclear cell activation. Proc Natl Acad Sci U S A 2003; 100:1920–1925.
http://www.ncbi.nlm.nih.gov/pubmed/12578963 - Shumyatsky GP, Malleret G, Shin RM, et al.
Stathmin, a gene enriched in the amygdala, controls both learned and innate fear. Cell 2005; 123:697–709.
http://www.ncbi.nlm.nih.gov/pubmed/16286011 - McGrath M, Kawachi I, Ascherio A, Colditz GA, Hunter DJ, De Vivo I.
Association between catechol-O-methyltransferase and phobic anxiety. Am J Psychiatry 2004; 161:1703–1705.
http://www.ncbi.nlm.nih.gov/pubmed/15337664 - Kubzansky LD, Sparrow D, Vokonas P, Kawachi I.
Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the Normative Aging Study. Psychosom Med 2001; 63:910–916.
http://www.ncbi.nlm.nih.gov/pubmed/11719629 - Giltay EJ, Kamphuis MH, Kalmijn S, Zitman FG, Kromhout D.
Dispositional optimism and the risk of cardiovascular death: the Zutphen Elderly Study. Arch Intern Med 2006; 166:431–436.
http://www.ncbi.nlm.nih.gov/pubmed/16505263 - Giltay EJ, Geleijnse JM, Zitman FG, Hoekstra T, Schouten EG.
Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly dutch men and women. Arch Gen Psychiatry 2004; 61:1126–1135.
http://www.ncbi.nlm.nih.gov/pubmed/15520360 - Matthews KA, Raikkonen K, Sutton-Tyrrell K, Kuller LH.
Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women. Psychosom Med 2004; 66:640–644.
http://www.ncbi.nlm.nih.gov/pubmed/15385685 - Glassman AH, Bigger JT, Gaffney M, Shapiro PA, Swenson JR.
Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry 2006; 63:283–288.
http://www.ncbi.nlm.nih.gov/pubmed/16520433