Anger and Depression Predict Artery-Hardening Risks, Behavior

A new study shows that depression and anger are associated with hardening of the arteries in women, in part, through physical and behavioral risk factors such as bad cholesterol levels, obesity and smoking.

Among women, "there is evidence that psychosocial distress is prospectively associated with increased risk of disease and premature mortality from cardiovascular events," say Thomas Rutledge, PhD, of the University of Pittsburgh and his associates. Their study's findings may help explain why.

These findings suggest that psychological factors may not only act as a red flag for potential heart disease risk, but may also offer methods for reducing heart risk through behavioral interventions.

The study showed that subjects with the most depression symptoms were 2.5 times more likely to smoke than subjects with the least depression symptoms. Depressed subjects were also less likely to exercise or be physically fit than non-depressed women.

Subjects who scored highest for outwardly displaying their anger were the most likely to have low levels of high-density lipoproteins (the good kind of cholesterol) and high levels of low-density lipoproteins (the bad kind). These women were also more likely to be overweight or obese.

Cynical hostility, defined as a consistent lack of trust and bitterness towards others, was also associated with atherosclerosis risk factors such as smoking, poor physical fitness and lower HDL levels.

The investigators initially detected an association between cynical hostility and high blood pressure, which disappeared once they controlled for socioeconomic status. This suggests that low socioeconomic status may increase the risk for both cynical hostility and hypertension, they said.

The study is published in the March/April issue of Psychosomatic Medicine.

The study included data on 688 women participating in the Women's Ischemia Syndrome Evaluation study, which was sponsored by the National Heart, Lung and Blood Institute. WISE enrolled women 18 years old and older who were referred for coronary angiography to evaluate suspected myocardial ischemia, a condition in which blood flow to the heart is limited by obstructions in the coronary arteries.

"Although the cross-sectional design used here prevents us from disentangling causal directions in these relationships, our findings indicate a need for prospective trials to evaluate the effects of behavioral modification on atherosclerosis risk factors and cardiac events," they say in their paper.

This study was funded in part by the National Heart, Lung and Blood Institute and the National Center for Research Resources, as well as by grants from the Gustavus and Louis Pfeiffer Research Foundation, the Women's Guild, Cedars-Sinai Medical Center, the Ladies' Hospital Aid Society of Western Pennsylvania and QMED, Inc.

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Psychosomatic Medicine is the official bimonthly peer-reviewed journal of the American Psychosomatic Society. For information about the journal, contact Joel E. Dimsdale, MD, at (619) 543-5468.