Anger Linked to Heart Disease

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Anger Linked to Heart Disease

 

Anger, Hostility, and Depression Tied to Inflammation, Heart Disease Risk

 

By Jennifer Warner

WebMD Medical News

Reviewed By Brunilda Nazario, MD on Wednesday, September 22, 2004

 

Sept. 22, 2004 -- A bad attitude may put your heart at risk, regardless

of how well you've got the other traditional heart disease risk factors

under control, according to a new study.

 

Researchers found otherwise healthy people prone to anger, hostility,

and depression have higher levels of a substance linked to narrowing of

the arteries and future heart disease risk called C-reactive protein

(CRP). This protein is released in the body in response to the

inflammation caused by stress, infection, and other threats to the

immune system.

 

Depression and anger have long been linked to a higher risk of heart

disease, but experts say this is one of the first studies to provide

proof of a possible mechanism behind the relationship.

 

Researchers say the findings show that these behavioral and

psychological factors might help account for the 50% of heart attacks

that occur among people without any of the traditional risk factors for

heart disease.

 

" These psychological behaviors do have implications in determining

health or the risk of disease that we have, " says researcher Edward

Suarez, PhD, associate professor of psychiatry and behavioral sciences

at Duke University Medical Center.

 

" This is the first study to show there is an independent association

between depression and C-reactive protein, " Suarez tells WebMD,

" regardless of their weight, blood pressure, [cholesterol] levels,

alcohol use, and exercise status. "

 

C-Reactive Protein Tied to Depression

 

In the study, published in the September issue of Psychosomatic

Medicine, 127 healthy men and women completed personality questionnaires

that assessed anger, hostility, and depressive symptoms. Blood tests

were then performed to measure CRP levels.

 

None of the participants had any history of heart disease or other risk

factors associated with heart disease and high CRP levels, such as

smoking, high blood pressure, diabetes, and obesity.

 

The study showed that healthy adults who had mild to moderate symptoms

of depression, anger, or hostility had levels of CRP, a marker of

inflammation in the blood, that were two to three times higher than

those of their calmer counterparts. And the more negative their moods,

the higher their CRP levels were.

 

Suarez says that it's the clustering of anger, hostility, and depression

that commonly occurs in the same individual that may produce the

greatest risk. For example, people with these attributes may evaluate

their surroundings in a cynically hostile way and then react with anger

to events, which is then commonly accompanied by mild to moderate

symptoms of depression.

 

Suarez explains that it may be that people prone to anger go through

life and consistently react negatively to life events. In response,

their bodies release stress hormones that eventually lead to an

elevation in CRP.

 

These CRP elevations do not fluctuate as easily as hormones and are

instead maintained for long periods of time, which may subsequently

increase the risk of narrowing of the arteries and heart disease.

 

Understanding Depression and Heart Disease

 

Researchers say the findings may be the first step in understanding the

complex relationship between psychological factors such as depression

and heart disease.

 

" It's noteworthy that people are at last looking for mechanisms to

explain the pretty well-established link between depression and heart

disease, " says Sylvia Wassertheil-Smoller, PhD, professor of

epidemiology and population health at Albert Einstein College of

Medicine of Yeshiva University in New York.

 

But she says it's still unclear, which direction the relationship flows,

whether depression increases inflammation or if inflammation is a part

of a syndrome that includes depression and other underlying processes.

 

" Nevertheless it's a biochemical link between depression and heart

disease because we know that CRP identifies people at future risk of

heart disease, " Wassertheil-Smoller tells WebMD. " It is a very

interesting link that needs to be pursued. "

 

Lawson Wulsin, MD, associate professor of psychiatry and family medicine

at the University of Cincinnati says this study adds to a growing body

of research on the interplay between the entire inflammatory process,

depression, and heart disease.

 

" Both depression and C-reactive protein are in the running as candidates

for the next major risk factor for coronary heart disease, says Wulsin.

" To show that they are linked at least in time is a step toward the

process of showing that they may be linked by cause and effect or that

they may be operating on the same pathway that later increases the risk

for heart disease. "

 

Researchers say the next step will be to conduct long-term studies to

see if the elevated CRP levels associated with depression, anger, and

hostility are associated with higher rates of heart disease over time.

 

Once the relationship between inflammation and psychological factors is

clearly established, researchers say they can begin looking at new

targets for heart disease prevention and treatment by either by

targeting the psychological symptoms or the inflammation itself.

 

SOURCES: Suarez, E. Psychosomatic Medicine, September 2004; vol 66.

Edward Suarez, associate professor of psychiatry and behavioral

sciences, Duke University Medical Center. Sylvia Wassertheil-Smoller,

PhD professor of epidemiology and population health, Albert Einstein

College of Medicine of Yeshiva University, New York. Lawson Wulsin, MD,

associate professor of psychiatry and family medicine, University of

Cincinnati.