Psychosocial Factors - Recognizing And Reducing Risk Factors: Heart Disease

Content provided by the Faculty of the Harvard Medical School

Psychosocial factors

The links between the heart and the mind are harder to quantify than those between the heart and the waistline, but most authorities think that psychological factors are — literally — heartfelt, and can contribute to cardiac risk. Psychological stress, anger, social isolation, and depression are often related: People who have one commonly have another. For example, significant stress can make people susceptible to depression. Evidence also suggests that such problems as stress, anger, and social isolation can increase the risk for coronary artery disease and the risk of dying after a heart attack.

Psychological stress can raise blood pressure, reduce blood flow to the heart, decrease the heart's pumping ability, trigger abnormal pumping rhythms, and activate the blood's clotting system. Some evidence suggests that stress and constant anger may increase LDL and triglyceride levels. It appears that long-term psychological stress may also activate molecules that fuel the inflammation that is at the heart of coronary artery disease.

What is not clear yet is whether improving psychosocial health and reducing stress actually reduce cardiac risk and the likelihood of having a heart attack. In part this reflects the challenge of doing research into psychological stress — which is so often accompanied by behaviors that are risky in their own right, such as smoking and overeating. It also reflects the challenge of persuading people to make changes in the way they think and behave. Still, some preliminary results are positive and indicate that attending to emotions and reducing stress may help your heart (and certainly can't hurt).

Daily life stress. Everyone knows that particular events, such as the death of a spouse or being fired from a job, are extremely stressful. Yet research indicates that less dramatic but more constant types of stress, such as taking care of a loved one, may be more harmful to your heart than major life changes. A 2003 analysis of the Nurses' Health Study, for instance, found that women who cared for a disabled spouse for at least nine hours a week were significantly more at risk of having a heart attack or dying from heart disease. (To protect yourself, see "Reduce stress.")

Depression. The relationship between depression and heart disease is a two-way street. Not only does depression appear to promote heart disease, but it can also result from a heart attack. A review of the medical literature in 2004 reported that people who are depressed are about twice as likely to develop coronary artery disease. Other studies show that people who already have heart disease are three times as likely to be depressed as other people. For as many as one in five people, depression follows a heart attack. Whether you've had a heart attack or not, if you feel depressed, tell your doctor. Depression can be treated successfully with antidepressants, psychosocial therapy, or both. Treating depression can make you feel better, and studies are under way to see whether effective treatment for depression can prevent or reverse heart problems or extend life.

Hostility and anger. You've no doubt heard that "Type A" personalities, who are hard-charging, competitive, and aggressive, are more at risk for heart disease than others. It turns out that's not entirely true. Some Type A people are happy and healthy, while others are not. As research has continued into specific elements of the Type A personality that put people at risk, one trait in particular — anger — seems to be most toxic to the heart. A 2004 review of the medical literature found that people who are angry are two to three times as likely to have a heart attack or other cardiac event as others.

Interestingly, people who have hypertension are somehow protected from this risk, at least according to one major epidemiological study. The Atherosclerosis Risk in Communities (ARIC) study asked almost 13,000 people to complete a questionnaire designed to assess how anger-prone they were and how that affected risk for heart disease. In general, the researchers found that the higher a person's chronic anger score, the greater the risk of developing coronary artery disease or having a coronary event such as a heart attack during the 72-month follow-up period. When they analyzed the data further, however, they found that people with hypertension were no more likely to experience a cardiac event if they were angry than if they were not. It may be that medications used to treat hypertension counter the physiological changes induced by anger and thus provide some protection.

Last updated:	May 03, 2007