Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: A prospective study in the normative aging study
Abstract
Background Anger, anxiety, and depression have each been identified as risk factors for coronary heart disease (CHD). Whether the apparent risk is a function of unique aspects of each emotion or due to a shared underlying dimension of negative affectivity is unclear. Purpose The goal of this study was to assess shared and unique contributions of anger, anxiety, and depression to incident CHD. Methods Data are from the Veterans Administration Normative Aging Study, an ongoing cohort of older men. Measures of anger, anxiety, and depression were obtained from 1,306 men completing the revised Minnesota Multiphasic Personality Inventory in 1986. From these measures we derived three near-orthogonal scales termed iso(lated)-anger, iso-anxiety, and iso-depression and a fourth scale measuring general distress. Results During an average of 10.9 years of follow-up, 161 cases of incident CHD occurred. When considered individually, iso-anxiety, iso-anger, and shared general distress were each associated with CHD risk. When all emotions were considered simultaneously, only iso-anxiety and shared general distress were associated with incident CHD. Conclusions Considering shared versus unique aspects of negative emotions may clarify the nature of their apparent toxicity in relation to CHD risk. General distress shared across negative emotions is an important component in the emotion-CHD relation. Aspects of anxiety may also independently increase CHD risk.
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Specific emotional experiences have distinct neurobiological and behavioral features and uniquely contribute to CVD risk.
“However, specific emotional experiences have distinct neurobiological and behavioral features, and they uniquely contribute to CVD risk. 10-13”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [10]
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“Some studies suggest that the existence of a possible “psychoneuroimmune link” between negative affectivity (depression, anger and anxiety [6], poor subjective wellbeing [7]), inflammatory markers, and the development and progression of CHD [2].”
BackgroundTully, P. J., Baker, R. A., Turnbull, D. A., Winefield, H. R., & Knight, J. L. (2009) · Journal of Behavioral Medicine · doi:10.1007/s10865-009-9225-4 · Cited by 61 · see citing works
“Despite sharing substantial conceptual and symptom overlap with depression, the role of anxiety in CAD has been researched less extensively though recent studies support an association to outcomes such as HRQOL among others (Hemingway and Marmot 1999 ;H o¨fer et al. 2005; Kubzansky et al. 2006; Rothenbacher et al. 200…”
ResultBoyle, S. H., Michalek, J. E., & Suarez, E. C. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000240779.55022.ff · Cited by 58 · see citing works
Calkins, S. D., Dollar, J. M., & Wideman, L. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000415 · Cited by 59 · see citing works
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Multimorbidity: Implications and directions for health psychology and behavioral medicine.
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“Management strategies in patients with comorbid mood disorders and CHD are problematic [9], partly because of the overlap of symptoms of depression and anxiety with the symptomatology of long-term heart conditions [10].”
BackgroundHoogwegt, M., Versteeg, H., Hansen, T., Thygesen, L., Pedersen, S., & Zwisler, A. (2013) · Circulation. Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.113.000158 · Cited by 46 · see citing works
“…negative affect component shared across different negative emotions has been shown to independently predict disease pathology in cardiac patients, 48 we decided to include a broad measure of negative affect instead of the more narrow representations of negative affect, such as anxiety and…”
BackgroundNefs, G., Pouwer, F., Pop, V. J. M., & Denollet, J. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.01.006 · Cited by 50 · see citing works
Death anxiety in patients with myocardial infarction or cancer
Şahan, E., Eroğlu, M. Z., Karataş, M. B., Mutluer, B. T., Uğurpala, C., & Berkol, T. D. (2018) · The Egyptian Heart Journal · doi:10.1016/j.ehj.2018.04.003 · Cited by 48 · see citing works
“While higher levels of anxiety predict for a heart attack according to literature, heart attack itself seems to be a predictor for higher levels of anxiety.(20,21) In our study state anxiety, trait anxiety and death anxiety were higher among patients who lived heart attack and state anxiety was associated with death a…”
BackgroundHakulinen, C., Jokela, M., Hintsanen, M., Merjonen, P., Pulkki-Råback, L., Seppälä, I., Lyytikäinen, L.-P., Lehtimäki, T., Kähönen, M., Viikari, J., et al. (2013) · Journal of Behavioral Medicine · doi:10.1007/s10865-012-9452-y · Cited by 47 · see citing works
“Both hostility (Barefoot et al., 1983; Everson et al., 1997; Koskenvuo et al., 1988) and anger (Gallacher et al., 1999; Kubzansky et al., 2006; Williams et al., 2001) have been repeatedly associated with coronary heart disease (CHD) risk and there is some evidence for an association of…”
BackgroundComorbidity in Anxiety Disorders
Merikangas, K. R., & Swanson, S. A. (2009) · Current topics in behavioral neurosciences · doi:10.1007/7854_2009_32 · Cited by 47 · see citing works
“There is substantial evidence supporting an association between cardiovascular diseases and anxiety disorders (Harter et al. 2003; Bonnet et al. 2005; Ballenger et al. 2001; Hansen 2003; Kubzansky et al. 2006).”
BackgroundAnxiety Disorders and Comorbid Medical Illness
Roy‐Byrne, P., Davidson, K. W., Kessler, R. C., Asmundson, G. J. G., Goodwin, R. D., Kubzansky, L. D., Lydiard, R. B., Massie, M. J., Katon, W. J., Laden, S. K., et al. (2008) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.6.4.foc467 · Cited by 47 · see citing works
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“Additional limitations of existing literature include sampling issues and substantial overlap between personality and other psychiatric risk factors for CHD, particularly depression ( Kubzansky, Cole, Kawachi, Vokonas, & Sparrow, 2006 ).”
BackgroundTurner, A., Phillips, L., Hambridge, J. A., Baker, A., Bowman, J., & Colyvas, K. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048671003646751 · Cited by 43 · see citing works
A healthy mix of emotions: underlying biological pathways linking emotions to physical health
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“Length of hospital stay (days) 6 [4-12]* 7 [4-13]* 6 [4-12]* 0.”
Herbst, S., Pietrzak, R. H., Wagner, J. A., White, W. B., & Petry, N. M. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181574977 · Cited by 41 · see citing works
“In contrast, the anxiety disorders assessed in this study were not significantly associated with CHD in multivariate analyses, although other studies suggested a possible role of anxiety in the development of CHD (32).”
ResultCompare, A., Mommersteeg, P. M. C., Faletra, F. F., et al. (2014) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e328365cd8c · Cited by 40 · see citing works
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“Caucasian 265 (85) 102 (82) 82 (68) 48 (74)”
Positive affect and medication adherence in chronic conditions: A systematic review.
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Janowski, K., Kurpas, D., Kusz, J., Mroczek, B., & Jedynak, T. (2013) · Stress and Health · doi:10.1002/smi.2493 · Cited by 40 · see citing works
Association between anxiety and C-reactive protein levels in stable coronary heart disease patients
Bankier, B., Barajas, J., Martinez-Rumayor, A., & Januzzi, J. L. (2009) · Psychosomatics · doi:10.1176/appi.psy.50.4.347 · Cited by 37 · see citing works
An Integrated Approach to the Diagnosis and Treatment of Anxiety Within the Practice of Cardiology
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McCambridge, S. A., & Consedine, N. S. (2014) · Emotion · doi:10.1037/a0035209 · Cited by 37 · see citing works
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Schöllgen, I., Huxhold, O., & Schmiedek, F. (2011) · Psychology and Aging · doi:10.1037/a0026115 · Cited by 34 · see citing works
Timmermans, I., Versteeg, H., Duijndam, S., Graafmans, C., Polak, P. E., & Denollet, J. (2017) · Journal of Health Psychology · doi:10.1177/1359105317709513 · Cited by 34 · see citing works
“depression, anxiety) is of great importance, since emotional distress is known to be associated with adverse cardiovascular outcomes (Frasure-Smith and Lespérance, 2008; Kubzansky et al., 2006; Roest et al., 2010).”
BackgroundHabitual total water intake and dimensions of mood in healthy young women
Muñoz, C. X., Johnson, E. C., McKenzie, A. L., Guelinckx, I., Graverholt, G., Casa, D. J., Maresh, C. M., & Armstrong, L. E. (2015) · Appetite · doi:10.1016/j.appet.2015.05.002 · Cited by 34 · see citing works
Sick at heart: the pathophysiology of negative emotions.
Kubzansky, L. D. (2007) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.74.suppl_1.s67 · Cited by 34 · see citing works
“The uniqueness of these three negative emotions as risks for incident CHD was recently explored in a prospective study of a population that was disease-free at baseline and was followed for 11 years.(36) General stress, anxiety, and depression measured at study entry were each strong predictors of incident CHD over th…”
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“For example, depression and anxiety are associated with a higher risk of coronary heart disease (CHD), disability, or all cause mortality [1–5].”
BackgroundPanic disorder and exercise avoidance
Muotri, R. W., & Bernik, M. A. (2014) · Revista Brasileira de Psiquiatria · doi:10.1590/1516-4446-2012-1012 · Cited by 33 · see citing works
Stewart, J. C., Hawkins, M. A. W., Khambaty, T., Perkins, A. J., & Callahan, C. M. (2016) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000315 · Cited by 32 · see citing works
Psychological distress and circulating inflammatory markers in healthy young adults
Goldman-Mellor, S. J., Brydon, L., & Steptoe, A. (2010) · Psychological Medicine · doi:10.1017/s0033291710000267 · Cited by 31 · see citing works
“Psychological distress has been linked prospectively with an increased risk for diseases such as atherosclerosis and stroke (Kubzansky et al. 2006; Steptoe, 2006 ; Irwin & Miller, 2007), a relationship particularly well established in coronary heart disease (CHD) patients (Barth et al.”
BackgroundAnxiety, Anger, and Mortality Risk Among Survivors of Myocardial Infarction
Wrenn, K. C., Mostofsky, E., Tofler, G., Muller, J., & Mittleman, M. (2013) · American Journal of Medicine · doi:10.1016/j.amjmed.2013.07.022 · Cited by 27 · see citing works
Atrial fibrillation and psychological factors: a systematic review
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“Literature shows that personality traits are highly PeerJ reviewing PDF | (2017:03:16584:1:2:NEW 29 May 2017) 246 associated with cardiovascular events [Kubzansky et al., 2006; Chida & Steptoe, 2009], and it 247 can be hypothesized that they also play a role in the development of AF.”
BackgroundCompare, A., Grossi, E., Buscema, M., Zarbo, C., Mao, X., Faletra, F. F., Pasotti, E., Moccetti, T., Mommersteeg, P. M. C., & Auricchio, A. (2013) · Cardiovascular Psychiatry and Neurology · doi:10.1155/2013/814967 · Cited by 28 · see citing works
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Puustinen, P. J., Koponen, H., Kautiainen, H., Mäntyselkä, P. T., & Vanhala, M. J. (2010) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-010-0134-x · Cited by 24 · see citing works
“The relationship between various psychological factors and cardiovascular disease (CVD) has been investigated extensively in the last few decades [14, 26, 27, 33 ].”
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Is Optimism a Protective Factor for Cardiovascular Disease?
Amonoo, H. L., Celano, C. M., Sadlonova, M., & Huffman, J. C. (2021) · Current Cardiology Reports · doi:10.1007/s11886-021-01590-4 · Cited by 22 · see citing works
Leo, D. G., Keller, S. S., & Proietti, R. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1411835 · Cited by 21 · see citing works
“Anxiety has been proposed as a possible independent risk factor for the onset of CVD (Suls, 2018; Karlsen et al., 2021).”
BackgroundEffects of Medical Comorbidity on Anxiety Treatment Outcomes in Primary Care
Campbell‐Sills, L., Stein, M. B., Sherbourne, C. D., Craske, M. G., Sullivan, G., Golinelli, D., Lang, A. J., Chavira, D. A., Bystritsky, A., Rose, R. D., et al. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31829def54 · Cited by 21 · see citing works
Emotional Intelligence and Coronary Heart Disease: How Close Is the Link?
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It Pays to Forgive! Aging, Forgiveness, Hostility, and Health
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“A more recent US survey of adult men (N = 1,457), which also used the CMHS, found that hostility was inversely related to age (Kubzansky et al. 2006).”
BackgroundGender Differences in Patients with Anxiety after Coronary Artery Bypass Surgery
Güzelhan, Y., Conkbayır, C., Uğurlucan, M., Yıldız, C. E., Alpagut, U., & Bozbuğa, N. (2018) · The Heart Surgery Forum · doi:10.1532/hsf.1451 · Cited by 20 · see citing works
Gender-specific association of psychological distress with cardiovascular risk scores
Puustinen, P. J., Koponen, H., Kautiainen, H., Mäntyselkä, P. T., & Vanhala, M. J. (2010) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813431003648131 · Cited by 20 · see citing works
- Authors
- Kubzansky, L. D., Cole, S. R., Kawachi, I., Vokonas, P., & Sparrow, D.
- Affiliations
- Harvard University (US)
- United States Department of Veterans Affairs (US)
- Johns Hopkins University (US)
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-02
- Volume
- 31
- Issue
- 1
- Pages
- 21-29
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- OpenAlex
- W1984742880
- Semantic Scholar
- 8775b99815c14e852ed051a5c0fb4eeda78d621d
- Cited by
- 203
- References
- 35
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 13 · 2020: 7 · 2019: 8 · 2018: 12 · 2017: 11 · 2016: 14 · 2015: 13 · 2014: 12 · 2013: 15 · 2012: 11
- FWCI
- 8.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (U01 AI42590, U01AI042590, U01AI035043, U01 AI-35043)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- coronary artery disease, anger, anxiety, depression, negative affectivity, general distress, incident cardiovascular events, older men
- MeSH terms
- Adult, Affect, Aged, Aged, 80 and over, Aging, Anger, Anxiety, Coronary Disease, Depression, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors
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