Emotional Risk Factors for Heart Disease

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Emotional Risk Factors for Heart Disease

• Jesse Stewart, Ph.D.
• 3.7.08

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Overview

• Health Psychology
• Emotional Factors and Heart Disease
• Pittsburgh Healthy Heart Project
• Future Research Plans
• Teaching Resources

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What is health psychology?
also called behavioral medicine
and medical psychology

• Branch of psychology concerned with understanding
  how psychological and social factors influence
  physical health and illness
• Emerged in the 1970s
  Became the 38th division of APA
  in 1978
• Has experienced rapid growth over the past 3
  decades

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Health Psychology Research Clinical Practice

• Research Areas
• Psychosocial risk factors for disease
• Pathways linking psychosocial factors and health
  outcomes
• Psychosocial intervention research

• Clinical Areas
• Behavioral risk factor modification
• Stress management
• Coping with chronic diseases
• Pain management
• Presurgical evaluations

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Health Psych
Psychology
Medicine
Mind-Body Interface
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Emotional Factors and Heart Disease
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Heart Disease

• Heart disease is the single leading cause of
  death in American men and women.
• Every 60 seconds an American will die from a
  coronary event.
• Heart disease occurs when the coronary arteries
  become hardened and narrowed due to the
  accumulation of plaque on the inner walls.
• Clinical manifestations of heart disease
• Angina (chest pain)
• Myocardial infarction (heart attack)
• Cardiac arrest / sudden cardiac death

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Source American Heart Association
2003 Total Cardiovascular Disease Age-Adjusted
Death Rates by State
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Traditional Risk Factors for Heart Disease

• Modifiable
• Smoking
• High LDL Cholesterol
• Low HDL Cholesterol
• Hypertension
• Diabetes
• Physical Inactivity
• Obesity

• Nonmodifiable
• Increasing Age
• Male Sex
• Family History

These factors explain only 50 of the occurrence
of heart disease.
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Emotional Risk Factors for Heart Disease

• Probable Risk Factors
• Depressive disorders
• Depressive symptoms
• Anxiety disorders
• Trait anxiety
• Hostility
• Anger

These factors may predict of heart disease above
and beyond traditional risk factors.
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Remaining Question Which negative emotions
are the most cardiotoxic?
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Cynicism Anger Aggression
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(No Transcript)
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Which negative emotions are the
most cardiotoxic?
Stewart et al. (2007). Archives of General
Psychiatry, 64, 225-233.
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The Pittsburgh Healthy Heart Project Timing
of Assessments
3.0 years
2.4 months
Negative Emotion Measures
Medical Update
Medical Screen
Subclinical Atherosclerosis
Subclinical Atherosclerosis
Participants were healthy, older adults (49
male, 84 white, mean age 61 years).
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Carotid Intima-Media Thickness (IMT)
Ultrasound scanners were used to obtain images of
the left and right carotid arteries.
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3-year Progression of Carotid IMT
Normal Carotid Artery
Wall Thickening and Plaque
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Analyses Predicting 3-year Change in IMT
1Log transformed. p lt .05. p lt .01.
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Analyses Predicting 3-year Change in IMT
1Log transformed. p lt .05. p lt .01.
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Analyses Predicting 3-year Change in IMT
p lt .05. p lt .01.
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Analyses Predicting 3-year Change in IMT
1These variables were examined in separate
models. 2Log transformed. p lt .05. p lt .01.
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Analyses Predicting 3-year Change in IMT
1Log transformed. p lt .05. p lt .01.
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Mean IMT Change


Group 3 greater than Group 1 (p lt .05). Group 2
greater than Group 1 (p .06).
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Summary of Findings

• Mild to moderate depressive symptoms were
  associated with more rapid thickening of the
  carotid arteries over 3-year period.
• Anxiety symptoms, hostility, and anger were not
  related to arterial thickening.

Take Home Message Depression may play an
important role in the early stages of heart
disease.
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What factors explain the association between
depressive symptoms and IMT progression?
Biological Pathways Traditional Risk Factors
ANS Dysfunction HPA Axis Dysregulation Enhanced
Inflammatory Processes Altered Platelet Function
Coronary Artery Disease
Negative Emotions
Behavioral Pathways Poor Health Behaviors Poor
Treatment Adherence
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Future Research
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Emotional Protective Factors for Heart Disease

• Probable Risk Factors
• Depressive disorders
• Depressive symptoms
• Anxiety disorders
• Trait anxiety
• Hostility
• Anger

• Possible Protective Factors
• Optimism
• Trait positive affect
• Trait happiness
• Emotional vitality (sense of energy,
  positive well-being and effective emotion
  regulation)

Enhancing positive emotions may help to prevent
the development of heart disease and
slow its progression.
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Other Research Questions

• Are the emotional risk factors for heart disease
  the same for men versus women? For Caucasian
  Americans versus African Americans?
• Is poor sleep quality a pathway through which
  negative emotions influence cardiovascular
  health?
• Do negative emotions experienced during
  adolescence have an effect on cardiovascular
  risk during adulthood?

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Teaching Resources
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www.uwgb.edu/gurungr/HealthPsychology.html
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Questions?
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Supplemental Slides
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Analyses Predicting 3-year Change in IMT
1Square-root transformed. p lt .05. p lt .01.
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Items of the BDI-II Subscales
Based on the results of the factor analyses
performed by Dozois, Dobson, Ahnberg (1998).
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Analyses Predicting 3-year Change in IMT
1Log transformed. p lt .05. p lt .01.
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IMT Change in Each BDI-II Group (Tertiles)
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IMT Change in Each BDI-II Group (Tertiles)

Group 3 greater than Group 1 (p lt .05).
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Conclusion

• Depression, but not anxiety and hostility/anger,
  may be involved in the early stages of CAD
  development.
• Results of this study are most consistent with
  the marker model.

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Clinical Significance of Carotid IMT

• Salonen Salonen (1993) Each 0.10 mm increase
  in CCA-IMT is associated with an 11 increase in
  3-year risk for MI.
• In the PHHP, the difference in CCA-IMT between
  participants in the upper tertile and lower
  tertile for BDI-II was 0.02 mm.
• Although the increase in MI risk associated with
  a change of this magnitude is small,
  considerable group differences would emerge over
  time.
• e.g., 11 increase in 3-year risk for MI after 15
  years