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The Clinical Impact of Negative Psychological States: Expanding the Spectrum of Risk for Coronary Artery Disease

From the Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts (L.D.K.); the Division of General Medicine, Columbia College of Physicians & Surgeons, and the Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY (K.W.D.); and the Division of Cardiology, St. Luke's–Roosevelt Hospital Center, and the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (A.R.).

Address correspondence and reprint requests to Laura D. Kubzansky, PhD, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115. E-mail: Lkubzans{at}hsph.harvard.edu

Objectives: Research has demonstrated a gradient relationship between depression and the risk of adverse cardiovascular events among both initially healthy individuals and those with known cardiac disease. Moreover, recent investigators have demonstrated that adverse outcomes are even associated with the presence of relatively mild symptoms, as measured by self-report scales like the Beck Depression Inventory. The association between even mild depressive symptoms and sequelae of cardiac disease raises the following question: Is the spectrum of psychological factors associated with cardiac disease greater than previously recognized?

Methods: To address this issue, we consider a small but emerging literature that has focused on effects of other negative psychologic states on cardiovascular health.

Results: Five negative states that have been linked in varying degrees to cardiovascular disease or disturbances are identified, including hopelessness, pessimism, rumination, anxiety, and anger. Considering a broader spectrum of risk may help to understand more fully the mechanisms by which depression and other negative affective states influence coronary heart disease risk.

Key Words: coronary artery disease • hopelessness • rumination • pessimism • anger • anxiety

Abbreviations: CAD = coronary artery disease; CABG = coronary artery bypass graft; MI = myocardial infarction; BDI = Beck Depression Inventory.

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