Depression and anger and coronary artery disease

Depression

Recent studies show an association between depression and an increased risk of coronary artery disease (CAD), although it is unclear whether depression contributes to the development of CAD or whether having CAD makes you more likely to be depressed.^{1, 2}

One study found that approximately 25% of people with acute cardiac illness also had major depression.³ Depression may also increase the risk of death from heart disease.⁴ People who are depressed may have an increased risk of developing CAD.

The exact mechanism isn't entirely understood, but it's thought that a depressed person may be more likely to smoke, be physically inactive, and have other behavioral traits that increase the risk of developing CAD. People who are depressed may be less likely to take care of themselves or seek medical attention when they have symptoms of CAD. In addition, it is possible that depression activates platelets and other blood components that can contribute to atherosclerosis. Finally, when a person is depressed, the body produces steroids and other chemicals that are linked to an increased risk of CAD.²

Treating depression is an important step in improving cardiac and overall health and quality of life. For more information, see the topic Depression.

Anger and hostility

Studies from the early 1970s first suggested that people with a "type A" personality (driven, pressured, competitive, aggressive) were at higher risk for CAD. Newer studies suggest that people who react with anger or are prone to anger are more likely to have a heart attack or other problems.⁵

The first step in overcoming frustration and anger is to recognize that you are feeling these emotions. Many people were taught as children not to express frustration and anger. If you are feeling bottled up inside and are not sure what to do about it, try:

• Talking with someone you trust. Talking may help you become more clear about what you are feeling.
• Talking out loud to yourself. You can even use a tape recorder and play back what you've recorded. This helps you hear yourself express your feelings as though you were listening to someone else.
• Writing about your feelings. It may be helpful to make a list of everything that is bothering you. You can then decide which items you can change and write down ways you can change them.
• Recognizing things you cannot change. There may be things that you can do nothing about. Simply writing them down is often helpful. Remind yourself that some things are beyond your control. Letting go of the wish that you could change them may be hard to do; you may need to remind yourself daily or many times throughout the day that these things are beyond your control.
• Making changes to help reduce your anger and frustration. For example, if your child's television programs bother you, move the television into a room where you can shut the door. Or you can wear earplugs if noises, such as the television or radio, seem louder than usual.

If you continue to have trouble overcoming your frustration and anger, or if you have had problems with anger in the past, talk about your concerns with someone you trust, such as a member of the clergy or a health professional. You may decide to join a support group or to seek counseling.

Citations

1. Ferketich AK, et al. (2000). Depression as an antecedent to heart disease among women and men in the NHANES I study. Archives of Internal Medicine, 160(9): 1261–1268.

2. Ariyo A, et al. (2000). Depressive symptoms and risks of coronary artery disease and mortality in elderly Americans. Circulation, 102(15): 1773–1779.

3. Januzzi JL, et al. (2000). The influence of anxiety and depression on outcomes of patients with coronary artery disease. Archives of Internal Medicine, 160(13): 1913–1921.

4. Penninx BWJH, et al. (2001). Depression and cardiac mortality. Archives of General Psychiatry, 58(3): 221–227.

5. Williams JE, et al. (2000). Anger proneness predicts coronary heart disease risk prospective analysis from the Atherosclerosis Risk in Communities (ARIC) study. Circulation, 101(17): 2034–2039.