Avoid a Broken Heart

How attitudes and emotional states affect the heart.

4 min read

Your lover is cheating on you. Your job has just been relocated to Taiwan. Your brother wants to borrow another grand. And to top it off, your cat's been scratching your antique divan. It doesn't help at this point for your doctor to tell you that hostility is bad for your heart.

That, however, has been the message of years of research. People who are chronically angry are more likely to get heart disease. Depression, too, puts you at risk for heart disease -- as well as for cancer, diabetes, and a long list of other ailments.

But along with the warnings, finally comes a little good news. Researchers reported in the Mayo Clinic Proceedings that hostile people not only are more likely to fall prey to heart disease, but also are more likely to benefit from treatment.

The research linking anger to heart problems has a long history that goes back to at least the 1960s, when California cardiologists Meyer Friedman and Ray Rosenman first coined the term "type A" to describe edgy, impatient people and showed that these people were more likely to have heart attacks.

But anger isn't the only kind of unhappiness that can harm the heart. Researchers in Norway discovered that patients with congestive heart failure who also suffered from severe depression were four times more likely to die within two years of treatment than patients who weren't depressed.

The study, published in the International Journal of Psychiatry in Medicine last November, included 119 patients suffering from congestive heart failure. Of the 20 patients who died from cardiac disease during the two-year study, 25% were depressed, compared to the 11.3% who were not depressed.

Knowing that sadness and anger are bad for your health, however, won't do much to make you feel better. That's why the report in the Mayo Clinic Proceedings comes as good news.

Researchers at the Ochsner Clinic in New Orleans studied 500 heart-attack victims. They found that 13% had high levels of hostility and unexpressed anger. All the patients underwent a standard 12-week cardiac rehabilitation program, including nutrition counseling, exercise training, and occasional psychosocial counseling.

At the end of the 12 weeks, the hostile patients showed more improvement in exercise capacity, body-fat reduction, total cholesterol levels, and HDL ("good") cholesterol levels than the "low-hostility" patients. They also reported lower levels of hostility, anxiety, and depression, and had fewer complaints of general physical discomfort.

"Higher-risk patients generally benefit more from most therapies," says Carl J. Lavie, M.D., the cardiologist who led the study and the co-director of cardiac rehabilitation and prevention at the Oschner Clinic. "But we were surprised that the more hostile patients had such marked benefits from the program."

There are lessons here not only for people who have suffered heart attacks but for others who might be headed in that direction, says Joshua Smyth, Ph.D., a psychologist at North Dakota State University in Fargo who studies how stress affects disease.

"We all know about the three biggies that are essential to mental and physical well-being, but they bear repeating," he says.

First, exercise regularly. Whether you walk, swim, ride a stationary bike, or take step aerobics, a consistent exercise program not only strengthens your body but also reduces your stress.

Second, foster nurturing relationships. Strong relationships with family and friends are essential to mental and physical health.

Finally, minimize stress. Some people find psychotherapy helps them express emotions, such as hostility, that can lead to health problems. Others reduce stress with exercises like yoga or biofeedback.

Such practices will likely benefit more than your heart, too. People who maintain a positive attitude when faced with stressful situations have stronger immune systems than their pessimistic peers, according to researchers at the University of California at Los Angeles.

After studying 50 students during their first semester of law school -- a notoriously angst-ridden time -- the UCLA researchers discovered that the "situational optimists," the students who were confident that they would do well in school, had more T cells and natural-killer cell activity than the so-called situational pessimists.

These cells are crucial to fighting off infection, says Shelley E. Taylor, a psychology professor at UCLA and a coauthor of the study that was published in the Journal of Personal and Social Psychology in 1998. "Bugs just don't hang around optimists as much as they do pessimists."

Coping with Stress

The Mind/Body Medical Institute