Heart Disease Tied to Depression, Anger

March 9, 2009 -- Depression, anger, and hostility may be red flags of heightened heart disease risk, even if you don't have heart disease right now.

That news comes from two studies published in the March 17 edition of the Journal of the American College of Cardiology.

Highlights from the studies include:

• Depression and heart disease: Sudden cardiac death may be more than twice as common among women with symptoms of major depression than women who aren't depressed. This finding comes from a study of more than 63,000 U.S. female nurses followed from 1992 to 2004. The nurses had no history of heart disease when the study started. The study also linked sudden cardiac death to antidepressant use, but it's not clear if that's related to the drugs or the depression.
• Anger/hostility and heart disease: Chronically angry or hostile adults with no history of heart disease may be 19% more likely than their peers to develop heart disease. And angry or hostile heart disease patients may be 24% more likely than other heart disease patients to have a poor prognosis. These findings came from reviewers who pooled data from 44 studies conducted in America, Europe, Asia, and Australia between 1983 and 2006.

The reports don't prove that depression, anger, or hostility caused heart disease. But the findings held regardless of other heart disease risk factors, suggesting a stubborn link among those traits.

It's a connection that doctors and patients need to take seriously and talk about, heart experts tell WebMD.

Heart Disease, Depression, Anger

"There is clearly a link between depression, anger, anxiety, stress, and outcomes in heart disease," says Philip Binkley, Wilson professor of medicine at The Ohio State University's division of cardiovascular medicine.

The new reports underscore that link, notes Redford Williams, MD, director of the Behavioral Medicine Research Center at Duke University.

"What these papers tell us is what we have all known and anybody would accept -- that being hostile and angry a lot of the time is bad for your health, being depressed is bad for your health," Williams says.

Williams tells WebMD that he "absolutely" considers chronic anger, hostility, or depression to be risk factors for heart disease, just like high blood pressure (hypertension), smoking, or high cholesterol.

Based on the new reports and previous research, "I think you pretty well have to conclude that yes indeed, these are risk factors," Williams says.

Binkley agrees.

"The biggest message that we try to get out to people is this is a risk factor and a health problem," Binkley says. "This is something we have to talk about. The worst thing is to ignore it."

Cardiologist Pamela Douglas, MD, Geller Professor of Medicine at Duke University, also sees a strong link between depression and heart disease -- but she stops short of calling depression a risk factor for heart disease. She says it's not clear which comes first, depression or heart disease. "It's sort of a chicken-or-the-egg issue," Douglas says.

All three experts agree that other heart disease risk factors often accompany depression -- and it never hurts to screen for heart hazards. And if you already know you have heart disease, you should be screened for depression, according to guidelines set in September 2008 by the American Heart Association.