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Psychological Factors and Cardiac Disorders

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The effects of psychological, social, and behavioral factors on cardiovascular disease have garnered considerable clinical attention and have been a primary focus of epidemiological and psychosomatic medicine research for the past 30 years. Patients with severe mental disorders have about twice the prevalence of the classic risk factors for coronary artery disease (CAD) (Birkenaes et al. 2006). Evidence from methodologically rigorous studies of a strong association between CAD and depressive disorders is especially compelling (Shapiro 2005). The prevalence of major depression in patients with CAD is much higher, especially after myocardial infarction, than in the general population. Depression not only commonly occurs alongside CAD but also negatively affects outcome in CAD. The magnitude of the effects of depression on morbidity and mortality in CAD is on a par with the effects of the recognized medical risk factors. Major depression is a significant predictor of mortality after an acute myocardial infarction, equal to the effect of predictors such as history of myocardial infarction or indexes of cardiac function (Carney et al. 2003; Frasure-Smith et al. 1993, 1995a). In an epidemiological study that followed a cohort of 3,000 individuals ages 55–85 for 4 years, major depression tripled the relative risk of cardiac mortality in those without heart disease and quadrupled it in those who did have cardiac disease (Penninx et al. 2001). Patients hospitalized for unstable angina who also had depressive symptoms were four times more likely to have myocardial infarction or die the following year than were those without depression (after adjusting for other factors) (Lesperance et al. 2000).

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Table Reference Number
TABLE 24–5. Illustrative studies supporting the effects of psychological factors on coronary artery disease

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