Going to the heart of the matter: do negative emotions cause coronary heart disease?

Objective: Negative emotions, such as anger, anxiety, and depression, have emerged as potentially important risk factors for coronary heart disease. T he purpose of this article is to consider the nature and function of emotio ns, to review epidemiological evidence for an association between the three negative emotions and coronary heart disease (CHD), to discuss briefly the mechanisms by which emotions may be linked to CHD, and to consider this ev idence in light of theoretical insights provided by mainstream psychologica l research on emotions. Methods: We collected articles published between 19 80 and 1998 on the relationship between each negative emotion and CHD. We a lso collected review articles or chapters published during the same time pe riod that considered mechanisms by which emotions may increase CHD risk. We used a qualitative approach to review the published literature. Results: E vidence that anxiety is involved in the onset of CHD is strongest, whereas evidence for an association between anger and CHD is limited but suggestive . Although depression has consistently been linked to mortality following a myocardial infarction, evidence for its role in the onset of coronary dise ase is quite mixed. Numerous unresolved issues leave our current understand ing of the emotion-health relationship incomplete. Psychological theories o f emotion are considered to help address gaps in our knowledge. Conclusion: Growing evidence indicates that negative emotions may influence the develo pment of CHD. The focused and specific consideration of negative emotions a nd their possible role in the etiology of CHD gives insight into current kn owledge and suggests important directions for future research. (C) 2000 Els evier Science Inc. All rights reserved.