Cardiovascular disorders and depression with irritability anger and hostility

An increased prevalence of depression has been reported in patients suffering fromseveral cardiac disorders. A large body of the literature supports the conclusion thatdepression is a risk factor for the development or aggravation of a cardiac disease.Similarly to depression, irritability/anger/hostility have also been associated with variouscardiovascular conditions, including Coronary Heart Disease (CHD), hypertension,cardiac arrhythmias, cardiovascular risk factors, and cardiovascular mortality.Intriguingly, there is a high comorbidity between depression andirritability/anger/hostility. Actually, some studies have recently suggested that thepresence of irritability/anger/hostility may define a special subtype of major depressivedisorder with increased cardiovascular morbidity. In this chapter, we describe the studiesthat have addressed the association between depression with irritability/anger/hostilityand cardiovascular conditions, particularly the cardiovascular risk factors. These studiessupport several related findings: 1) an association between major depressive disorder(MDD) with irritability and vascular disease; 2) an increased severity of subcorticalwhite matter lesions in MDD with anger attacks; and 3) an association of anger attacks inMDD patients who are also smokers (with smoking history >11 years) and have hightotal serum cholesterol (≥200mg/dL). Patients with MDD and cardiac disease were alsoreported to have increased sympathetic arousal and insomnia. Other studies howeversupport the finding that patients with high depressive tendencies and lack of anger orhostility would represent an extremely severe form of exhaustion, also associated with anincreased cardiovascular morbidity; suggesting that the relationship between depression with irritability/anger/hostility and cardiovascular disease is rather complex. Inconclusion, the current literature reviewed here suggests the clinical subtype ofdepression accompanied by irritability/anger/hostility may be associated with high ratesof cardiovascular disease and cardiac risk factors. Some studies suggest that vascularchanges in the brain may be more characteristic for this depressive subtype and mayrepresent the biological link explaining the association with cardiac disease. Establishingthis clinical and biological subtype of depression could have significant clinical impact,allowing clinicians to define a population at risk which may need increased clinicalattention, both from cardiologists and from psychiatrists.