The clinical impact of negative psychological states: Expanding the spectrum of risk for coronary artery disease

Objectives: Research has demonstrated a gradient relationship between depression and the risk of adverse cardiovascular events among both initially healthy individuals and those with known cardiac disease. Moreover, recent investigators have demonstrated that adverse outcomes are even associated with the presence of relatively mild symptoms, as measured by self-report scales like the Beck Depression Inventory. The association between even mild depressive symptoms and sequelae of cardiac disease raises the following question: Is the spectrum of psychological factors associated with cardiac disease greater than previously recognized? Methods: To address this issue, we consider a small but emerging literature that has focused on effects of other negative psychologic states on cardiovascular health. Results: Five negative states that have been linked in varying degrees to cardiovascular disease or disturbances are identified, including hopelessness, pessimism, rumination, anxiety, and anger. Considering a broader spectrum of risk may help to understand more fully the mechanisms by which depression and other negative affective states influence coronary heart disease risk.