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Psychological factors associated with coronary heart disease

  • Andrej Marusic (a1)


Objectives: Psychological coronary-proncncss is most probably one of the first recognised risk factors for coronary heart disease (CHD). The mechanisms by which psychological risk factors might exert their influence on the cardiovascular system arc less clear than those for the more standard biological risk factors. The aim of this review was to classify all possible mechanisms of potentiation of CHD by psychological factors.

Method: A MEDLINE search was conducted by selecting literature on both standard biological risk factors (eg. dyslipidaemia, hypertension, smoking) and psychological risk factors (eg. personality traits, behavioural characteristics, coping with stress) for CHD.

Results: It was suggested that six biological mechanisms could mediate psychological influences specifically for CHD, of course, together with the seventh mechanism of general alterations in health-related behaviours. These are: increased oxygen demand of the heart muscle, decreased blood supply to the heart muscle, increased concentration of blood, enhanced blood clotting, increase in cholesterol and other plasma lipids, disturbances of blood sugar level, and alterations in health-related behaviours.

Conclusions: If more studies of CHD were conducted with both physical and psychological risk factors simultaneously, it would be possible to investigate which of the above suggested mechanisms are important, which could in turn substantially improve both primary and secondary preventive measures.



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1.Williams, RB Jr.Neurocardiology. Kalamazoo, Michigan: The Upjohn Company, 1989.
2.Osler, W. The Limleian lectures on angina pectoris. Lancet 1910; 1: 839–44.
3.Dunbar, F. Psychosomatic diagnosis. New York: Harper and Row, 1943.
4.Friedman, M, Rosenman, RH. Association of specific behaviour pattern with blood and cardiovascular findings. JAMA 1959; 169: 1286–96.
5.Farmer, JA, Gotto, AM Jr.Dyslipidemia and other risk factors for coronary artery disease. In: Heart disease. A textbook of cardiovascular medicine. 5th ed. Ed: Braunwald, E. Philadelphia: WB Saunders, 1997; 1126–60.
6.Marmor, M, Winkelstein, W Jr.Epidemiologic observations on intervention trials for prevention of coronary heart disease. Am J Epidemiol 1975; 101: 177–81.
7.Dembroski, TM. Czajkowski, SM. Historical and current developments in coronary-prone behaviour. In: In search of coronary-prone behaviour: Beyond Type A. Eds: Siegman, AW, Dembroski, TM. New Jersey: Hillsdale, Lawrence Erlbaum Associates Inc. Publishers, 1989; 2139.
8.MRFIT Research Group. Risk factor changes and mortality results. JAMA 1982; 248: 1465–77.
9.Kop, WJ. Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosom Med 1999; 61: 476–87.
10.Rozanski, A, Blumenrhal, JA, Kaplan, J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99: 2192–217.
11.Manuck, SB, Marsland, AL, Kaplan, JR, Williams, JK. The pathogenicity of behaviour and its neuroendocrine mediation: An example from coronary artery disease. Psychosom Med 1995; 57: 275–83.
12.Schneiderman, N. Psychophysiologic factors in atherogenesis and coronary artery disease. Circulation 1987; 76 (suppl 1): 141–7.
13.Cohen, S, Kaplan, JR, Manuck, SB. Social support and coronary heart disease: Underlying psychological and biological mechanisms. In: Social support and cardiovascular disease. Eds: Shumaker, SA, Czajkowski, SM. New York: Plenum, 1994: 195221.
14.Suis, J, Rittenhouse, JD. Models of linkages between personality and disease. In: Personality and disease. Wiley series on health psychology/behavioural medicine. Ed: Friedman, HS. New York: John Wiley & Sons, 1990: 3864.
15.Goldstein, HS, Edelberg, R, Meier, CF, Davis, L. Relationship of resting blood pressure and heart rate to experienced anger and expressed anger. Psychosom Med 1988; 50: 321–9.
16.Meredith, IT, Esler, MD. Eisenhofer, G, Jennings, GL. The effects of simple daily life stresses on cardiac sympathetic activity, myocardial oxygen consumption and hemodynamics. Circulation 1990; 82: III516.
17.Yeung, AC, Ganz, P, Selwyn, AP. Interactions between mental stress and coronary endorbehal dysfunction. Homeostasis 1993; 34: 244–51.
18.Specchia, Get al.Mental arithmetic stress testing in patients with coronary artery disease. Am Heart J 1984; 108: 5663.
19.Pickering, T, Gerin, W. Cardiovascular reactivity in the laboratory and the role of behavioural factors in hypertension: A critical review. Ann Behav Med 1990; 12: 316.
20.Henry, JP, Grim, CE. Psychosocial mechanisms of primary hypertension. J Hypertens 1990; 8: 783–93.
21.Cobb, S, Rose, RM. Hypertension, peptic ulcer and diabetes in air traffic controllers. JAMA 1973; 224: 489–92.
22.Winkleby, MA, Ragland, DR, Syme, SL. Self-reported stressors and hypertension: Evidence of an inverse association. Am J Epidemiol 1988; 127: 124–34.
23.Hayrhornthwaite, JA. Behavioural stress, sodium intake, and blood pressure. Homeostasis 1993; 34: 302–12.
24.Obrist, PA. Cardiovascular psychophysiology: A perspective. New York: Plenum Press. 1981.
25.Brody, MJ, Natelson, BH, Anderson, EAet al.Behavioural mechanisms in hypertension. Circulation 1987; 76: 195–100.
26.Fredrikson, M, Matthews, KA. Cardiovascular responses to behavioural stress and hypertension: A meta-analytic review. Ann Behav Med 1990; 12: 30–9.
27.Fredrikson, M, Tuomisto, M, Berginan-Losman, B. Neuroendocrine and cardiovascular stress reactivity in middle-aged normotensive adults with parental history of cardiovascular disease. Psychophysiology 1991; 28: 656–64.
28.Miller, SB, Friese, M, Sita, A. Parental history of hypertension, sodium loading, and cardiovascular response to stress. Psychosom Med 1995; 57: 381–9.
29.Deary, IJ, MacLullich, AM. Mardon, J. Reporting of minor physical symptoms and family incidence of hypertension and heart disease. Relationships with personality and Type A behaviour. Person Individ Diff 1991; 12: 747–51.
30.Rosenman, RH. Personality, behaviour patterns, and heart disease. In: Llandbook of stress, medicine, and health. Ed: Cooper, CL. Boca Raton, New York, London, Tokyo: CRC Press. 1996: 217–31.
31.Suis, J, Wan, CK, Costa, PT. Relationship of trait anger to resting blood-pressure – a metaanalysis. Health Psychol 1995; 14: 444–56.
32.Irvine, MJ, Garner, DM, Olmstead, MP, Logan, AG. Personality differences between hypertensive and normotensive individuals: Influence of knowledge of hypertension status. Psychosom Med 1989; 51: 537–49.
33.Sloan, RP, Shapiro, PA, Bagiella, E, Myers, MM, Gorman, JM. Cardiac autonomic control buffets blood pressure variability responses to challenge: A psychophysiologic model of coronary artery disease. Psychosom Med 1999; 61: 5868.
34.Gullette, EC, Blumenthal, JA, Babyak, M. Effects of mental stress on myocardial ischemia during daily life? JAMA 1997; 277: 1521–6.
35.Legault, SE, Breisblatt, WM, Jennings, JR, Manuck, SB, Follansbee, WP. Myocardial ischaemia during mental stress tesing: Is the mechanism different from exercise-induced ischaemia? Homeostasis 1993; 34: 252–65.
36.Nabel, EG, Ganz, P, Gordon, JB, Alexander, RW, Selwyn, AP. Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressure test. Circulation 1988; 77: 4552.
37.Gordon, JBet al.Atherosclerosis influences the vasomotor response of epicardial coronary arteries to exercise. J Clin Invest 1989; 83: 1946–52.
38.Yeung, ACet al.The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991; 325: 1551–6.
39.Schoder, Het al.Effect of mental stress on myocardial blood flow and vasomorion in patients with coronary arrery disease. J Nucl Med 2000; 41: 11–6.
40.Ludmer, PLet al.Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986; 315: 1046–51.
41.Fujii, J, Imataka, K. Elevation of blood pressure and hemoconcentration induced by mental stress. Homeostasis 1993; 34: 280–8.
42.Muldoon, MF, Bachen, EA, Manuck, SB, Waldstein, SR, Bricker, PL, Bennett, JA. Acute cholesterol responses to mental stress and change in posture. Arch Int Med 1992; 152: 775–80.
43.Patterson, SM, Gottdiener, JS, Hecht, GM, Vargot, S, Krantz, DS. Effects of acute mental stress on serum lipids: Mediating effects of plasma volume. Psychosom Med 1993; 55: 525–32.
44.Hilsted, J, Christensen, NJ, Larsen, S. Effects of catecholamines and insulin on plasma volume and intravascular mass of albumin in man. Clin Sci 1989; 77: 149–55.
45.Kamarck, T, Jennings, JR. Biobehavioral factors in sudden cardiac death. Psychol Bull 1991; 96: 435–64.
46.Cannon, WB. Bodily changes in pain, hunger, fear, and rage. Boston: Branford, 1929.
47.Patterson, SM, Kranrz, DS. Effects of psychological and physical stress on platelet function. Homeostasis 1993; 34: 271–9.
48.Hultin, MB. Fibrinogen and facror VII as risk factors in vascular disease. Prog Hemost Thromb 1991; 10: 215–41.
49.Siegrisr, J, Perer, R, Cremer, P, Seidel, D. Chronic work stress is associated with atherogenic lipids and elevared fibrinogen in middle-aged men. J Int Med 1997; 242: 149–56.
50.Grignani, Get al.Platelet activation by emotional stress in patients with coronary arrery disease. Circulation 1991; 83 (suppl II): II128–36.
51.Markovitz, JH, Matthews, KA. Platelets and coronary heart disease: Potential psychophysiologic mechanisms. Psychosom Med 1991; 53: 643–68.
52.Stoney, CM, Matthews, KA, McDonald, RH, Johnson, CA. Sex differences in lipid, lipoprotein, cardiovascular, and neuroendocrine responses to acute stress. Psychophysiology 1988; 25: 645–56.
53.McCann, BS, Magee, MS, Broyles, FC, Vaughan, M, Albers, JJ, Knopp, RH. Acute psychological stress and epinephrine infusion in normolipidemic and hyperlipidemic men: Effects on plasma lipid and apoprotein concentrations. Psychosom Med 1995; 57: 165–76.
54.Helz, JW, Templeton, B. Evidence of the role of psychosocial factors in diabetes mellitus: A review. Am J Psychiatry 1990; 147: 1275–82.
55.Kemmer, FW, Bisping, R, Steingruber, HJet al. Psychological stress and metabolic control in patients with type I diabetes mellitus. N Engl J Med 1986; 314: 1078–84.
56.Tattersall, R, Gregory, R, Selby, C, Kerr, D, Heller, S. Course of brittle diabetes: 12 year follow up. Br Med J 1991; 302: 1240–3.
57.Deary, IJ, Frier, BM. Personality, stress, and diabetes. In: Stress and emotion: Anxiety, anger, and curiosity. Vol. 15. Eds: Spielberger, CDet al.Washington, DC: Taylor & Francis, 1995: 3349.
58.Alvarez, MA, Portilla, L, Gonzales, R, Ezcurra, E. Insulin response to short stress period. Psychoneuroendocrinology 1989; 14: 241–4.
59.Raikkonen, K, Keltikangas-Jarvinen, L, Hautanen, A. The role of psychological coronary risk factors in insulin and glucose metabolism. J Psychosom Res 1994; 38: 705–13.
60.Ornish, Det al.Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990; 336: 129–33.
61.Ornish, Det al.Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001–7.
62.Wright, L, Carbonari, J, Voyles, W. A factor analytic study of physical risk variables for CHD. J Clin Psychol 1992: 48: 165–70
63.Wright, L, Murcer, S, Adams, K, Welch, S, Paris, D. The factor analytic structure of seven physical CHD risk factors: A replication study. J Clin Psychol 1994; 50: 216–9.
64.Marusic, A, Gudionsson, GH, Eysenck, HJ, Starc, R. Biological and psychosocial risk factors in ischaemic heart disease: Empirical findings and a biopsychosocial model. Person Individ Diff 1999; 26: 285304.


Psychological factors associated with coronary heart disease

  • Andrej Marusic (a1)


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