Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study)

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Abstract

Negative emotions, such as depression and anxiety, have been associated with the development of coronary heart disease (CHD). In multivariate models, negative emotions have predicted CHD outcomes, such as nonfatal myocardial infarction and CHD mortality. Few studies, however, have investigated this relation while controlling for variables associated with the metabolic syndrome or those indicative of sympathetic nervous system activity. We prospectively examined the relation between negative emotions and incident CHD in older men (mean 60.3 ± 7.9 years) participating in the Normative Aging Study (NAS). Four hundred ninety-eight men who completed the Minnesota Multiphasic Personality Inventory (MMPI) and who participated in a subsequent laboratory assessment were included in the study. All men were not on medication and free of diagnosed CHD and diabetes. Negative emotions were measured by the MMPI Welsh A scale, which is comprised of 39 items measuring symptoms of depression and anxiety. Negative emotion score, sociodemographic characteristics, health behaviors, components of the metabolic syndrome, and stress hormones were used to predict incident CHD over a 3-year follow-up period. During follow-up, 45 CHD events were observed. In unadjusted logistic regression analyses, negative emotions significantly predicted the incidence of CHD (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.01 to 1.10, p = 0.02). After adjusting for potential covariates, negative emotions continued to predict the incidence of CHD (OR 1.06, 95% CI 1.01 to 1.12, p = 0.02) A linear, dose-response relation was observed (chi-square 10.8, degree of freedom 2, p = 0.005): participants who had the highest level of negative emotions experienced the greatest incidence of CHD.

Section snippets

Participants

The NAS is a longitudinal study designed to examine biomedical and psychosocial changes involved in the normal aging process. This study involved a cohort of 2,280 men living in the greater Boston area who were between 21 and 80 years of age at enrollment (1961 to 1970). Study participants were predominantly white, high school educated, and free of any chronic medical conditions, such as cardiovascular disease, cancer, or diabetes mellitus. The NAS study timeline involved regular examinations

Sample characteristics

Sociodemographic, behavioral, and physiologic characteristics of study participants are listed in Table 1. Study participants were older men (mean age 60 ± 7.83 years), and, generally, of at least high school education. The average negative emotions score was 6.92 ± 6.78 (range 0 to 35). Approximately 88% of the sample consumed alcohol (defined as >1 drink/year) and 10.4% were active cigarette smokers. Study participants, on average, consumed 2,008 calories per day, had 551 alcoholic beverages

Discussion

The results of this study indicate that negative emotions, such as depression and anxiety, were associated with an increased risk of developing CHD in a sample of healthy, older men. Specifically, a 1 SD increase in the negative emotion score resulted in a 51% increase in the risk of developing CHD over the 3-year follow-up period. This association remained significant even while controlling for relevant covariates, including components of the metabolic syndrome (post-challenge insulin and

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The VA Normative Aging Study (NAS) is supported by the Cooperative Studies Program/ERIC, US Department of Veterans Affairs, and is a research component of the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, Massachusetts. Some of the data analyzed in this project were obtained with the support of grant HL37871 from the National Heart, Lung, and Blood Institute and grant AG02287 from the National Institute on Aging, Bethesda, Maryland. This research was also supported by grant 5K23 HL004473-02 from the National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, Maryland.

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