Many experts say that one key pathway connecting emotion and atherosclerosis is inflammation, the process by which the immune system produces cells and molecules to purge outside invaders. Gregory Miller, a psychologist at the University of British Columbia, has identified inflammation as a "biological superhighway" connecting emotional stress and heart disease in a never-ending loop. In the short term, he explains, stress serves a purpose: By initiating inflammation, it mobilizes the body's immune cells to eliminate infection and heal injury. But when stress is long-lasting, the engine of inflammation can run without end. Over the long term, inflammatory molecules can "spill into the brain, where they may cause apathy, social withdrawal, fatigue, and changes in eating habits." Although the symptoms look very similar to those of depression and are being defined as such, "we're not yet sure if they're the same depression you see in a clinic staffed by psychiatrists," Miller says. Whatever it's ultimately labeled, heart patients who have these depressive symptoms and are not treated for them will see their heart disease progress faster, he adds.
The biological superhighway connecting emotion and the heart runs "two ways," Miller emphasizes. "Chronic stress and events with certain emotional themes can kick off an inflammatory process that leads people down the road to both depression and cardiovascular disease." On the other hand, inflammation can start with heart disease, which then causes stress and eventually depression, he says.
Healthy Personality: How Temperament Protects the Heart
Are you the life of the party or painfully shy? Optimistic or pessimistic? So focused on a task that sirens won't budge you—or distracted by the rustling breeze? It's only recently that we've found a connection between temperament and cardiovascular risk.
For years cardiologists pointed to one high-risk temperament: the hothead, quick to anger and fast to explode. The archetype, a TV miniseries cliche, is the jealous boyfriend or rageful boss who, faced with challenge, turns red, grips his chest, and winds up wired to monitors before the commercial break. At especially high risk is the eruptive person who has what psychologists call "trait anger"—the tendency to get mad with minimal provocation and then respond aggressively at the drop of a hat. In a wide range of studies conducted since 2000, researchers have found that trait anger can predict strokes and atherosclerosis. The angriest people face twice the risk of those with normal temperaments, and cardiovascular problems increase in tandem with the level of anger itself.
These days researchers say that more nuanced personality types may also play some role in heart function and health. Those who are optimistic and friendly, it turns out, may have healthier hearts and less chance of heart trouble than the pessimistic or shy. Harvard's Kubzansky says states like hopelessness and even the tendency to ruminate and worry are associated with heart disease.
In one telling study, Dutch researchers asked young extroverts and introverts to focus on tasks. The extroverted children were more distracted by irrelevant information and had more trouble focusing. Introverts—who inhabited a more circumscribed zone of comfort—ignored the extraneous, and their focus was superior as a result. But even though introverts were better at focusing, their cardiac rhythms showed that they were more heart-stressed when a distraction occurred.
Another recent study shows the value of being trusting. University of Michigan scientists reached that conclusion by rating people according to trust, stress, and depression, and then measuring the presence of three markers of inflammation—fibrinogen, C-reactive protein, and IL-6, all linked with narrowing of the arteries and future heart-disease risk. Higher levels of cynical distrust were associated with higher levels of all three markers, while chronic stress was linked with higher levels of IL-6 and C-reactive protein, and depression was associated with higher levels of IL-6.
If you already have heart disease, depression may put you at grave risk. Duke and University of North Carolina scientists found that congestive heart-failure patients are about 50 percent likelier to die or be hospitalized for their heart condition if they are depressed as well. Duke medical psychologist Andrew Sherwood, the study's lead investigator, says depression can be as important for heart-challenged folks as traditional risk factors like high cholesterol and hypertension. Among the explanations for the findings, says Sherwood, could be the heart's ability to react to everyday stress, or the possibility that depressed patients don't comply with medical treatments or make healthy lifestyle choices in such areas as diet and smoking.
Not everyone with heart disease can point to an emotional trigger—but when emotional factors are at the root, the triggering of a heart attack may be likelier for some. In male patients with heart attacks triggered by emotion like anger or stress, blood pressure and heart activity took longer to return to normal than in those without an emotional prelude to the event, according to Andrew Steptoe, a cardiologist at University College in London. The study shows that some people are more vulnerable to heart attacks "because of the way they respond biologically when confronted with a socially demanding situation," Steptoe says.
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