Heart and mind: are we closer to disentangling the relationship between emotions and poor prognosis in heart disease?

Abstract

This editorial refers to ‘Fear of dying and inflammation following acute coronary syndrome’, by A. Steptoe et al. doi:10.1093/eurheartj/ehr132 ‘A mental disturbance provoking pain, excessive joy, hope or anxiety extends to the heart, where it affects temper and rate’.William Harvey, English physician, 1578–1657 The idea that emotions might be tied to coronary heart disease (CHD) is not new, but a strong and cumulative body of empirical evidence is now available to support this notion. Negative emotions [e.g. depression and the distressed (Type D) personality] have been implicated in the risk of incident CHD in apparently healthy individuals, the risk of mortality in patients with established CHD, or both, while positive emotions (e.g. optimism) seem to be protective for both incident CHD and its progression.1–3 For sceptics, it might be tempting to dismiss this evidence arguing that these patients have more cardiovascular risk factors, more severe disease, or receive less than optimal treatment. However, these studies have been well controlled with statistical adjustment for traditional biomedical risk factors and indicators of disease severity, and patients have received state-of-the art treatment.4,5 In their seminal paper, Steptoe and colleagues demonstrate that one in five patients report intense distress and fear of dying at the time of admission for acute coronary syndrome (ACS), and that such emotions are linked to increased immune activation.6 The odds of high tumour necrosis factor-α (TNF-α) levels was 4.67 in patients with intense distress at the time of admission, controlling for pain intensity at the time of ACS, sociodemographic factors, medication, and clinical risk. Fear of dying was also associated …