, Volume 31, Issue 1, pp 21-29

Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: A prospective study in the normative aging study

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Background: Anger, anxiety, and depression have each been identified as risk factors for coronary heart disease (CHD). Whether the apparent risk is a function of unique aspects of each emotion or due to a shared underlying dimension of negative affectivity is unclear.Purpose: The goal of this study was to assess shared and unique contributions of anger, anxiety, and depression to incidentCHD. Methods: Data are from the Veterans Administration Normative Aging Study, an ongoing cohort of older men. Measures of anger, anxiety, and depression were obtained from 1,306 men completing the revised Minnesota Multiphasic Personality Inventory in 1986. From these measures we derived three nearorthogonal scales termed iso(lated)-anger, iso-anxiety, and iso-depression and a fourth scale measuring general distress.Results: During an average of 10.9 years of follow-up, 161 cases of incident CHD occurred. When considered individually, iso-anxiety, iso-anger, and shared general distress were each associated with CHD risk. When all emotions were considered simultaneously, only iso-anxiety and shared general distress were associated with incidentCHD. Conclusions: Considering shared versus unique aspects of negative emotions may clarify the nature of their apparent toxicity in relation toCHDsrisk. General distress shared across negative emotions is an important component in the emotionCHD relation. Aspects of anxiety may also independently increaseCHD risk.

This study was supported by a V.A. Medical Research Service Merit Review Award. The V.A. Normative Aging Study is supported by the Cooperative Studies Program/ERIC, Department of Veterans Affairs, and is a component of the Massachusetts Veterans Epidemiology Research and Information Center. Dr. Kawachi is supported by the Mac-Arthur Foundation Network on Socioeconomic Status and Health. Dr. Cole is supported by the National Institute of Allergy and Infectious Diseases via data coordinating centers: Multicenter AIDS Cohort (U01-AI-35043) and Women’s Interagency HIV (U01-AI-42590) Studies.