Annals of Behavioral Medicine

, Volume 20, Issue 2, pp 47–58

Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence

  • Laura D. Kubzansky
  • Ichiro Kawachi
  • Scott T. Weiss
  • David Sparrow


The purpose of this review is to examine the epidemiological, psychological, and experimental evidence for an association between anxiety and coronary heart disease (CHD). Papers published during the years 1980–1996 on anxiety and CHD and relevant publications from earlier years were selected for this review. Epidemiologic evidence suggests that anxiety may be a risk factor for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atherogenesis (e.g. via increased risk of hypertension); and (c) triggering fatal coronary events, either through arrhythmia, plaque rupture, coronary vasospasm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, which may indicate increased risk of fatal ventricular arrhythmias. The strength, consistency, and dose-response gradient of the association between anxiety and CHD, together with the biologic plausibility of the experimental evidence, suggest that anxiety may contribute to risk of CHD and that the relationship warrants further investigation.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. (1).
    Coryell W, Noyes R, Clancy J: Excess mortality in panic disorder.Archives of General Psychiatry. 1982,39:701–703.PubMedGoogle Scholar
  2. (2).
    Coryell W, Noyes R, House JD: Mortality among outpatients with anxiety disorders.American Journal of Psychiatry. 1986,143:508–510.PubMedGoogle Scholar
  3. (3).
    Haines AP, Imeson JD, Meade TW: Phobic anxiety and ischaemic heart disease.British Medical Journal Clinical Research Ed. 1987,295(6593):297–299.PubMedGoogle Scholar
  4. (4).
    Kawachi I, Colditz GA, Ascherio A, et al: Prospective study of phobic anxiety and risk of coronary heart disease in men.Circulation. 1994,89(5):1992–1997.PubMedGoogle Scholar
  5. (5).
    Kawachi I, Sparrow D, Vokonas PS, Weiss ST: Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study.Circulation. 1994,90(5):2225–2229.PubMedGoogle Scholar
  6. (6).
    Eaker ED, Pinsky J, Castelli WP: Myocardial infarction and coronary death among women: Psychosocial predictors from a 20-year follow-up of women in the Framingham Study.American Journal of Epidemiology. 1992,135(8):854–864.PubMedGoogle Scholar
  7. (7).
    Tellegen A: Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In Tuma AH, Maser JD (eds),Anxiety and the Anxiety Disorders. Hillsdale, NJ: Erlbaum, 1985.Google Scholar
  8. (8).
    Barlow DH:Anxiety and Its Disorders. New York: The Guilford Press, 1988.Google Scholar
  9. (9).
    Regier DA, Kaelber CT: The Epidemiologic Catchment Area (ECA) Program: Studying the prevalence and incidence of psychopathology. In Tsuang MT, Tohen M, Zahner GEP (eds),Textbook in Psychiatric Epidemiology. New York: Wiley Liss, 1995, 135–155.Google Scholar
  10. (10).
    Frijda NH: Emotions are functional, most of the time. In Ekman P, Davidson RJ, (eds),The Nature of Emotion. New York: Oxford University Press, 1994, 112–122.Google Scholar
  11. (11).
    Kamarck T, Jennings JR: Biobehavioral factors in sudden cardiac death.Psychological Bulletin. 1991,109:42–75.PubMedGoogle Scholar
  12. (12).
    Scherer KR: Emotion as a process: Function, origin and regulation.Social Science Information. 1982,21(4–5):555–570.Google Scholar
  13. (13).
    Arnold MB:Emotion and Personality. New York: Columbia University Press, 1960.Google Scholar
  14. (14).
    Ellsworth PC: Some implications of cognitive appraisal theories of emotion. In Strongman KT (ed),International Review of Studies of Emotion. New York: John Wiley & Sons, LTD, 1991, 143–161.Google Scholar
  15. (15).
    Frijda NH:The Emotions. Cambridge, England: Cambridge University Press, 1986.Google Scholar
  16. (16).
    Lazarus RL (ed):Nebraska Symposium on Motivation, 1968. Emotions and Adaptation: Conceptual and Empirical Relations. Lincoln, NE: University of Nebraska Press, 1968.Google Scholar
  17. (17).
    Ellsworth PC, Smith CA: From appraisal to emotion: Differences among unpleasant feelings.Motivation and Emotion. 1988,12(3): 271–302.Google Scholar
  18. (18).
    Frijda NH: Moods, emotions episodes, and emotions. In Lewis M, Haviland JM (eds),Handbook of Emotions. New York: The Guilford Press, 1993, 381–405.Google Scholar
  19. (19).
    Lader M, Marks I:Clinical Anxiety. London: Heinemann, 1973.Google Scholar
  20. (20).
    Ohman A: Fear and anxiety as emotional phenomena: Clinical phenomenology, evolutionary perspectives, and information-processing mechanisms. In Lewis M, Haviland JM (eds),Hand-Book of Emotions. New York: The Guilford Press, 1993, 511–536.Google Scholar
  21. (21).
    Clark LA, Watson D: Distinguishing functional from dysfunctional affective responses. In Ekman P, Davidson RJ (eds),The Nature of Emotion. New York: Oxford University Press, 1994, 131–137.Google Scholar
  22. (22).
    Spielberger CD, Sarason JG:Stress and Anxiety. Washington, DC: Hemisphere, 1978.Google Scholar
  23. (23).
    Kendall PC, Butcher JN:Handbook of Research Methods in Clinical Psychiatry. New York: Wiley, 1982.Google Scholar
  24. (24).
    Kendall RE:The Role of Diagnosis in Psychiatry. Oxford: Blackwell, 1975.Google Scholar
  25. (25).
    Booth-Kewley S, Friedman HS: Psychological predictors of heart disease: A quantitative review.Psychological Bulletin. 1987,101: 343–362.PubMedGoogle Scholar
  26. (26).
    Friedman M:Pathogenesis of Coronary Artery Disease. New York: McGraw-Hill, 1969.Google Scholar
  27. (27).
    Krantz DS, Durel LA: Psychobiological substrates of the Type A behavior pattern.Health Psychology. 1983,2:393–411.Google Scholar
  28. (28).
    Dembroski TM, Weiss SM, Shields JL, Haynes S, Feinleib M:Coronary-Prone Behavior. New York: Springer-Verlag, 1978.Google Scholar
  29. (29).
    Frasure-Smith N, Lesperance F, Talajic M: Depression and 18-month prognosis after myocardial infarction [see comments].Circulation. 1995,91(4):999–1005.PubMedGoogle Scholar
  30. (30).
    Matthews KA: Coronary heart disease and Type A behaviors: Update on and alternative to the Booth-Kewley and Friedman (1987) quantitative review.Psychological Bulletin. 1988,104:373–380.PubMedGoogle Scholar
  31. (31).
    Kawachi I, Sparrow D, Spiro III A, Vokonas P, Weiss ST: A prospective study of anger and coronary heart disease. The Normative Aging Study.Circulation. 1996,94(9):2090–2095.PubMedGoogle Scholar
  32. (32).
    Clark LA: The anxiety and depressive disorders: Descriptive psychopathology and differential diagnosis. In Kendall PC, Watson D (eds),Anxiety and Depression: Distinctive and Overlapping Features. New York: Academic Press, 1989, 83–129.Google Scholar
  33. (33).
    Breier A, Charney DS, Heninger GR: Major depression in patients with agoraphobia and panic disorder.Archives of General Psychiatry. 1984,41:1129–1135.PubMedGoogle Scholar
  34. (34).
    Forrester AW, Lipsey JR, Teitelbaum ML, et al: Depression following myocardial infarction.International Journal of Psychiatry in Medicine. 1992,22:33–46.PubMedGoogle Scholar
  35. (35).
    Carney RM, Rich MW, Freedland KE, et al: Major depressive disorder predicts cardiac events in patients with coronary artery disease.Psychosomatic Medicine. 1988,50(6):627–633.PubMedGoogle Scholar
  36. (36).
    Hayward C: Psychiatric illness and cardiovascular disease risk.Epidemiologic Reviews. 1995,17:129–138.PubMedGoogle Scholar
  37. (37).
    Clark LA, Watson D: Tripartite model of anxiety and depression: Psychometric considerations and taxonomic implications.Journal of Abnormal Psychology. 1991,100:316–336.PubMedGoogle Scholar
  38. (38).
    Eriksen CW: Cognitive responses to internally cued anxiety. In Spielberger CD (ed),Anxiety and Behavior. New York: Academic Press, 1966, 327–360.Google Scholar
  39. (39).
    Noyes Jr. R, Clancy J, Hoenk PR, Slymen DJ: The prognosis of anxiety neurosis.Archives of General Psychiatry. 1980,37:173–178.PubMedGoogle Scholar
  40. (40).
    Denollet J, Sys SU, Stroobant N, et al: Personality as independent predictor of long-term mortality in patients with coronary heart disease [see comments].Lancet. 1996,347(8999):417–421.PubMedGoogle Scholar
  41. (41).
    Weissman MM, Markowitz JS, Ouellette R, Greenwald S, Kahn JP: Panic disorder and cardiovascular/cerebrovascular problems: Results from a community survey.American Journal of Psychiatry. 1990,147:1504–1508.PubMedGoogle Scholar
  42. (42).
    Talbott E, Kuller LH, Perper J, Murphy PA: Sudden unexpected death in women: Biologic and psychosocial origins.American Journal of Epidemiology. 1981,114:671–682.PubMedGoogle Scholar
  43. (43).
    Tennant CC, Langeluddecke PM: Psychological correlates of coronary heart disease.Psychological Medicine. 1985,15:581–588.PubMedGoogle Scholar
  44. (44).
    Borkovec TD, Robinson E, Pruzinsky T, Dupree J: Preliminary explanation of worry: Some characteristics and processes.Behaviour Research and Therapy. 1983,21:9–16.PubMedGoogle Scholar
  45. (45).
    Kubzansky LD, Kawachi I, Spiro III, A, et al: Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the Normative Aging Study.Circulation. 1997,95(4):818–824.PubMedGoogle Scholar
  46. (46).
    Allgulander C, Lavori PW: Excess mortality among 3,302 patients with ‘pure’ anxiety neurosis.Archive of General Psychiatry. 1991,48:599–602.Google Scholar
  47. (47).
    Wheeler EO, White PD, Reed EW, Cohen ME: Neurocirculatory asthenia (anxiety neurosis, effort syndrome, neurasthenia): A twenty-year follow-up study of one hundred and seventy-three patients.Journal of the American Medical Association. 1950,142:878–889.PubMedGoogle Scholar
  48. (48).
    Martin RL, Cloninger CR, Guze SB, Clayton PJ: Mortality in a follow-up of 500 psychiatric outpatients.Archives of General Psychiatry. 1985,42:47–54.PubMedGoogle Scholar
  49. (49).
    Wardwell WI, Bahnson CB: Behavioral variables and myocardial infarction in the Southeastern Connecticut Heart Study.Journal of Chronic Disease. 1973,26:447–461.Google Scholar
  50. (50).
    Berkson J: Limitations of the application of fourfold table analysis to hospital data.Biometrics. 1946,2:47–53.Google Scholar
  51. (51).
    Bass C, Wade C: Chest pain with normal coronary arteries: A comparative study of psychiatric and social morbidity.Psychological Medicine. 1984,14:51–61.PubMedGoogle Scholar
  52. (52).
    Thorogood M, Cowen P, Mann J, Murphy M, Vessey M: Fatal myocardial infarction and use of psychotropic drugs in young women.Lancet. 1992,340:1067–1068.PubMedGoogle Scholar
  53. (53).
    Anonymous: Psychotropic drugs and myocardial infarction: Cause for or caused by panic? (editorial).Lancet. 1992,340(8827):1069–1070.Google Scholar
  54. (54).
    Tilley S: Alcohol, other drugs and tobacco use and anxiolytic effectiveness: A comparison of anxious patients and psychiatric nurses.British Journal of Psychiatry. 1987,151:389–392.PubMedCrossRefGoogle Scholar
  55. (55).
    Taylor CB, King R, Ehlers A, et al: Treadmill exercise test and ambulatory measures in panic attacks.American Journal of Cardiology. 1987,60:48J-52J.PubMedGoogle Scholar
  56. (56).
    Pohl R, Yeragani VK, Balon R, et al: Smoking in patients with panic disorder.Psychiatry Research. 1992,43:253–262.PubMedGoogle Scholar
  57. (57).
    Breslau N, Kilbey M, Andreski P: Nicotine dependence, major depression, and anxiety in young adults.Archives of General Psychiatry. 1991,48:1069–1074.PubMedGoogle Scholar
  58. (58).
    Fisher M, Schneider M, Pegler C, et al: Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school.Journal of Adolescent Health. 1991,12:377–384.PubMedGoogle Scholar
  59. (59).
    LaPorte DJ: A fatiguing effect in obese patients during partial fasting: Increase in vulnerability to emotion-related events and anxiety.International Journal of Eating Disorders. 1990,9:345–355.Google Scholar
  60. (60).
    Schneiderman N: Psychophysiologic factors in atherogenesis and coronary artery disease.Circulation. 1987,76(1, Pt. 2):I41-I47.PubMedGoogle Scholar
  61. (61).
    Starkman MN, Cameron OG, Ness RM, Zelnik T: Peripheral catecholamine levels and symptoms of anxiety: Studies in patients with and without pheochromocytoma.Psychosomatic Medicine. 1990,52:129–142.PubMedGoogle Scholar
  62. (62).
    Sevy S, Papadimtriou GN, Surmont DW, Goldman S, Mendlewicz J: Noradrenergic function in generalized anxiety disorder, major depressive disorder, and healthy subjects.Biological Psychiatry. 1989,25:141–152.PubMedGoogle Scholar
  63. (63).
    Middleton HC: Cardiovascular dystonia in recovered panic patients.Journal of Affective Disorders. 1990,19:229–236.PubMedGoogle Scholar
  64. (64).
    Hoehn-Saric R, McLeod DR, Zimmerli WD: Psychophysiological response patterns in panic disorder.Acta Psychiatrica Scandinavica. 1991,83:4–11.PubMedGoogle Scholar
  65. (65).
    Clark DB, Taylor CB, Hayward C, et al: Motor activity and tonic heart rate in panic disorder.Psychiatry Research. 1990,32:45–53.PubMedGoogle Scholar
  66. (66).
    Dunner D: Anxiety and panic: Relationship to depression and cardiac disorders.Psychosomatics. 1985,26(11 Suppl.):18–22.PubMedGoogle Scholar
  67. (67).
    Charney DS, Heninger GR: Abnormal regulation of noradrenergic function in panic disorders: Effects of clonidine in healthy subjects and patients with agoraphobia and panic disorder.Archives of General Psychiatry. 1986,43:1042–1054.PubMedGoogle Scholar
  68. (68).
    Katon W: Panic disorder: Epidemiology, diagnosis, and treatment in primary care.Journal of Clinical Psychiatry. 1986,10(Suppl.): 21–27.Google Scholar
  69. (69).
    Wells KB, Golding JM, Burnam MA: Affective, substances use, and anxiety disorders in persons with arthritis, diabetes, heart disease, high blood pressure, or chronic lung conditions.General Hospital Psychiatry. 1989,11:320–327.PubMedGoogle Scholar
  70. (70).
    Noyes R, Clancy J, Hoenk PR, Slymen DR: Anxiety neurosis and physical illness.Comprehensive Psychiatry. 1978,19:407–413.PubMedGoogle Scholar
  71. (71).
    Jenkins CD, Sooervell PD, Hames CG: Does blood pressure rise with age? …or with stress?Journal of Human Stress. 1983,9:4–12.PubMedGoogle Scholar
  72. (72).
    Pernini C, Muller FB, Buhler FR: Suppressed aggression accelerates early development of essential hypertension.Journal of Hypertension. 1991,9:499–503.Google Scholar
  73. (73).
    Markovitz JH, Matthews KA, Wing RR, Kuller LH, Meilahn EN: Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women.Journal of Hypertension. 1991,9(5):399–406.PubMedGoogle Scholar
  74. (74).
    Markovitz JH, Matthews KA, Kannel WB, Cobb JL, D'Agostino RB: Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension? [see comments].Journal of the American Medical Association. 1993,270(20):2439–2443.PubMedGoogle Scholar
  75. (75).
    Jonas BS, Franks P, Ingram DD: Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study.Archives of Family Medicine. 1997,6:43–49.PubMedGoogle Scholar
  76. (76).
    Shedler J, Mayman M, Manis M: The illusion of mental health.American Psychologist. 1993,48(11):1117–1131.PubMedGoogle Scholar
  77. (77).
    Warrenburg S, Levine J, Schwartz GE, et al: Defensive coping and blood pressure reactivity in medical patients.Journal of Behavioral Medicine. 1989,12(5):407–424.PubMedGoogle Scholar
  78. (78).
    Sommers-Flanagan J, Greenberg RP: Psychosocial variables and hypertension: A new look at an old controversy.The Journal of Nervous and Mental Disease. 1989,177(1):15–24.PubMedGoogle Scholar
  79. (79).
    King AC, Barr Taylor C, Albright CA, Haskell WL: The relationship between repressive and defensive coping styles and blood pressure responses in healthy, middle-aged men and women.Journal of Psychosomatic Research. 1990,34(4):461–471.PubMedGoogle Scholar
  80. (80).
    Hayward C, Taylor CB, Roth WT, King R, Agras WS: Plasma lipid levels in patients with panic disorder or agoraphobia.American Journal of Psychiatry. 1989,146:917–919.PubMedGoogle Scholar
  81. (81).
    Bajwa WK, Asnis GM, Sanderson WC, Irfan A, van Praag HM: High cholesterol levels in patients with panic disorder.American Journal of Psychiatry. 1992,149:376–378.PubMedGoogle Scholar
  82. (82).
    Tancer ME, Stein MB, Moul DE, Uhde TW: Normal serum cholesterol in panic disorder.Biological Psychiatry. 1990,27:99–101.PubMedGoogle Scholar
  83. (83).
    Niaura R, Stoney CM, Herbert PN: Lipids in psychological research: The last decade.Biological Psychology. 1992,34:1–43.PubMedGoogle Scholar
  84. (84).
    Grinker RR: The psychosomatic aspects of anxiety. In Spielberger CD (ed),Anxiety and Behavior. New York: Academic Press, 1966, 131–132.Google Scholar
  85. (85).
    Lown B: Sudden cardiac death: Biobehavioral perspective.Circulation. 1987,76(1, Pt. 2):I186-I196.PubMedGoogle Scholar
  86. (86).
    Lown B, Ruberman W: The concept of precoronary care.Modern Concepts of Cardiovascular Disease. 1970,39:97–102.PubMedGoogle Scholar
  87. (87).
    Lown B, Graboys TB: Management of patients with malignant ventricular arrhythmias.American Journal of Cardiology. 1977,39(6):910–918.PubMedGoogle Scholar
  88. (88).
    Taggart P, Carruthers M, Somerville W: Electrocardiogram, plasma catecholamines, and lipids, and their modification by oxyprenolol when speaking before an audience.Lancet. 1973,2:341–346.PubMedGoogle Scholar
  89. (89).
    Taggart P, Gibbons D, Somerville W: Some effects of motor-car driving on the normal and abnormal heart.British Medical Journal. 1969,4:130–134.PubMedGoogle Scholar
  90. (90).
    Benson H, Alexander S, Feldman CL: Decreased premature ventricular contractions through use of the relaxation response in patients with stable ischemic heart disease.Lancet. 1975,1:380–382.Google Scholar
  91. (91).
    Weiss T, Engel BT: Operant conditioning of heart rate in patients with premature ventricular contractions.Psychosomatic Medicine. 1971,33:301–321.PubMedGoogle Scholar
  92. (92).
    Katz C, Martin RD, Landa B, Chadda KD: Relationship of psychologic factors to frequent symptomatic ventricular arrhythmia.American Journal of Medicine. 1985,78:589–594.PubMedGoogle Scholar
  93. (93).
    Orth-Gomer K, Edwards ME, Erhardt L, Sjogren A, Theorell T: Relation between ventricular arrhythmias and psychological profile.Acta Medica Scandinavica. 1980,207:31–36.PubMedGoogle Scholar
  94. (94).
    Freeman AM, Cohen-Cole S, Fleece L, Waldo A, Folks DG: Psychiatric symptoms, Type A behavior and arrhythmias following coronary bypass.Psychosomatics. 1984,25:586–589.PubMedGoogle Scholar
  95. (95).
    Follick MJ, Ahern DK, Gorkin L, et al: Relation of psychosocial and stress reactivity variables to ventricular arrhythmias in the Cardiac Arrhythmia Pilot Study (CAPS).American Journal of Cardiology. 1990,66:63–67.PubMedGoogle Scholar
  96. (96).
    Follick MJ, Gorkin L, Capone RJ, et al: Psychological distress as a predictor of ventricular arrhythmias in a post-myocardial infarct population.American Heart Journal. 1988,116:32–36.PubMedGoogle Scholar
  97. (97).
    Yeragani VK, Pohl R, Berger R, et al: Decreased heart rate variability in panic disorder patients: A study of power-spectral analysis of heart rate.Psychiatry Research. 1993,46:89–103.PubMedGoogle Scholar
  98. (98).
    Stein MB, Tancer ME, Uhde TW: Heart rate and plasma norepinephrine responsivity to orthostatic challenge in anxiety disorders. Comparison of patients with panic disorder and social phobia and normal control subjects.Archives of General Psychiatry. 1992,49:311–317.PubMedGoogle Scholar
  99. (99).
    van Ravenswaaij-Arts CMA, Kollee LAA, Hopman JCW, Stoelinga GBA, van Geijn HP: Heart rate variability.Annals of Internal Medicine. 1993,118:436–447.PubMedGoogle Scholar
  100. (100).
    Lown B, Verrier RL: Neural activity and ventricular fibrillation.New England Journal of Medicine. 1976,294(21):1165–1170.PubMedGoogle Scholar
  101. (101).
    Billman GE, Schwartz PJ, Stone HL: Baroreceptor reflex control of heart rate: A predictor of sudden cardiac death.Circulation. 1982,66:874–880.PubMedGoogle Scholar
  102. (102).
    Wharton JM, Coleman RE, Strauss HC: The role of the autonomic nervous system in sudden cardiac death.Trends in Cardiovascular Medicine. 1992,2:65–71.Google Scholar
  103. (103).
    Schwartz PJ, La Rovere MT, Vanoli E: Autonomic nervous system and sudden cardiac death. Experimental basis and clinical observations for post-myocardial infarction risk stratification.Circulation. 1992,85(Suppl. I):177–191.Google Scholar
  104. (104).
    Martin GJ, Magid NM, Myers G, et al: Heart rate variability and sudden death secondary to coronary artery disease during ambulatory electrocardiographic monitoring.American Journal of Cardiology. 1987,60(1):86–89.PubMedGoogle Scholar
  105. (105).
    Kleiger RE, Miller JP, Bigger Jr. JT, Moss AJ: Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.American Journal of Cardiology. 1987,59(4):256–262.PubMedGoogle Scholar
  106. (106).
    Huikuri HV, Linnaluoto MK, Seppanen T, et al: Circadian rhythm of heart rate variability in survivors of cardiac arrest.American Journal of Cardiology. 1992,70:610–615.PubMedGoogle Scholar
  107. (107).
    Bigger Jr. JT, Fleiss JL, Steinman RC, et al: Frequency domain measures of heart period variability and mortality after myocardial infarction.Circulation 1992,85(1):164–171.PubMedGoogle Scholar
  108. (108).
    Molgaard H, Sorensen KE, Bjerregaard P: Attenuated 24-h heart rate variability in apparently healthy subjects, subsequently suffering sudden cardiac death.Clinical Autonomic Research. 1991,1:223–233.Google Scholar
  109. (109).
    Fei L, Anderson MH, Katritsis D, et al: Decreased heart rate variability in survivors of sudden cardiac death not associated with coronary artery disease.British Heart Journal. 1994,71:16–21.PubMedGoogle Scholar
  110. (110).
    Miyawaki E, Salzman C: Autonomic nervous system tests in psychiatry: Implications and potential uses of heart rate variability.Integrative Psychiatry. 1991,7:21–28.Google Scholar
  111. (111).
    Friedman BH, Thayer JF, Borkovec TD, et al: Autonomic characteristics of nonclinical panic and blood phobia.Biological Psychiatry. 1993,34:298–310.PubMedGoogle Scholar
  112. (112).
    Carney RM, Rich MW, Tevelde A, et al: The relationship between heart rate, heart rate variability, and depression in patients with coronary artery disease.Journal of Psychosomatic Research. 1988,32:159–164.PubMedGoogle Scholar
  113. (113).
    Garcia CC, Kagan J, Reznick JS: Behavioral inhibition in young children.Child Development. 1984,55:1005–1019.Google Scholar
  114. (114).
    Kagan J, Reznick JS, Snidman N: Biological bases of childhood shyness.Science. 1988,240:167–171.PubMedGoogle Scholar
  115. (115).
    Kagan J, Reznick JS, Gibbons J: Inhibited and uninhibited types of children.Child Development. 1989,60:838–845.PubMedGoogle Scholar
  116. (116).
    Yeragani VK, Balon R, Pohl R, et al: Decreased R-R variance in panic disorder patients.Acta Psychiatrica Scandinavica. 1990,81:554–559.PubMedGoogle Scholar
  117. (117).
    Kawachi I, Sparrow D, Vokonas PS, Weiss ST: Decreased heart rate variability in men with phobic anxiety (data from the Normative Aging Study).American Journal of Cardiology. 1995,75,(14):882–885.PubMedGoogle Scholar
  118. (118).
    Offerhaus RE: Heart rate variability in psychiatry. In Kitney RJ, Rompelman O (eds),The Study of Heart Rate Variability, Oxford, England: Oxford University Press, 1980:225–238.Google Scholar
  119. (119).
    Pagani M, Mazzuero G, Ferrari A, et al: Symphathovagal interaction during mental stress: A study using spectral analysis of heart rate variability in healthy control subjects and patients with a prior myocardial infarction.Circulation. 1991,83(Suppl. II):II-42–II-51.Google Scholar
  120. (120).
    Fuller BF: The effects of stress-anxiety and coping styles on heart-rate variability.International Journal of Psychophysiology. 1992,12:81–86.PubMedGoogle Scholar
  121. (121).
    Rasmussen K, Ravnsbaek J, Funch-Jenson P, Bagger JP: Oesophageal spasm in patients with coronary artery spasm.Lancet. 1986,1(8474):174–176.PubMedGoogle Scholar
  122. (122).
    Davies, MJ, Thomas A: Thrombosis and acute coronary artery lesions in sudden cardiac ischemic death.New England Journal of Medicine. 1984,310:1137–1140.PubMedGoogle Scholar
  123. (123).
    Falk E: Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi.British Heart Journal. 1983,50:127–134.PubMedGoogle Scholar
  124. (124).
    Gorlin R, Fuster V, Ambrose JA: Anatomic-physiologic links between acute coronary syndromes.Circulation. 1986,74:6–9.PubMedGoogle Scholar
  125. (125).
    Mittleman MA, Maclure M, Sherwood JB, et al: Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators [see comments].Circulation. 1995,92(7):1720–1725.PubMedGoogle Scholar
  126. (126).
    Gelernt MD, Hochman JS: Acute myocardial infarction triggered by emotional stress.American Journal of Cardiology. 1992,69:1512–1513.PubMedGoogle Scholar
  127. (127).
    Tofler GH, Stone PH, Maclure M, et al: Analysis of possible triggers of acute myocardial infarction (the MILIS Study).American Journal of Cardiology. 1990,66: 22–27.PubMedGoogle Scholar
  128. (128).
    Reich P, DeSilva RA, Lown B, Murawski BJ Acute psychological disturbance preceding life-threatening ventricular arrhythmias.Journal of the American Medical Association. 1981246:233–235.PubMedGoogle Scholar
  129. (129).
    Levine SP, Towell BL, Suarez AM, et al: Platelet activation and secretion associated with emotional stress.Circulation. 1985,71:1129–1134.PubMedGoogle Scholar
  130. (130).
    Fleischman AI, Bierenbaum ML, Stier A: Effect of stress due to anticipated minor surgery upon in vivo platelet aggregation in humans.Journal of Human Stress. 1976,2:33–37.PubMedGoogle Scholar
  131. (131).
    Gordon JL, Bowyer DE, Evans CW, Mitchinson MJ: Human platelet reactivity during stressful diagnostic procedures.Journal of Clinical Pathology. 1973,26:958–962.PubMedGoogle Scholar
  132. (132).
    Haft JI, Arkel YS: Effect of emotional stress on platelet aggregation in humans.Chest. 1976,70:501–505.PubMedGoogle Scholar
  133. (133).
    Mest HJ, Zehl U, Sziegoleit W, Taube C, Forster W: Influence of mental stress on plasma level of prostaglandins, thromboxane B, and on circulating platelet aggregates in man.Prostaglandins. Leukotrienes and Medicine. 1982,8:553–563.Google Scholar
  134. (134).
    Neiss R: Reconceptualizing arousal: Psychobiological states in motor performance.Psychological Bulletin. 1988,103(3):345–366.PubMedGoogle Scholar
  135. (135).
    Leventhal H, Patrick-Miller L: Emotion and illness: The mind is in the body. In Lewis M, Haviland JM (eds),Handbook of Emotions New York: The Guilford Press, 1993, 365–380.Google Scholar
  136. (136).
    Myerburg RJ, Kessler KM, Castellanos A: Sudden cardiac death: Epidemiology, transient risk, and intervention assessment [see comments].Annals of Internal Medicine. 1993,119(12):1187–1197.PubMedGoogle Scholar
  137. (137).
    Marmot M, Winkelstein Jr. W: Epidemiologic observations on intervention trials for prevention of coronary heart disease.American Journal of Epidemiology. 1975,101(3):177–181.PubMedGoogle Scholar
  138. (138).
    Anderson NB, Armstead CA: Toward understanding the association of socioeconomic status and health: A new challenge for the biopsychosocial approach.Psychosomatic Medicine. 1995,57:213–225.PubMedGoogle Scholar
  139. (139).
    Pincus T, Callahan LF: What explains the association between socioeconomic status and health: Primarily access or medical care or mind-body variables?Advances: The Journal of Mind-Body Health. 1995,11:4–36.Google Scholar
  140. (140).
    Kemper TD: Sociological models in the explanation of emotions. In Lewis M, Haviland JM (eds),Handbook of Emotions. New York: The Guilford Press, 1993, 41–52.Google Scholar

Copyright information

© The Society of Behavioral Medicine 1998

Authors and Affiliations

  • Laura D. Kubzansky
    • 1
  • Ichiro Kawachi
    • 1
  • Scott T. Weiss
    • 2
  • David Sparrow
  1. 1.Department of Health and Social BehaviorHarvard School of Public HealthBoston
  2. 2.Channing LaboratoryBrigham Women's Hospital Beth Israel Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations