Researchers examined data on 950 people in Australia and New Zealand
with stable coronary artery disease, which happens when plaque
accumulates in the arteries supplying the heart and causes them to
harden and narrow. Also called atherosclerosis, this process can
weaken the heart muscle, cause an irregular heartbeat and lead to
About 4 percent of participants reported regularly suffering from
moderate or severe psychological distress over the first four years
of the study, and they were roughly four times more likely to die of
heart disease and almost three times more likely to die from any
cause during the next 12 years compared to people with no distress.
The heart patients who reported only occasional or mild distress,
however, didn’t appear to have an increased risk of premature death,
researchers report in the journal Heart.
“This really indicates that over the longer term it is the amount of
distress that matters,” said lead author Dr. Ralph Stewart, a
cardiologist at Auckland City Hospital and the University of
“We do not yet know whether treatments for anxiety and distress
reduce mortality, but there is enough evidence to recommend that
people should look for ways to reduce high levels of persistent
distress,” Stewart said by email.
At the start of the study, all of the participants had experienced a
heart attack or hospitalization for unstable angina, when the heart
doesn’t get enough blood flow or receive enough oxygen, in the
previous 3 to 36 months.
They completed a psychological questionnaire when they joined the
study, and again after six months and at one year, two years and
Questions to assess depression and anxiety asked, among other
things, if participants felt constantly under strain, found life a
struggle all the time, got scared or panicky for no good reason, or
thought they played a useful part in things.
Overall, 587 people, or 62 percent, were not distressed at any of
the psychological assessments. Another 255 individuals, or 27
percent, reported at least mild distress during two or more
assessments and 35 people, or about 4 percent, regularly suffered
from moderate or severe psychological distress.
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Researchers followed half of the participants for at least 12 years.
During this monitoring period, 398 people died from all causes and
199 died from cardiovascular disease.
The study wasn’t a controlled experiment designed to prove that
depression or anxiety causes premature death for people with heart
Another limitation of the study is that the psychological
assessments stopped after four years, so it’s possible the findings
might underestimate the impact of persistent distress, the authors
The psychological assessment used in the study also doesn’t do a
good job of pinpointing the exact nature of stress and is no longer
used for assessing it, Dr. Gjin Ndrepepa, a researcher with the
German Heart Center Munich at the Technical University of Munich,
writes in an accompanying editorial.
But mental distress can activate the body’s so-called flight or
fight response, the sympathetic nervous system, and boost levels of
stress hormones, Ndrepepa told Reuters Health by email. This might
contribute to elevated blood pressure, high cholesterol or diabetes
and prompt unhealthy behaviors like smoking or drinking or being
“These stress-related internal and external adverse reactions
aggravate the progression of the disease and predispose people to
poor outcomes including increased odds of death,” Ndrepepa said. “My
belief is that depressed patients with coronary heart disease,
particularly severely depressed ones, should be treated for
SOURCE: http://bit.ly/2tYpfHi and http://bit.ly/2tl15Zy Heart,
online June 26, 2017.
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