Mental Stress and the Cardiovascular System Part IV. Chronic Mental Stress and Cardiovascular Disease: Depression and Anxiety

In this portion of our series on mental stress and the cardiovascular system, we review the roles that depression and anxiety play in the development, progression, and outcome of coronary artery disease. Depression, in the immediate post-myocardial infarction period, is an important risk factor for subsequent unfavorable cardiac events during the 1- or 2-year period following infarction. In long-term follow-up, preliminary findings suggest that depressive symptoms identify subjects at increased risk for coronary heart disease. Epidemiologic evidence is lacking to demonstrate that patients with anxiety-related psychiatric illness have a higher prevalence of cardiovascular disease than their less anxious counterparts. Depression and anxiety, of course, warrant treatment independent of their impact on coronary artery disease. Also, aspects of these psychiatric illnesses may mimic clinical features of coronary artery disease or may develop following the clinical manifestations of coronary artery disease.