Background: Coronary heart disease is now well recognized as a psychosomatic illness. Emotional disturbance increasingly appears to have an impact on both the development of coronary artery disease over time and the precipitation of acute coronary heart disease events.
Method: This descriptive review is based on systematic literature reviews from 1980 to 2000 with an emphasis on predictive and prospective studies.
Results: The empirical evidence linking emotional disturbances such as anxiety, depression and anger to coronary heart disease is now robust. There is also increasing evidence for the underlying pathophysiology that may link emotions to coronary heart disease.
Conclusions: Emotional disorders and coronary artery disease commonly coexist. Emotional disorders often follow events of coronary heart disease. Prospective studies, however, now show that emotional disturbance is also a significant risk factor for coronary artery disease and especially in those with pre-existing disease. It is important both to diagnose emotional disorders early in coronary heart disease patients and implement effective treatments with the likelihood of reducing subsequent morbidity and mortality.