Psychological Risk Factors for Cardiac Events

There is abundant evidence that depression, anxiety, and anger increase the risk for cardiac events in patients with coronary heart disease. Denollet and Brutsaert1 are to be commended for contributing a generally well-conducted study of psychological predictors of cardiac end points to this rapidly growing literature. They have found that the combination of “negative affectivity” and social inhibition predicts cardiac events independently of established medical risk factors. Prospective studies such as theirs, in which potential confounders are adequately measured and cardiac end points carefully documented, are needed to substantiate the effects of psychological factors on medical outcomes after acute myocardial infarction (MI).Unfortunately, the authors may have gone beyond their data in asserting that they have identified a personality trait that both predicts cardiac events and explains why such disparate mood states as depression, anxiety, and anger predict cardiac events as well. It is not at all clear that they have substantiated this claim or that it is time to abandon research on depression, anxiety, and anger in favor of this personality trait.Absent from the authors’ discussion is any reference to an established theory of personality. It is by no means universally accepted among personality theorists that a single trait accounts for every negative mood state (cf Cloninger et al2 ) or that the combination of negative affectivity and social inhibition defines a persistent “distressed personality type.” In this light, it makes more sense to conclude simply that patients with coronary heart disease who are both emotionally distressed and socially inhibited …