Negative Emotions and 3-Year Progression of Subclinical Atherosclerosis

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Abstract
Considerable evidence from prospective studies suggests that individual differences in the experience and expression of various negative emotions—ie, depression, anxiety, and hostility/anger—are associated with an increased risk of coronary artery disease (CAD) in initially healthy populations.1 A limitation of this literature, however, is that most investigations have examined the influence of a single negative emotion (eg, depression only) on CAD outcomes. As Suls and Bunde1(p270) recently discussed, this approach is not ideal because of the “appreciable construct and measurement overlap” that exists between these psychological factors. For instance, self-report measures of depression are highly correlated with anxiety measures (coefficients typically range from 0.45-0.75),2 and self-report measures of hostility/anger are moderately correlated with both depression and anxiety measures (coefficients usually range from 0.25-0.50).3-6 Because of this overlap, it is possible that all 3 of these negative emotions are independent risk factors, with each factor uniquely contributing to CAD development. It is also possible that 1 or more of these negative emotions are merely markers for another negative emotion that itself is a CAD risk factor (eg, hostility may predict future CAD simply by virtue of its relationship with depression). A third possibility is that these negative emotions reflect the same underlying factor (eg, negative affectivity7), and it is this common factor that is strongly associated with CAD risk and that accounts for the individual negative emotion–CAD relationships.