An Expert Working Group of the National Heart Foundation of Australia undertook a review of systematic reviews of the evidence relating to major psychosocial risk factors to assess whether there are independent associations between any of the factors and the development and progression of coronary heart disease (CHD), or the occurrence of acute cardiac events.
The expert group concluded that (i) there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and (ii) there is no strong or consistent evidence for a causal association between chronic life events, work-related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD.
The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking, dyslipidaemia and hypertension.
The identified psychosocial risk factors should be taken into account during individual CHD risk assessment and management, and have implications for public health policy and research.
- 1. Stress Working Party. Stress and cardiovascular disease: a report from the National Heart Foundation of Australia. Med J Aust 1988; 148: 510-513.
- 2. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: AGPS, 1995.
- 3. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol 1991; 44: 1271-1278.
- 4. Kuper H, Marmot M, Hemingway H. Systematic review of prospective cohort studies of psychosocial factors in the aetiology and prognosis of coronary heart disease. Semin Vasc Med 2002; 2: 267-314.
- 5. Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med 1997; 127: 380-387.
- 6. Jadad AR, McQuay HJ. Meta-analyses to evaluate analgesic interventions: a systematic qualitative review of their methodology. J Clin Epidemiol 1996; 49: 235-243.
- 7. Hill AB. The environment and disease association or causation. Proc R Soc Med 1965; 58: 295-300.
- 8. Peach H. Reading systematic reviews. Aust Fam Phys 2002; 31: 736-740.
- 9. United States Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore: Williams and Wilkins, 1996.
- 10. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology and treatment. Arch Gen Psychiatry 1998; 55: 580-592.
- 11. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99: 2192-2217.
- 12. Kubzansky LD, Kawachi I. Going to the heart of the matter. Do negative emotions cause coronary heart disease? J Psychosom Res 2000; 48: 323-337.
- 13. Scheier MF, Bridges MW. Person variables and health: personality predispositions and acute psychological states as shared determinants for disease. Psychosom Med 1995; 57: 255-268.
- 14. Eriksen W. The role of social support in the pathogenesis of coronary heart disease: a literature review. Fam Pract 1994; 11: 201-209.
- 15. Tennant C. Life stress, social support and coronary heart disease. Aust N Z J Psychiatry 1999; 33: 636-641.
- 16. Hemingway H, Malik M, Marmot M. Social and psychosocial influences on sudden cardiac death, ventricular arrhythmia and cardiac autonomic function. Eur Heart J 2001; 22: 1082-1101.
- 17. Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Public Health 1994; 15: 381-411.
- 18. Friedman M, Roseman RH. Type A behaviour and your heart. New York: Knopf, 1974.
- 19. Miller TQ, Smith TW, Turner CW, et al. A meta-analytic review of research on hostility and physical health. Psychol Bull 1996; 119: 322-348.
- 20. Fleet RP, Lavoi K, Beitman B. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res 2000; 48: 347-356.
- 21. Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR. Publication bias in clinical research. Lancet 1991; 337: 867-872.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.