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Jesse C. Stewart, PhD; Denise L. Janicki, PhD; Matthew F. Muldoon, MD, MPH; Kim Sutton-Tyrrell, RN, DrPH; Thomas W. Kamarck, PhD

Arch Gen Psychiatry. 2007;64(2):225-233.

Context  Although depression, anxiety, and hostility/anger have each been associated with an increased risk of coronary artery disease, these overlapping negative emotions have not been simultaneously examined as predictors of the progression of subclinical atherosclerosis.

Objective  To evaluate the relative importance of depressive symptoms, anxiety symptoms, and hostility/anger in predicting subclinical atherosclerotic progression over a 3-year period.

Design/Setting  The Pittsburgh Healthy Heart Project, an ongoing prospective cohort study of healthy, older men and women from the general community. At baseline, questionnaires were administered to assess depressive symptoms, anxiety symptoms, hostility, anger experience, and anger expression. Mean carotid intima-media thickness was assessed by B-mode ultrasonography during the baseline and 3-year follow-up visits.

Participants  Of the 464 adults enrolled in the project, 324 (69.8%) were included in this report because they had complete baseline and follow-up data.

Main Outcome Measure  Three-year change in mean carotid intima-media thickness.

Results  Regression analyses indicated that higher depressive symptoms at baseline were associated with greater 3-year change in carotid intima-media thickness (R² = 0.026, P = .002), even after taking into account demographic factors, cardiovascular risk factors, medication use, medical conditions, and other correlated negative emotions. Measures of anxiety symptoms, hostility, anger experience, and anger expression were each unrelated to intima-media thickness change. Post hoc analyses examining depressive symptom clusters showed that the somatic-vegetative symptoms of depression (R² = 0.027, P = .002), but not the cognitive-affective symptoms, were positively associated with intima-media thickness change.

Conclusion  Our findings suggest that the somatic-vegetative features of depression, but perhaps not anxiety and hostility/anger, may play an important role in the earlier stages of the development of coronary artery disease.

Author Affiliations: Departments of Psychiatry (Dr Stewart) and Medicine (Dr Muldoon), University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Psychology, University of Pittsburgh (Drs Janicki and Kamarck); and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh (Dr Sutton-Tyrrell). Dr Stewart is now with the Department of Psychology, Indiana University–Purdue University Indianapolis. Dr Janicki is now with the Department of Psychology, Carnegie Mellon University, Pittsburgh.

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