Psychological distress and cardiovascular disease: the Circulatory Risk in Communities Study (CIRCS)

Although a number of epidemiological studies have reported that psychological factors are associated with increased risk of cardiovascular morbidity and mortality, the relevant epidemiological data are mostly limited to Western populations. The present study sought to examine associations of depressive symptoms, anger expression, and tension with the incidence of cardiovascular disease in the Circulatory Risk in Communities Study (CIRCS). Depressive symptoms were measured in 901 men and women by using the Zung Self-Rating Depression Scale (SDS); anger expression and tension were measured in 6292 men and women by using the Anger Expression Scale and Framingham Tension Scale. As compared with the participants with SDS scores in the lowest tertile, those with scores in the highest tertile had twice the age- and sex-adjusted hazard ratio of total stroke. However, this excess risk was present only for ischemic stroke. Participants in the highest tertile also had a 7-fold adjusted hazard ratio of coronary heart disease, as compared with those in the lowest tertile. These associations were virtually unchanged after further adjustment for covariates. Men with "anger-in" scores in the highest tertile had a 1.5-fold age-adjusted relative risk of hypertension as compared with those in the lowest tertile; anger-in score was not associated with hypertension in women. In men and women, there were no associations between hypertension and either "anger-out" or tension scores. These findings generally support the hypothesis that-as is the case in Western populations-anger suppression and depression increase the risk of cardiovascular disease among Japanese.