Annu. Rev. Public Health 2005. 26:469–500 doi: 10.1146/annurev.publhealth.26.021304.144542 Copyright c  2005 by Annual Reviews. All rights reserved First published online as a Review in Advance on January 11, 2005 P SYCHOSOCIAL FACTORS AND CARDIOVASCULAR DISEASES Susan A. Everson-Rose 1,2,3 and Ten´ e T. Lewis 1 Departments of Preventive Medicine 1 and Psychology 2 and Rush Institute for Healthy Aging, 3 Rush University Medical Center, Chicago, Illinois 60612; email: Susan_A_Everson@rush.edu, Tene_T_Lewis@rush.edu Key Words depression, anger, hostility, stress, pathophysiological mechanisms ■ Abstract Rapidly accruing evidence from a diversity of disciplines supports the hypothesis that psychosocial factors are related to morbidity and mortality due to car- diovascular diseases. We review relevant literature on (a) negative emotional states, including depression, anger and hostility, and anxiety; (b) chronic and acute psy- chosocial stressors; and (c) social ties, social support, and social conflict. All three of these psychosocial domains have been significantly associated with increased risk of cardiovascular morbidity and mortality. We also discuss critical pathophysiological mechanisms and pathways that likely operate in a synergistic and integrative way to promote atherogenesis and related clinical manifestations. We conclude by discussing some of the important challenges and opportunities for future investigations. OVERVIEW Traditional cardiovascular risk factors, including smoking, high blood pressure, high cholesterol, and diabetes, do not fully account for or explain the excess bur- den of cardiovascular diseases (CVD) in the population. Most individuals who develop CVD have at least one of these risk factors (67); nevertheless, other fac- tors contribute to the development and progression of CVD. Several psychosocial characteristics are importantly related to coronary heart disease (CHD), hyperten- sion, stroke, and other cardiovascular disorders. Indeed, the literature on this topic is quite expansive. The purpose of this review is to provide a selected summary of key findings in this literature. We note some of the classic studies and historical developments important to the field and focus on prospective, epidemiological studies, with clinical endpoints [e.g., myocardial infarction (MI), CVD mortal- ity, stroke] and/or subclinical cardiovascular disease (e.g., carotid atherosclerosis, coronary calcification) as the outcome. We begin with current statistics on the impact and cost of CVD, outline and review the literature on three important psy- chosocial domains that have received much of the research attention, discuss key pathophysiological mechanisms and pathways by which psychosocial factors may 0163-7525/05/0421-0469$20.00 469 Annu. Rev. Public Health 2005.26:469-500. Downloaded from www.annualreviews.org Access provided by 52.73.204.196 on 05/16/22. For personal use only.