CORONARY HEART DISEASE (S. VIRANI AND S. NADERI, SECTION EDITOR) The Impact of Psychological Functioning on Cardiovascular Disease Kevin S. Masters 1 & Jonathan A. Shaffer 1 & Kaitlyn M. Vagnini 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Purpose of Review We report on recent findings pertaining to the relationship of both negative and positive indicators of psychological functioning with cardiovascular disease (CVD) and briefly describe possible mechanistic pathways to account for these relationships. Recent Findings A body of observational literature suggests that (1) depression is predictive of CVD and is a consequence of CVD; (2) anxiety is related to CVD but the precise nature of this relationship remains unclear; and (3) negative affectivity and Type D personality are constructs that combine aspects of negative psychological functioning that have shown relationships with CVD and are worthy of future investigation. Positive psychological constructs of meaning/purpose and optimism predict better cardiovascular outcomes and other positive psychological constructs have received promising, but limited, attention in the literature. Summary Key remaining questions concern the magnitude and directionality of possible causal relationships as well as the mechanisms accounting for them. Keywords Cardiovascular disease . Depression . Meaning in life . Anxiety . Optimism . Purpose in life Introduction Cardiovascular disease (CVD) remains the leading cause of death in the USA, taking more than 645,000 lives per year, and causing about one in every four deaths [1]. An increasing body of literature suggests that psychological and behavioral factors affect cardiovascular function. Investigators have iden- tified a number of behavior-based CVD risk factors, including smoking, unhealthy diet, and inactive lifestyle. An estimated 80% of CVDs are considered preventable through engaging in healthy behaviors, such as eating a healthy diet, participating in adequate physical activity, maintaining a healthy weight, and abstaining from smoking [2]. Well-known CVD risk factors, such as hypertension, hy- percholesterolemia, and cigarette smoking, are highly influ- enced by behavioral practices, and behavior, itself, is influ- enced by psychological characteristics and functioning. However, these psychological factors have received some- what less attention in the medical literature regarding their possible influence on the development and progression of CVD. Nevertheless, there has been a growing literature inves- tigating the role of mental disorders (e.g., anxiety and depres- sion) and negative psychological factors (e.g., negative affect including hostility, anger, and Type D personality) on CVD morbidity and mortality. In this review, we will highlight re- cent research (within in the last 5 years) on anxiety, depres- sion, stress and post-traumatic stress disorder (PTSD), and negative affect in relation to CVD. Those interested in work prior to this time may refer to reviews by Edmondson and Cohen [3], Rozasnki [4], Hare and colleagues [5], and Suls and Bunde [6]. A relatively smaller empirical literature has investigated the possible protective role of positive psychological factors (e.g., meaning and purpose, optimism) and well-being on CVD. Nevertheless, there is a growing body of literature demonstrat- ing that positive psychological factors may, indeed, serve a protective role in CVD. We will review selected positive psy- chological factors (e.g., meaning and purpose, optimism) and their relation to CVD, highlighting research within the past 5 years. Table 1 presents a summary of key findings related to CVD and both positive and negative psychological factors discussed in this article. This article is part of the Topical Collection on Coronary Heart Disease * Kevin S. Masters kevin.masters@ucdenver.edu 1 Department of Psychology, University of Colorado Denver, Denver, CO 80217-3364, USA Current Atherosclerosis Reports (2020) 22:51 https://doi.org/10.1007/s11883-020-00877-1