Dr. Thomas W. Heinrich

The angry and hostile components of the Type A personality and the pessimistic outlook and internalized negative emotions of the Type D personality predict "poor outcomes" for occurrence and tolerance of heart attacks, notes Dr. Thomas Heinrich, an assistant professor of psychiatry and behavioral medicine at the Medical College of Wisconsin.

Depression can also harm the cardiovascular system, notes Heinrich.He serves as chief of the consultation psychiatry service at Froedtert Hospital, where he sees patients with simultaneously occurring medical and psychiatric problems (such as heart disease and depression)."Depression can be thought of hormonally as a chronic stress response," he explains.Chronic high levels of stress hormones can lead to cardiovascular risk factors such as obesity and high blood pressure.On the flip side, people experiencing depression may be more likely to make poor lifestyle choices that leave them open to heart disease.As a result of one of these means or perhaps a combination of both, Heinrich notes, "depression is an independent risk factor for the development of cardiovascular disease."

Patients who have heart disease and experience depression also have a much higher risk of developing, and dying from, subsequent cardiac problems.This is especially troubling, Heinrich says, because a significant number of patients with coronary artery disease are depressed."Depression is a risk factor for having another heart attack, just like elevated cholesterol, just like smoking," he says.The problem, he continues, is that unlike the other risk factors, treating depression hasn't necessarily been shown to reduce the risk.Of course, he adds, because depression impairs a person's life so greatly, alleviating that burden is a worthwhile goal in and of itself.
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It's important that patients be proactive in talking to their physicians if they have concerns about emotional stress, says Heinrich, since it might not be the first issue on every doctor's mind.

Medically Unexplained Symptoms and the Concept of Somatization by Thomas W. Heinrich, MD
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Dr. Heinrich is chief, Psychiatric Consultation Service and assistant professor of Psychiatry at the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin.Please address correspondence to Thomas Heinrich, MD, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, Wisconsin 53226; phone (414) 456.8950; fax (414) 456.6295; e-mail.