Do Negative Emotions, Stress, and Anxiety Lead to Heart Disease?

While causality is still unproven, there appears to be an association between coronary heart disease and anger and other untoward feelings.

978-0-307-71990-4.jpg After receiving the diagnosis of heart disease, one of the first questions is always "Why did I get coronary heart disease?" We all know the traditional risk factors for heart disease: high cholesterol, smoking, obesity, poor diet, diabetes, family history, lack of exercise. Should we add stress and negative emotions to this list? Even after hundreds of scientific studies on this topic, the question still generates controversy and, in some cases, intense emotion.

While causality is unproven, there appears to be an association between coronary heart disease and anger, anxiety, and depression. Some suggest this could be due to the damaging behaviors that often accompany negative emotions (e.g., smoking, poor diet, lack of exercise), or the physiological effects that emotions can have on the heart and blood vessels (e.g., high blood pressure). Later, we will delve more deeply into how emotional stress affects the heart. For now, we will present the evidence suggesting an association between development of heart disease and two negative emotions, anger and anxiety.


The relationship between the heart and the constellation of emotional traits that includes anger, hostility, and cynicism has been examined extensively in observational studies. Although such studies are not considered the highest level of evidence, the findings are so consistent that they can't be ignored.

For some of us, anger and frustration begin early in the day. Cut off by the guy in the Pinto. Then stuck behind a slow truck -- what is wrong with that guy? Got around the truck, but still missed every single light. Almost there, but reached the final intersection just as road construction began -- why do they have to do this during rush hour, anyway? Spilled the coffee reaching for the parking pass. Why can't they have automatic parking gates? Arrived at work ten minutes late, frustrated and mad at the world. If this is your typical morning, you are not going to like what we have to say next.

Repeated bouts of anger are associated with thickening of the arteries and development of plaque, possible precursors to heart attacks. Over time, people who are frequently angry appear to have an increased risk of developing coronary heart disease. The stronger and more frequent the bouts of anger, the greater the risk of heart disease.

Some scientists argue that expressing anger, rather than holding it in, is better for the heart. This is unproven. Yelling might make you feel better for a moment, but it will probably endanger your job or your relationships -- leading to further stress and anger. A more effective strategy includes avoiding situations that trigger anger, and managing anger when it does occur. People who anger easily are frequently also pessimistic and cynical, and pessimism is bad for your heart. In an observational study of nearly 100,000 women, those with a pessimistic, cynical disposition developed more coronary heart disease, had more heart attacks, and died earlier than optimists. Cynical women were also more likely to develop cancer.


Like anger, anxiety may forecast the development of coronary heart disease. We all know the tight feeling that we get in the chest when we become very anxious, so we should not be surprised to learn that this emotion can affect heart health. The circumstantial evidence supporting anxiety as a marker of heart risk is strong. In an observational study of 50,000 18- to 20-year-old Swedish men, those with high levels of anxiety substantially increased their risk of developing coronary heart disease over the next 37 years. A recent meta-analysis incorporating twenty studies and nearly 250,000 individuals also found that anxiety is associated with development of coronary heart disease.

Once again, the more frequent and intense the anxiety and worry, the more likely the development of heart disease. Veterans with post-traumatic stress disorder, which is characterized by intense anxiety, tend to have more calcium (a marker of coronary blockages) in their hearts' arteries than do soldiers without the disorder. On the civilian front, people who suffer from panic disorders face an increased risk of developing heart problems.