Associations between Emotional Distress and Coronary Heart Disease: Analysis of National Health Interview Survey 2008-2009

Background:  Studies investigating psychological factors have shown that negative emotions independently influence coronary heart disease (CHD) outcomes, contribute to decreased quality of life, poor prognosis, and decreased medication adherence.  Extant comorbidities, such as diabetes, obesity, hypertension and inadequate sleep are significant correlates of CHD. Yet, the research that has been conducted to distinguish what proportion is independently attributable to these factors lacks consensus.  

Methods: In a cross-sectional study using a nationally representative sample, we examined the independent associations between emotional distress and CHD among 25, 352 adults from the National Health Interview Survey (2008-2009).  Relationships were examined using a multivariate hierarchical logistic regression model controlling for sociodemographic variables, self-reported physician diagnosed medical history, sleep duration, emotional distress, and health behaviors.

Results:  The overall prevalence of participants reporting CHD from the NHIS data was 5.1%, of which 75.2 % self-reported hypertension, 30.5% diabetes, 26.6% <6 or >9 hrs of sleep and 16.4% emotional distress.  While the least prevalent self-reported condition at baseline, analysis revealed individuals reporting emotional distress had an estimated two-fold increased risk for CHD [OR = 2.00 95% CI: 2.00-2.01; p<0.0001]. The estimated risk of CHD for participants reporting diabetes and inadequate sleep were increased by 84% and 14%, respectively. 

Conclusion:  In this study, emotional distress confers significant risk for CHD beyond traditional risk factors, such as diabetes and obesity. Our findings suggest that clinicians should work with their patients to promote emotional vitality and wellness to blunt the negative impact emotional distress has on cardiovascular health and refer for mental health services when appropriate.