title: Secondary prevention of ischemic heart disease. The case for aggressive behavioral monitoring and intervention.
abstract: The hierarchy of evidence for arguing causality of a disease by any factor consists of epidemiological and, ultimately, treatment studies. The application of these criteria to chronic negative emotion as a risk factor for ischemic heart disease (IHD) is relatively new. However, controlled prospective evidence now indicates that anger, depression, and anxiety may play a major role in the genesis of IHD. And the strongest form of evidence, a controlled clinical trial that used randomly assigned subjects, exists, implicating anger as a strong predictor in the development of IHD. Resistance to the utility of this avenue of care is not based on evidence alone because widely accepted risk factors and/or treatment modalities often have less persuasive evidence, or less powerful effects, than do the emotional factors. Rather, such resistance is largely due to "paradigmatic scotomata"--conceptual difficulties for those not familiar with biopsychosocial research. Routine psychometric screening of IHD patients may provide a cost-effective means of alerting cardiologists and internists to the relatively high levels of distress among their patients.
authors.affiliation: Division of Consultation-Liaison Psychiatry, Henry Ford Hospital, Detroit, MI 48202.
authors.forename: M W
authors.initials: MW
authors.lastname: Ketterer
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000517:prevention & control* / Q000601:surgery / Q000628:therapy; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013315:Stress, Psychological / Q000517:prevention & control; D014434:Type A Personality
chemical_list: D001241:Aspirin