title: Negative emotions and 3-year progression of subclinical atherosclerosis.
abstract: BACKGROUND
  Although depression, anxiety, and hostility/anger have each been associated with an increased risk of coronary artery disease, these overlapping negative emotions have not been simultaneously examined as predictors of the progression of subclinical atherosclerosis.
  
  
  OBJECTIVE
  To evaluate the relative importance of depressive symptoms, anxiety symptoms, and hostility/anger in predicting subclinical atherosclerotic progression over a 3-year period. Design/
  
  
  METHODS
  The Pittsburgh Healthy Heart Project, an ongoing prospective cohort study of healthy, older men and women from the general community. At baseline, questionnaires were administered to assess depressive symptoms, anxiety symptoms, hostility, anger experience, and anger expression. Mean carotid intima-media thickness was assessed by B-mode ultrasonography during the baseline and 3-year follow-up visits.
  
  
  METHODS
  Of the 464 adults enrolled in the project, 324 (69.8%) were included in this report because they had complete baseline and follow-up data. Main Outcome Measure Three-year change in mean carotid intima-media thickness.
  
  
  RESULTS
  Regression analyses indicated that higher depressive symptoms at baseline were associated with greater 3-year change in carotid intima-media thickness (DeltaR(2) = 0.026, P = .002), even after taking into account demographic factors, cardiovascular risk factors, medication use, medical conditions, and other correlated negative emotions. Measures of anxiety symptoms, hostility, anger experience, and anger expression were each unrelated to intima-media thickness change. Post hoc analyses examining depressive symptom clusters showed that the somatic-vegetative symptoms of depression (DeltaR(2) = 0.027, P = .002), but not the cognitive-affective symptoms, were positively associated with intima-media thickness change.
  
  
  CONCLUSIONS
  Our findings suggest that the somatic-vegetative features of depression, but perhaps not anxiety and hostility/anger, may play an important role in the earlier stages of the development of coronary artery disease.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. jstew@iupui.edu
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Stewart
authors.forename: Denise L
authors.initials: DL
authors.lastname: Janicki
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Muldoon
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Kamarck
mesh_terms: D000328:Adult; D000786:Anger; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology / Q000473:pathology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D018450:Disease Progression; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006791:Hostility; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography