"The inherited nature of early heart disease may be largely due to the family transmission of psychosocial and emotional distress, and specifically anger in males," says lead author Mark W. Ketterer, Ph.D., of Henry Ford Hospital's Department of Behavioral Health.
Based on these results, Dr. Ketterer recommends that clinicians who treat patients - especially male patients - for early onset heart disease consider having them evaluated by a psychiatric or behavioral professional. Treating emotional distress has been shown to be an effective way to decrease morbidity and mortality from heart disease.
Dr. Ketterer will present his study March 6 at the annual meeting of the American Psychosomatic Society in Phoenix, Ariz.
One hundred men and women with documented heart disease were asked about a family history of early heart disease and their age of first diagnosis. They also were evaluated for traditional cardiovascular risk factors including high blood pressure, high cholesterol, diabetes, smoking and excessive body weight.
The men and women completed a 58-item stress symptom checklist that asked about the frequency of symptoms of stress, including aggravation, irritation, anger and impatience, depression, anxiety and worry. The test provided two parallel versions of the same questionnaire - one to be completed by the cardiac patient and one for a spouse, family member or friend to complete about the patient.
"Because men often are in denial about emotional stress, it's imperative that we gather another perspective on their level of stress," says Dr. Ketterer.
Among the study's findings were:
Family history of heart disease had a greater impact on men than women. The average age of heart disease diagnosis was 12 years earlier for men with a positive family history of early heart disease compared to those without such a history. For women, the average age of heart diagnosis was two years earlier.
None of the traditional risk factors for heart disease - high blood pressure, high cholesterol, diabetes, smoking, excessive body weight - was significantly different for those with a family history of early heart disease, when compared to those who did not have a family history on early onset.
Men with a family history of early heart disease had significantly higher stress symptom scores than men with no family history of early heart disease. Most of the relationship between a family history of early heart disease, and a personal history of early diagnosis was explained by anger ratings for the males as reported by spouses or friends. This implies that the propensity for anger is what is inherited and increases the risk of early heart disease.
"Depression and stress are known risk factors for heart disease, and they both have strong heritibility," says Dr. Ketterer. "None of the other risk factors, including high cholesterol, high blood pressure or diabetes, were shown to have a significant familial link in this group.
"Therefore, it's likely that men who have an early onset of heart disease might have a genetic predisposition to stress, which causes the heart disease."
As part of its cardiac rehabilitation program, the Henry Ford Heart & Vascular Institute employs an aggressive behavior modification program that cover topics such as healthy communication, assertiveness training, behavior modification, relaxation techniques and coping strategies. The program has been shown to help heart patients reduce their stress level and also reduce their incidence of chest pain - a leading indicator of heart disease.
Part of the Henry Ford Health System, the Henry Ford Heart & Vascular Institute is a leader and innovator in comprehensive cardiac care, research and education, offering one of the nation's most successful heart failure treatment, transplantation and rehabilitation programs. This year, the Institute was ranked 14th nationally as a leading cardiac center by U.S. News & World Report.