Background: Coronary heart disease (CHD) is the leading cause of death in women aged over 40 years in the United States, for whom it conveys a worse prognosis than for men. Recently, psychosocial factors have been understood to represent significant risk factors for developing CHD, as well as having a worse outcome with established CHD. However, these factors are often overlooked, in particular comorbid psychiatric disorders and psychiatric symptoms. To summarize the current knowledge in this interdisciplinary field, the authors conducted a review of CHD in women, taking into account psychosocial aspects, in particular psychiatric disorders. Methods: Medline searches using the keywords ‘psychiatric disorder’ and ‘coronary heart disease’ and ‘women’, and ‘psychiatric disorder’ and ‘cardiac disease’ and ‘women’, were performed, covering the time span from the beginning of the Medline database until January 1, 2001. Results: Quoted items included depression, panic disorder, generalized anxiety disorder, mitral valve prolapse, chest pain, anorexia nervosa, menopause, alcohol abuse, cocaine use, sleep disorder, sexual dysfunction, hostility and type A behavior, as well as other psychosocial aspects. There is accumulating evidence of significant associations between psychosocial factors, in particular psychiatric disorders and psychiatric symptoms, and the development and recurrence of CHD in women. Conclusions: However, in summary, the topic still seems to be neglected. Future research into psychiatric disorders and psychiatric symptoms and CHD in women is strongly required, and the focus on women exclusively is underlined.

1.
American Heart Association: Heart and Stroke Facts Statistics. Dallas, American Heart Association, 1993.
2.
Frasure-Smith N, Lesperance F, Juneau M, Talajic M, Bourassa MG: Gender, depression, and one-year prognosis after myocardial infarction. Psychosom Med 1999;61:26–37.
3.
Welin C, Lappas G, Wilhelmsen L: Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med 2000;247:629–639.
4.
Carney RM, Freedland KE, Sheline YI, Weiss ES: Depression and coronary heart disease: A review for cardiologists. Clin Cardiol 1997;20:196–200.
5.
Stewart TD, Atlas SA: Syndrome X, depression, and chaos: Relevance to medical practice. Conn Med 2000;64:343–345.
6.
Boisseau R, Servant D, Parquet PJ: Psychopathological disorders and coronary diseases (in French). Rev Med Interne 1997;18:303–310.
7.
Barrick CB: Sad, glad, or mad hearts? Epidemiological evidence for a causal relationship between mood disorders and coronary artery disease. J Affect Disord 1999;53:193–201.
8.
Anda R, Williamson D, Jones D, Macera C, Eaker E, Glassman A, Marks J: Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults. Epidemiology 1993;4:285–294.
9.
Hippisley-Cox J, Fielding K, Pringle M: Depression as a risk factor for ischaemic heart disease in men: Population based case-control study. BMJ 1998;316:1714–1719.
10.
Hallstrom T, Lapidus L, Bengtsson C, Edstrom K: Psychosocial factors and risk of ischaemic heart disease and death in women: A twelve-year follow-up of participants in the population study of women in Gothenburg, Sweden. J Psychosom Res 1986;30:451–459.
11.
Horsten M, Mittleman MA, Wamala SP, Schenck-Gustafsson K, Orth-Gomer K: Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study. Eur Heart J 2000;21:1072–1080.
12.
Burker EJ, Blumenthal JA, Feldman M, Burnett R, White W, Smith LR, Croughwell N, Schell R, Newman M, Reves JG: Depression in male and female patients undergoing cardiac surgery. Br J Clin Psychol 1995;34:119–128.
13.
Stern MJ, Pascale L, Ackerman A: Life adjustment postmyocardial infarction: Determining predictive variables. Arch Intern Med 1977;137:1680–1685.
14.
Ades PA: Cardiac rehabilitation in older coronary patients. J Am Geriatr Soc 1999;47:98–105.
15.
Lavie CJ, Milani RV: Benefits of cardiac rehabilitation and exercise training in elderly women. Am J Cardiol 1997;79:664–666.
16.
Beitman BD, Basha I, Flaker G, DeRosear L, Mukerji V, Trombka L, Katon W: Atypical or nonanginal chest pain. Panic disorder or coronary artery disease? Arch Intern Med 1987;147:1548–1552.
17.
Lint DW, Taylor CB, Fried-Behar L, Kenardy J: Does ischemia occur with panic attacks? Am J Psychiatry 1995;152:1678–1680.
18.
Lessmeier TJ, Gamperling D, Johnson-Liddon V, Fromm BS, Steinman RT, Meissner MD, Lehmann MH: Unrecognized paroxysmal supraventricular tachycardia. Potential for misdiagnosis as panic disorder. Arch Intern Med 1997;157:537–543.
19.
Kane FJ Jr, Harper RG, Wittels E: Angina as a symptom of psychiatric illness. South Med J 1988;81:1412–1416.
20.
Watkins LL, Grossman P, Krishnan R, Blumenthal JA: Anxiety reduces baroreflex cardiac control in older adults with major depression. Psychosom Med 1999;61:334–340.
21.
Kantor JS, Zitrin CM, Zeldis SM: Mitral valve prolapse syndrome in agoraphobic patients. Am J Psychiatry 1980;137:467–469.
22.
Cordas TA, Rossi EG, Grinberg M, Gentil V, Bernik MA, Bellotti G, Pileggi F: Mitral valve prolapse and panic disorder (in Portuguese). Arq Bras Cardiol 1991;56:139–142.
23.
Boudoulas H, King BD, Wooley CF: Mitral valve prolapse: A marker for anxiety or overlapping phenomenon? Psychopathology 1984;17(suppl 1):98–106.
24.
Lochen ML, Rasmussen K: Palpitations and lifestyle: Impact of depression and self-rated health. The Nordland Health Study. Scand J Soc Med 1996;24:140–144.
25.
Flugelman MY, Weisstub E, Galun E, Weiss AT, Fischer D, Kaplan De-Nour A, Gotsman MS, Eliakim M: Clinical, psychological and thallium stress studies in patients with chest pain and normal coronary arteries. Int J Cardiol 1991;33:401–408.
26.
Bengtson A, Karlsson T, Herlitz J: Differences between men and women on the waiting list for coronary revascularization. J Adv Nurs 2000;31:1361–1367.
27.
Schocken DD, Holloway JD, Powers PS: Weight loss and the heart. Effects of anorexia nervosa and starvation. Arch Intern Med 1989;149:877–881.
28.
De Simone G, Scalfi L, Galderisi M, Celentano A, Di Biase G, Tammaro P, Garofalo M, Mureddu GF, de Divitiis O, Contaldo F: Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 1994;71:287–292.
29.
Beumont PJ, Large M: Hypophosphataemia, delirium and cardiac arrhythmia in anorexia nervosa. Med J Aust 1991;155:519–522.
30.
Isner JM, Roberts WC, Heymsfield SB, Yager J: Anorexia nervosa and sudden death. Ann Intern Med 1985;102:49–52.
31.
Judd HL, Cleary RE, Creasman WT, Figge DC, Kase N, Rosenwaks Z, Tagatz GE: Estrogen replacement therapy. Obstet Gynecol 1981;58:267–275.
32.
Calaf i Alsina J: Benefits of hormone replacement therapy – overview and update. Int J Fertil Womens Med 1997;42(suppl 2):329–346.
33.
Steffen AM, Thompson LW, Gallagher-Thompson D, Koin D: Physical and psychosocial correlates of hormone replacement therapy with chronically stressed postmenopausal women. J Aging Health 1999;11:3–26.
34.
Prelevic GM, Jacobs HS: Menopause and post-menopause. Baillieres Clin Endocrinol Metab 1997;11:311–340.
35.
Slone D, Shapiro S, Kaufman DW, Rosenberg L, Miettinen OS, Stolley PD: Risk of myocardial infarction in relation to current and discontinued use of oral contraceptives. N Engl J Med 1981;305:420–424.
36.
Thacker HL: Menopause. Prim Care 1997;24:205–221.
37.
Bidikov I, Meier DE: Clinical decision-making with the woman after menopause. Geriatrics 1997;52:28–35.
38.
Hamlett K, Eaker ED, Stokes J 3rd: Psychosocial correlates of alcohol intake among women aged 45 to 64 years: The Framingham Study. J Behav Med 1989;12:525–542.
39.
Makela P, Valkonen T, Poikolainen K: Estimated numbers of deaths from coronary heart disease ‘caused’ and ‘prevented’ by alcohol: An example from Finland. J Stud Alcohol 1997;58:455–463.
40.
Hanna EZ, Chou SP, Grant BF: The relationship between drinking and heart disease morbidity in the United States: Results from the National Health Interview Survey. Alcohol Clin Exp Res 1997;21:111–118.
41.
Anyanwu E, Watson N: Alcohol dependence: A critical look at the effects of alcohol metabolism. Rev Environ Health 1997;12:201–213.
42.
Little BB, Snell LM, Klein VR, Gilstrap LC 3rd: Cocaine abuse during pregnancy: Maternal and fetal implications. Obstet Gynecol 1989;73:157–160.
43.
Mehta SK, Finkelhor RS, Anderson RL, Harcar-Sevcik RA, Wasser TE, Bahler RC: Transient myocardial ischemia in infants prenatally exposed to cocaine. J Pediatr 1993;122:945–949.
44.
Asplund R: Sleep and cardiac diseases amongst elderly people. J Intern Med 1994;236:65–71.
45.
Asplund R, Aberg H: Sleep and cardiac symptoms amongst women aged 40–64 years. J Intern Med 1998;243:209–213.
46.
Welin CL, Rosengren A, Wilhelmsen LW: Behavioural characteristics in patients with myocardial infarction: A case-control study. J Cardiovasc Risk 1995;2:247–254.
47.
Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio T, Reynolds CF, Robbins J: Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatr Soc 2000;48:115–123.
48.
Abramov LA: Sexual life and sexual frigidity among women developing acute myocardial infarction. Psychosom Med 1976;38:418–425.
49.
Bass C: Type A behaviour in patients with chest pain: Test-retest reliability and psychometric correlates of Bortner scale. J Psychosom Res 1984;28:289–300.
50.
Low KG, Fleisher C, Colman R, Dionne A, Casey G, Legendre S: Psychosocial variables, age, and angiographically-determined coronary artery disease in women. Ann Behav Med 1998;20:221–226.
51.
Billing E, Hjemdahl P, Rehnqvist N: Psychosocial variables in female vs male patients with stable angina pectoris and matched healthy controls. Eur Heart J 1997;18:911–918.
52.
Hansen V, Jacobsen BK: Mental distress and social conditions and lifestyle in northern Norway. BMJ 1989;299:85–88.
53.
Tofler GH, Stone PH, Maclure M, Edelman E, Davis VG, Robertson T, Antman EM, Muller JE: Analysis of possible triggers of acute myocardial infarction (the MILIS study). Am J Cardiol 1990;66:22–27.
54.
Mann JI, Doll R, Thorogood M, Vessey MP, Waters WE: Risk factors for myocardial infarction in young women. Br J Prev Soc Med 1976;30:94–100.
55.
Coelho R, Ramos E, Prata J, Barros H: Psychosocial indexes and cardiovascular risk factors in a community sample. Psychother Psychosom 2000;69:261–274.
56.
Talbott E, Kuller LH, Detre K, Perper J: Biologic and psychosocial risk factors of sudden death from coronary disease in white women. Am J Cardiol 1977;39:858–864.
57.
Beard CM, Griffin MR, Offord KP, Edwards WD: Risk factors for sudden unexpected cardiac death in young women in Rochester, Minnesota, 1960 through 1974. Mayo Clin Proc 1986;61:186–191.
58.
Bass C, Akhras F, Upward J, Keates J, Lowe D, Harry J, Jackson G: Does atenolol improve physical and psychological function after coronary artery bypass surgery: A controlled study. J Psychosom Res 1987;31:521–529.
59.
Duits AA, Duivenvoorden HJ, Boeke S, Taams MA, Mochtar B, Krauss XH, Passchier J, Erdman RA: The course of anxiety and depression in patients undergoing coronary artery bypass graft surgery. J Psychosom Res 1998;45:127–138.
60.
Wiklund I, Heritz J, Johansson S, Bengtson A, Karlson BW, Persson NG: Subjective symptoms and well-being differ in women and men after myocardial infarction. Eur Heart J 1993;14:1315–1319.
61.
Riegel B, Gocka I: Gender differences in adjustment to acute myocardial infarction. Heart Lung 1995;24:457–466.
62.
Surtees PG: In the shadow of adversity: The evolution and resolution of anxiety and depressive disorder. Br J Psychiatry 1995;166:583–594.
63.
Alfredsson L, Spetz CL, Theorell T: Type of occupation and near-future hospitalization for myocardial infarction and some other diagnoses. Int J Epidemiol 1985;14:378–388.
64.
Bosma H, Stansfeld SA, Marmot MG: Job control, personal characteristics, and heart disease. J Occup Health Psychol 1998;3:402–409.
65.
Schwalb H: Risk factors of coronary heart diseases in hospitalized psychic patients (in German). MMW Münch Med Wochenschr 1975;117:1181–1188.
66.
Schwalb H, van Eimeren W, Friedrich HU: Coronary heart disease in hospitalized mental patients. An eletrocardiographic prevalence study (in German). MMW Münch Med Wochenschr 1975;117:1905–1910.
67.
Schwalb H, Eckman F, van Eimeren W: ECG changes in psychiatric patients under long-term therapy with psychopharmaca (in German). Fortschr Neurol Psychiatr Grenzgeb 1978;46:484–490.
68.
Schwalb H, Bruninghaus H, Eckmann F, Haag F, Jaspersen J, Jungling D, Waldenfels W: The mortality from ischaemic heart diseases in hospitalized psychiatric patients (in German). Klin Wochenschr 1976;54:31–33.
69.
Aronson MK, Ooi WL, Morgenstern H, Hafner A, Masur D, Crystal H, Frishman WH, Fisher D, Katzman R: Women, myocardial infarction, and dementia in the very old. Neurology 1990;40:1102–1106.
70.
Ahto M, Isoaho R, Puolijoki H, Laippala P, Sulkava R, Kivela SL: Cognitive impairment among elderly coronary heart disease patients. Gerontology 1999;45:87–95.
71.
Cobbs EL, Ralapati AN: Health of older women. Med Clin North Am 1998;82:127–144.
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