Psychiatric Disorders and Coronary Heart Disease in Women – A Still Neglected Topic: Review of the Literature from 1971 to 2000

Abstract

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.

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“…To test our study results also in clinical settings of acute cardiac or stroke patients, future research needs to subtype affective disorders in these clinical samples. It is likely to be beneficial for future analyses into this topic to also consider gender aspects of the relationship between affective disorders and CHD as well as the category minor depression, which is routinely underdiagnosed and undertreated [51]. Recent studies have found that minor depression often occurs in first-episode CHD patients (9% point prevalence) [50] and in postacute CHD patients enrolled in a cardiac rehabilitation program (6.1% point prevalence) [52].…”

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