Psychosomatics 41:372-373, August 2000
© 2000 The Academy of Psychosomatic Medicine
Psychological Factors, Immunity, and Heart Disease
Leo Sher, M.D. , Section on Biological Rhythms, National Institute of Mental Health, Building 10, Room 3S-231, 9000 Rockville Pike, Bethesda, MD 20892
Key Words: Psychological Factors Affecting Physical Condition
TO THE EDITOR: Studies of psychiatric patients, community samples, and patients with known heart disease demonstrated that depressive disorders, stressful life events, and poor social support are associated with increased incidence, morbidity, and mortality of atherosclerotic heart disease.1–3 Considerable evidence suggests that depression is an independent risk factor in the pathophysiologic progression of cardiovascular disease. Although depression, stress, and poor social supports are risk factors, the exact mechanism by which they affect heart disease is not as yet well understood. I propose that the immune system may be involved in the effects of psychological factors on the cardiovascular system.2,3
It has been established that psychological factors may significantly affect the immune system.2–4 For example, general stress, bereavement, and depressive disorders are associated with decreased lymphocyte mitogen response and natural killer-cell changes. It is important to note that chronic stress in humans does not lead to immunologic adaptation to the level of healthy control subjects.
There is substantial evidence that coronary heart disease is associated with infection.2,3,5 It has been suggested that inflammation in the atherosclerotic plaque may be a causative mechanism for coronary heart disease. Anti-inflammatory agents (e.g., aspirin) as well as antibiotics may have important therapeutic effects on atherosclerosis.
On the basis of the observations that some psychological factors promote the development of disorders of the cardiovascular system, that the same psychological factors decrease immunity and promote infection, and that there is evidence that the infectious process is involved in the pathogenesis of coronary heart disease, I suggest that the development of infection and inflammation in the atherosclerotic plaque is related to the psychological disorders that suppress the immune system. Antidepressive medications and psychological treatments (such as therapy for stress reduction and anger control, muscle relaxation therapy, etc.) may improve the state of the immune system, decrease the inflammation in the atherosclerotic plaques, and improve the condition of patients with coronary heart disease. Future studies of mechanisms by which psychological factors influence the cardiovascular system are merited.
REFERENCES
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Tennant C: Life stress, social support and coronary artery disease. Austral N Z J Psychiatry 1999; 33:636–641[CrossRef][Medline]
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Sher L: Effects of psychological factors on the development of cardiovascular pathology: role of the immune system and infection. Med Hypotheses 1999; 53:112–113[CrossRef][Medline]
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Sher L: The role of the immune system and infection in the effects of psychological factors on the cardiovascular system. Can J Psychiatry 1998; 43:954–955
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Kiecolt-Glaser JK, Glaser R: Stress and immune function in humans, in Psychoneuroimmunology, Second Edition, edited by Ader R, Felten DL, Cohen N. San Diego, CA, Academic Press, 1991, pp 847–867
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Danesh J, Collins R, Peto R: Chronic infection and coronary heart disease: is there a link? Lancet 1997; 350:430–436
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