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J Affect Disord. 1999 May;53(2):193-201.

Sad, glad, or mad hearts? Epidemiological evidence for a causal relationship between mood disorders and coronary artery disease.

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College of Health Professions, Towson University, MD 21252, USA.



To examine the epidemiological evidence to determine if there is sufficient support for the hypothesis that mood disorders convey a risk factor in the pathogenesis of coronary artery disease (CAD).


Based on a review of the related research on Type A behavioral pattern (TABP) and other variables such as anger and hostility and their relationship to coronary artery disease (CAD), the findings were analyzed to ascertain any clinical patterns or similarities between behaviors of Type A and those in mood disorders. Using the given epidemiological criteria for a causal relationship, the association between the mood and coronary artery disease was explored.


There are similar symptoms and behaviors noted among Type A, manic, cyclothymic and hyperthymic individuals. There is sufficient historical and contemporaneous epidemiological evidence to support the notion that mood disorders confer risk for CAD, but it is premature to describe it as a causative factor. Depressive symptoms and general mood disorders emerged as toxic risk factors for CAD.


This article presents only a selective literature review, and it is limited by an epidemiological analyses of secondary sources. The impact of this limitation on the interpretation of the analyses is discussed.


Patients require scrupulous clinical assessment for the presence of mood disorders including subtype; the stakes are high, since their cardiac health status may depend upon it. Pathophysiological pathways may play a covariate role in both mood and coronary disease, and some tentative hypotheses regarding the role of catchecholamines and cortisol are explored.


There is evidence to justify studying the role of mood as a covariate risk factor in the pathogenesis of CAD. Implications for mental health, public health, primary care practice, and psychometric measurement are discussed. The hypothesis that mood disorders are a cause of CAD requires further research.

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