Abstract
Psychological stress may play a role in the development of stroke, coronary heart disease, and hypertension, but epidemiological data on these topics have been limited to predominantly Western populations. We sought to examine the relationship of depressive symptoms, anger expression, and anxiety with cardiovascular diseases among Japanese men and women. (1) A 10.3-year prospective study on the relationship between depressive symptoms and the incidence of stroke and coronary heart disease was conducted with 901 men and women aged 40 to 78 years in a rural Japanese community. Depressive symptoms were measured at baseline with the use of the Zung Self-Rating Depression Scale (SDS). During the 10-year follow-up, 69 strokes and 21 coronary heart diseases occurred. Persons with SDS scores in the high tertile had twice the age- and sex-adjusted relative risk of total stroke as those with scores in the low tertile. The excess risk was confined to ischemic stroke. Persons with SDS scores in the high tertile had a 7-fold higher age- and sex-adjusted relative risk of coronary heart disease than did those with scores in the low tertile. Depressive symptoms predict the risk of ischemic stroke and coronary heart disease among Japanese. (2) A 4-year prospective study on the relationship of anger expression and anxiety with hypertension was conducted with 4,970 normotensive men and women aged 30 to 74 years in four rural and urban communities. Anger expression was estimated at baseline using the anger-out and anger-in scores of the Spielberger Anger Expression Scale. Anxiety was measured with the use of the Framingham Tension Scale. Men with anger-in scores in the high tertile had a 1.5-fold higher age-adjusted relative risk of hypertension than did those with scores in the low tertile. For women, the anger-in score was not associated with hypertension. There was no relation between the anger-out or anxiety score and hypertension in either men or women. Suppressed anger predicts the risk of hypertension among Japanese men, but not women.
