Several different psychological factors can take a toll on heart health, and each factor seems to act at different stages through different mechanisms, research suggests.

Willem J. Kop, Ph.D. summarized studies on mental health and heart health in a 2003 issue of the journal Brain, Behavior and Immunity. He classifies psychological risk factors for coronary disease into three categories - chronic, episodic and acute - based on their duration and closeness in time to the haeart problems.

• Chronic psychological factors that are those associated with increased risk of a first heart attack. These include long-term, stable characteristics such as a hostile personality, Type A behavior or low socioeconomic status. These factors have been shown to play an important role in early disease stages when the build up of artery-blocking plaque is beginning.
• Research has found that fat deposits, inflammation of the arteries and higher white blood cell counts all result from these psychological traits by way of the nervous system.
• Low socioeconomic status, for example, correlates with increased exposure to bacteria and viruses, to higher level of proteins that regulate the immune response (cytokines) and to elevated C-reactive protein, a marker for inflammation.
• A similar pattern holds true for episodic risk factors like depression or exhaustion, which can last from several weeks to two years. Episodic mental health conditions may lead to the creation of unstable plaques. Stable plaques partially intrude into arteries; while unstable ones threaten to break off and completely block critical blood vessels in the heart, causing heart attacks.
• C-reactive protein rises in people with depression and in exhausted individuals over 65. Depression also correlates with elements of the immune system, including increased cytokines, lymphocytes and white blood cells. Being overweight strengthens the connection between depression and inflammatory markers.
• Acute psychological risk factors can directly trigger heart attacks once coronary artery disease has reached advanced stages. Outbursts of anger can double the risk of heart attack by reducing blood supply to the heart and promoting plaque rupture. Stress has been shown to impair heart function in 30 to 60 percent of patients with coronary disease.The mind and the body are one system. This research strongly supports the idea that psychological factors are involved in cardiovascular disease. Learning to better manage stress, depression, and hostility may pay dividends in better heart health.