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Higher symptom levels of a variety of measures of emotional distress have been associated with cardiovascular disease (CVD), especially among women. Here, our goal was to investigate the association between a composite measure of psychological distress and incident cardiovascular events.

In a prospective cohort study, we assessed 662 individuals (28% women; 30% blacks) with stable coronary artery disease. We used a composite score of psychological distress derived through summation of Z‐transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress) as a predictor of an adjudicated composite end point of adverse events (cardiovascular death, myocardial infarction, stroke, heart failure, or unstable angina). During a mean follow‐up of 2.8 years, 120 (18%) subjects developed CVD events. In the …