Objectives: While depression and heart disease often co-occur in Western countries, less is known about the association of anxiety and alcohol use disorders with heart disease and about the cross-cultural consistency of this association. Consistency across emotional disorders and cultures would suggest that relatively universal mechanisms underlie the association. Methods: Surveys with 18 random population samples of household-residing adults in 17 countries in Europe, the Americas, the Middle East, Africa, Asia and the South Pacific were carried out. Medically recognized heart disease was ascertained by self-report. Mental disorders were assessed with the World Mental Health Composite International Diagnostic Interview, a fully structured diagnostic interview. Results: Specific mood and anxiety disorders occurred among persons with heart disease at rates higher than those among persons without heart disease. Adjusted for sex and age, the pooled odds ratios (95% confidence interval) were 2.1 (1.9-2.5) for mood disorders, 2.2 (1.9-2.5) for anxiety disorders and 1.4 (1.0-1.9) for alcohol abuse/dependence among persons with versus those without heart disease. These patterns were similar across countries. Conclusions: An excess of anxiety disorders and that of mood disorders are found among persons with heart disease. These associations hold true across countries despite substantial between-country differences in culture and mental disorder prevalence rates. These results suggest that similar mechanisms underlie the association and that a broad spectrum of mood-anxiety disorders should be considered in research on the comorbidity of mental disorders and heart disease. © 2007 Elsevier Inc. All rights reserved.