Chronic Stress: A Link to Cardiovascular Disease

While we sometimes think of our bodies and minds as separate, there are strong connections between the two. The more we learn about mental health, the more we have identified its impacts and relation to our overall physical health. Nearly one in three people with a long-term physical health condition has a co-occurring mental health condition − most frequently, depression and anxiety. Perhaps more importantly, research confirms that coronary heart disease and mental illness are among the leading worldwide causes of mortality.

A growing body of research demonstrates the connection between mental health disorders and heart disease, indicating that risk factors and effects can stem from both biological pathways and risky health behaviors. For decades clinicians thought that the link between mental and heart health was strictly behavioral (i.e., smoking). But new research indicates that there may be physiological changes; in essence, the same chemical factors that stimulate mental health can also impact heart disease.

Cited in an article for the American Heart Association, Nieca Goldberg, M.D., medical director for the Joan H. Tisch Center for Women's Health at NYU’s Langone Medical Center, mentions that stress could be an additional, dangerous risk factor. Because hormones like adrenaline and cortisol increase under duress, the body’s blood pressure and heart rate can also spike. And other physiological effects occur in people with depression, anxiety, and PTSD, including reduced blood flow to the heart. Over time, these effects can cause heart disease.

Specific research highlights that those with severe mental illness have an increased risk of developing coronary heart disease. The same research indicates that mental health diseases and coronary heart disease have shared biological, behavioral, psychological and genetic mechanisms. Moreover, increasing evidence shows that mental health conditions can develop after severe cardiac events like heart failure and stroke. Large-scale, critical cardiac events can influence factors surrounding fear of mortality or disability, financial problems associated with the event, a sense of uncertainty, and diminished mood. In heart attack patients who also have depression, behaviors often include decreased motivation due to changes in the nervous system and hormonal balance.

Additionally, anxiety and depression can increase unhealthy heart behaviors like smoking, poor medication adherence and sedentary lifestyle. Those with mental health conditions may have fewer coping mechanisms to combat stress, leading to difficulty in making heart-healthy choices that reduce risk for heart disease. Lastly, there are overlapping symptoms in heart disease and depression (fatigue, low energy, difficulty sleeping).

In essence, there is a two-way relationship between heart disease and mental health conditions. Cited in an article for Johns Hopkins Medicine, Roy Charles Ziegelstein, M.D. states: “A percentage of people with no history of depression become depressed after a heart attack or after developing heart failure. And people with depression but no previously detected heart disease, seem to develop heart disease at a higher rate than the general population.”

There are specific groups that have higher rates of heart disease, stemming from co-occurring mental health conditions. These include veterans, women and minorities. Because no patients are the same – and many deal with unique sets of circumstances – it’s important for providers to work on an individual level to help patients cope in healthier ways. Given that cardiovascular disease is a leading cause of mortality, coupled with depression rates spiking during the pandemic, it’s essential for providers to help their patients keep both mental and physical health in check.

References

Abed MA, et al. Anxiety and adverse health outcomes among cardiac patients: a biobehavioral model. J Cardiovasc Nurs 2014;29(4):354–63.

De Hert, Marc, et al. The intriguing relationship between coronary heart disease and mental disorders. Dialogues Clin Neurosci 2018 Mar; 20(1):31–40.