Does Our Mental Health Affect Our Heart?

Does our mental health affects our heart?

This is an important topic as we see the increase in mental health issues as a result of the pandemic. Most of us consider heart disease as a physical condition, but our thoughts, attitudes and emotions are just as important. A large and growing body of research shows that mental health is associated with risk factors for heart disease. These effects can arise both directly, through biological pathways, and indirectly, through risky health behaviors.

Mind Body Connections to Heart Disease

1. Stress can contribute to abnormally high blood pressure and circulation problems
2. Research has now clearly demonstrated that negative psychological factors, personality traits, and mental health disorders can affect cardiovascular health
3. Chronic anger and hostility have been linked to increased risk of heart disease
4. Several meta-analyses of studies examining the association of anxiety and heart disease have been published, with the largest study from 2016 including a large number of participants (2)
5. An optimistic frame of mind has been shown to be associated  with healthy aging and a lower risk of heart disease including  stroke and heart failure, and a lower risk of all-cause  mortality(2)
6. A greater sense of purpose in life has been associated with better cardiovascular health, longevity, and reduced risk of heart disease including decreased risk of both heart attack and stroke(2)
7. Clinical depression can not only increase the risk of heart disease but also worsen an existing condition.

Does Depression Affect Our Heart?

Depression has been proven to be a such a risk factor in cardiac disease that the American Heart Association (AHA) has recommended that all cardiac patients be screened for depression

“When you experience depression, anxiety or stress your heart rate and blood pressure rise, there’s reduced blood flow to the heart and your body produces higher levels of cortisol, a stress hormone. Over time, these effects can lead to heart disease.” AHA 

AHA recommends using simple screening questions and an easy-to-administer survey called the Patient Health Questionnaire (PHQ-2).(1) PHQ-2  involves asking two screening questions for depression.

1. Over the past 2 weeks, have you felt down, depressed, or hopeless?
2. Over the past 2 weeks, have you felt little interest or pleasure in doing things?

If you answer yes to both of these questions, there is a high likelihood of clinical depression, and your health care provider can provide recommendations to help you get the treatment you need. Your health care provider can also administer the Patient Health Questionnaire 9 (PHQ-9), a nine-item question list that can better define your depression and guide treatment.

“Long-term studies reveal that men and women diagnosed with clinical depression are more than twice as likely to develop coronary artery disease or suffer a heart attack. In addition, heart patients are three times as likely to be depressed at any given time than the population as a whole.”

American Psychological Association

The  American Heart Association

Research linking mental and cardiovascular health has reached critical mass. In a scientific statement in 2021  commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health  and disease they state :

“Cardiovascular Disease (CVD)  should not be addressed as an isolated entity but rather as one part of an integrated system in which mind, heart, and body are interconnected. Both positive psychological status and negative psychological status appear to affect cardiovascular health  directly.” (2)

How Does Our Mental Health Affect Our Heart?

Psychological factors may influence heart health through

• direct changes in physical biology
• indirect effects on behaviors that influence cardiac  health
• resources that buffer detrimental effects of stressful experiences

A Cause and a Result?

Depression can be both a cause of and a result of cardiovascular (heart) disease. Even mild depression is a common and significant risk factor for developing heart disease and can also raise the risk of future cardiovascular complications.

Here are a few ways heart disease and depression are linked

The Inflammation Link

For decades, researchers have been investigating a potential association between inflammation and depression(2). The studies to date confirm people with depression often have elevated blood markers for inflammation. One recent study of more than 43,000 women concluded that eating an ‘inflammatory diet’ correlated with an increased risk of developing depression.

Foods to Limit on an Anti-inflammatory Diet

• Alcohol
• Fast food and fried foods of all kinds
• ‘Processed’ foods like lunch meats and hot dogs
• Meats, especially red meats like beef and pork
• Refined grains, such as breads or tortillas made with white flour
• Snack foods like packaged chips and crackers
• Sugar, including table sugar, sodas, candy and anything else that contains added sugar
• Trans fats of all kinds, including margarine

Foods to Eat on an Anti-inflammatory Diet

The Mediterranean Diet is naturally anti-inflammatory, and you can easily access information on how to adopt this heart-healthy eating pattern that may also benefit depression and heart heath.

Biological Processes (3)

• Anger and hostility are associated with increased platelet aggregation and inflammation (2)
• Patients with depression have been shown to have

• • •  increased platelet reactivity
    • decreased heart variability
    • increased inflammation markers (such as C-reactive protein or CRP)

which are all risk factors for cardiovascular disease and can increase the risk of an adverse cardiac event such as a heart attack or blood clots.

• Some studies demonstrate associations of depression with higher concentrations of LDL (low-density) and VLDL (very-low-density lipoprotein cholesterol) whereas higher psychological health has been linked to elevated HDL (high-density lipoprotein cholesterol levels) only.(2)
• Chronic persistent stress can also lead to increased sympathetic tone, decreased vagal tone, decreased heart rate variability, and increased arterial stiffness and endothelial dysfunction (2)

Depression links to lifestyle factors that contribute to heart disease

• poor eating and over eating
• inactivity
•  drug or alcohol abuse
• social isolation
• smoking
• weight gain
• medication non compliance
• missed preventive health screenings

Common symptoms of depression and heart disease

• low energy
• sleep problems
• irritability
• lack of physical activity

Assessing Depression

Early detection and treatment of depression in heart patients are crucial to improve a patient’s quality of life and possibly prevent a recurrent coronary event. Studies have shown for people with heart disease, depression can increase the risk of an adverse cardiac event such as a heart attack or blood clots.

So What Can You Do?

I believe we all have an inborn, innate capacity to meet stress head on and transform stress into growth. I see it every day. We are resilient. We are able to bounce back and learn. Considering the important effect stress and psychological states have on our heart, it is important to build resilience.

Resilience won’t make your problems go away — but resilience can give you the ability to better handle stress. A large body of research shows that experiencing more stress than we can cope with and adapt to isn’t good for cardiovascular health — or our ability to develop heart-healthy habits. That’s true for both men and women. If you aren’t as resilient as you’d like to be, you can develop skills to become more resilient.

CLICK HERE for my FREE EBOOK “Mental Well-Being and Resilience A Self-Care Guide” This eBook is filled with Self-Care strategies to support your mental and physical health and help you build resilience. NOTE This information does not constitute medical advice. This is compiled for educational purposes only. Your doctor knows you best. Talk to your doctor for specific questions about your personal health.

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THE DR KAREN HEALTH SHOW podcast series titled “Is There A Mind/Heart Connection? CLICK HERE FOR PART 1 CLICK HERE FOR PART2

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REFERENCES

1. Litchman JH, et al. Depression and coronary heart disease: Recommendations for screening, referral and treatment. A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, Oct 21 2008. 118(17):1768-1775.
2. Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Lifestyle and Cardiometabolic Health. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation.2021;143:e763–e783. doi: 10.1161/CIR.0000000000000947

3. Giovanni Amodeo Maria Allegra Trusso and Andrea Fagiolini Depression and Inflammation: Disentangling a Clear Yet Complex and Multifaceted Link Neuropsychiatry (2017) Volume 7, Issue 4

4. Depression & Heart Disease article HERE