The Link Between Mental Health and Cardiovascular Disease: Breaking Down the Connection

For ages, the connection between the mind and body has been theorized. These discoveries indicate that depression and anxiety are not merely "in the mind." They are genuine illnesses akin to any other physical ailments and can adversely affect the entire body, including the cardiovascular system.

Despite extensive research demonstrating a clear link between mental health and cardiovascular diseases, patients with conditions such as coronary disease, myocardial infarction, heart failure, and arrhythmias are often not evaluated for psychological distress or mental illness as potential contributors to or outcomes of their cardiovascular disorders.Psychological distress and mental distress encompass a range of symptoms and experiences within an individual's inner life that are commonly perceived as troubling, confusing, or abnormal. Mental distress extends beyond the confines of the term "mental illness," which denotes explicitly medically defined conditions. Individuals experiencing mental distress may exhibit symptoms such as anxiety, emotional confusion, hallucinations, anger, and depression without meeting the criteria for a medical diagnosis of mental illness. Various life circumstances, including grief, stress, job loss, sleep deprivation, substance abuse, trauma, abuse, or accidents, can precipitate mental distress. While mental distress may resolve without medical intervention, it can serve as a trigger for cardiovascular events.

The presence of overlapping symptoms between cardiovascular disease and mental distress, such as palpitations, chest tightness, and shortness of breath, poses challenges for physicians and patients in discerning a causal or related role for mental health. Primary care physicians and cardiologists typically focus on managing symptoms and mitigating risk factors, often leaving limited time to address emotional well-being. Additionally, societal stigma surrounding mental illness historically inhibits open discussions about mental health among patients and their families.

This blog underscores the significance of mental health and its associations with cardiovascular disease, highlighting the need for greater recognition and integration of mental health considerations in the management of cardiovascular conditions.

Depression and Cardiovascular disease

Depression is significantly more prevalent among patients with cardiovascular disease, with rates approximately three times higher than those observed in the general population. However, depression remains frequently underdiagnosed within medical settings. Recognized as a significant risk factor for coronary heart disease, akin to conditions like hyperlipidaemia, diabetes, hypertension, and smoking, depression poses a substantial health concern.

Adults grappling with depression, whether with or without prior cardiovascular disease, face an approximate 80% increase in the risk of developing new or exacerbating existing cardiovascular complications, including heightened rates of hospitalizations and mortality. Moreover, depression commonly coexists with conditions such as angina, amplifying the risk of adverse cardiac events such as myocardial infarction, stroke, sudden death, and atrial fibrillation.

The relationship between depression, anxiety, and cardiovascular disease is bidirectional. Both depression and anxiety can elevate the risk of developing cardiovascular disease, while the presence of cardiovascular disease can, in turn, heighten the likelihood of experiencing depression and anxiety. This reciprocal association underscores the importance of addressing mental health concerns as an integral component of comprehensive cardiovascular care to enhance patient outcomes.

Anxiety, psychological distress, and cardiovascular disease

Although the evidence is not as robust as for depression, anxiety, anger, and stress have been implicated in increasing the risk of cardiovascular disease. Even general anxiety related to daily tasks, without meeting the diagnostic criteria for generalized anxiety disorder, along with psychological distress encompassing anger and stress, has been linked to the development and exacerbation of cardiovascular diseases. Furthermore, the impact of these psychological factors may be cumulative, with repeated episodes associated with a heightened risk of cardiovascular diseases, as well as symptoms mirroring cardiovascular conditions such as chest pain and palpitations, even in the absence of structural or functional heart abnormalities.

While anxiety disorders are typically characterized by chronicity, acute episodes of anxiety and negative emotions like anger, fear, and severe emotional stress can trigger the release of adrenaline, temporarily elevating blood pressure and causing arterial constriction. These physiological responses can precipitate myocardial infarction, including classic infarction or the "broken heart syndrome," and induce cardiac irregularities such as atrial fibrillation, atrial flutter, tachycardia, premature ventricular contractions, and even sudden death. Repeated temporary spikes in blood pressure may also contribute to plaque disruption, increasing the risk of myocardial infarction or strokes. In individuals with a weakened aorta, such as those with aortic aneurysm or survivors of aortic dissection, these fluctuations in blood pressure can lead to aortic dissection or rupture.

Recommendations

Mental distress and mental illnesses carry significant potential for severe cardiovascular consequences. Therefore, it is crucial for patients to openly discuss their mental health concerns with their healthcare provider regularly. Clinicians should also prioritize assessing the mental well-being of their patients, as mental illnesses often go undetected.

Smoking is a well-known risk factor for heart diseases and disorders, exacerbating feelings of stress and depression. While individuals may experience temporary relaxation from smoking, it often leads to heightened irritability and anxiety in between cigarettes. Eliminating this harmful habit is essential for promoting a healthy heart and mind.

High cholesterol levels also contribute to the risk of cardiovascular diseases and disorders. Adopting a diet low in cholesterol can significantly reduce the likelihood of heart-related conditions and concurrent mental illness. Incorporating fruits and vegetables as the main components of meals instead of fatty meats can positively impact heart health and mental well-being. Additionally, maintaining a healthy diet plays a pivotal role in combating obesity, another risk factor for poor heart health and mental illness.

Both medication and non-medication interventions, such as cognitive-behavioural therapy, mindfulness meditation, yoga, transcendental meditation, slow breathing exercises, and regular exercise, serve as effective treatment options. These interventions have the potential to reverse many cardiovascular changes associated with mental distress and mental illness. Engaging in moderate-intensity aerobic exercise for at least 30 minutes on five or more days per week has significantly reduced the risk of myocardial infarction and mortality from cardiovascular disease.

It's essential to remember that if you're experiencing depression, anxiety, or stress as a result of heart disease or stroke, seeking follow-up care is crucial. Collaborate closely with your healthcare provider to address both your mental well-being and heart health effectively. Book your appointment now.