- New research has highlighted mental health’s influence on heart disease risk.
- A study found people with mental health disorders were up to three times more likely to experience heart health concerns.
- Mental disorders may influence heart health through ways such as inflammation, high blood pressure, and oxidative stress, according to experts.
A new study has found that certain mental health conditions including anxiety, depression and insomnia may increase the risk of heart disease.
Cardiovascular disease (CVD) is the leading cause of death among men and women in the United States, accounting for 1 in every 5 deaths.
Various factors are believed to increase an individual’s risk of heart disease, ranging from genetics and ethnicity to lifestyle factors, such as smoking and lack of exercise.
Previous studies have also explored the influence of mental health disorders on heart disease risk.
Findings from an extensive new analysis published May 8 in the European Journal of Preventive Cardiology suggest there may be a significant association.
And while heart disease is often associated with older individuals, the researchers in this study wanted to explore the link in earlier years, and saw risk was also elevated for those in their 20s and 30s.
Mental health disorders linked to greater risk of heart disease
The study authors searched the Korean National Health Insurance Service database for individuals ages 20 to 39. After excluding those with a history of myocardial infarction known as heart attack or stroke, they were left with 6,557,727 adults, all of whom underwent health examinations between 2009 and 2012.
Of this group, 856,927 (13.1%) had at least one mental health disorder, with almost half (47.9%) experiencing anxiety. A large proportion of the remaining participants had depression and insomnia (21.2% and 20%, respectively). Other concerns included bipolar disorder, eating disorders, post-traumatic stress disorder (PTSD), and substance use disorder.
The health statuses of all participants were then monitored for an average of 7.6 years, until December 2018. In this period, a total of 16,133 myocardial infarctions and 10,509 strokes were reported.
The research team then looked at the correlation between mental health disorders and CVD, taking into account additional risk factors such as age, sex, income, physical activity, smoking and drinking habits, and health concerns including diabetes and kidney disease.
They found that participants diagnosed with a mental health disorder were up to three times more likely to experience either a heart attack or stroke compared to those who did not have mental health concerns.
The level of elevated heart disease risk varied between mental health disorders. For instance, individuals with PTSD were 213% more likely to experience a heart attack, and those with schizophrenia 161% more likely. While anxiety accounted for the majority of mental health disorders noted, this only related to a 53% increased risk.
Despite those with PTSD being at the highest risk of CVD, the researchers found their risk of stroke was not elevated. This was also the case for individuals with eating disorders.
Dr. Majid Basit, a cardiologist with Memorial Hermann in Houston, highlighted that these findings contradict many previous studies. However, the researchers did not offer any potential explanations for this differing outcome, simply stating that more investigation is required.
Risk profile associations with sex and age
The research team also explored how the results varied between age groups and sex. Those in their 20s with anxiety, depression, personality disorder, or schizophrenia, were at greater risk of heart attack than those in their 30s with these mental health concerns.
So why might age be a factor?
“It is difficult to know for sure, but it would be important to point out that mental health disorders can have varying effects on individuals at different stages of life,” said Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica.
Those of this age “are often in a period of transition, such as starting a new job, attending a new educational institution, or moving to a new city,” he told Healthline. “This can be stressful and may exacerbate mental health symptoms.”
Furthermore, he continued, “individuals in their 20s may be more likely to take on unhealthy coping mechanisms and also engage in riskier behaviors, further increasing their risk of cardiovascular events.”
“Older patients tend to be more mature,” Basit added, “and more likely to seek mental health counseling and support from friends and family.”
Regarding differences in sex, women with depression or insomnia were found to be more likely to experience heart attack or stroke compared to men.
Dr. Wafi Momin, a cardiologist with UTHealth Houston Heart & Vascular and Memorial Hermann, said that heart disease in women is underrecognized, while women are also more likely than men to be diagnosed with anxiety and depression.
“Naturally, these two occurrences likely tend to result in a statistic that shows higher occurrence of heart disease in women compared to men,” he told Healthline.
Dr. Trent G. Orfanos, director of integrative and functional cardiology at Case Integrative Health in Chicago, Illinois, highlighted that hormone differences between women and men might also play a role. Mental health can lead to physiological concerns (such as inflammation) that may impact estrogen’s “protective” properties.
However, he noted this potential association “would have to be investigated by further studies.”
Why mental health may influence heart disease
In recent years, there’s been plenty of talk about how the brain and gut are linked. But the association between the brain and heart is also significant and “a commonly overlooked issue,” said Momin.
Experts believe poor mental well-being may influence heart health in various ways. That said, it’s important to understand that “while having a mental health problem may increase the risk of developing heart disease, it doesn’t guarantee somebody will get [it],” said Dr. Robert Segal, a board-certified cardiologist, founder of Manhattan Cardiology, Medical Offices of Manhattan, and co-founder of LabFinder.
Those with mental disorders typically have higher oxidative stress markers, said Orfanos.
“Essentially, oxidative stress refers to the imbalance between free radicals and antioxidants in your body,” he explained. “When free radicals are not balanced by antioxidants, they can damage your body, leading to many chronic diseases including high blood pressure and heart disease.”
The relationship between mental health and inflammation is somewhat cyclical: Mental disorders can lead to inflammation, while higher inflammation has been linked to increased risk of developing a mental health concern.
Additionally, “a risk factor for heart disease is chronic inflammation,” said Segal.
Chronic stress, for instance, “can cause the body to become inflamed,” he told Healthline, with cortisol, the body’s stress hormone, being a leading player in inflammation.
Autonomic nervous system dysfunction
“Some mental disorders can impact the autonomic nervous system (ANS),” explained Segal. This system “regulates uncontrollable body processes, like blood pressure and heart rate.”
When the ANS is unable to function correctly, “heart rhythm irregularities and a higher risk of heart disease can result,” he said.
High blood pressure and cholesterol
Various mental health concerns are linked with higher blood pressure and cholesterol levels — two factors highly implicated in heart disease.
Studies have found those with depression and PTSD are at greater risk of higher blood pressure, while others have linked anxiety and schizophrenia to increased cholesterol.
Some with mental health concerns engage in unhealthy behaviors to help manage or cope with their disorder.
Data from the 2018 National Survey on Drug Use and Health found that 9.3 million Americans had a concurring mental health disorder and substance use disorder. Meanwhile, government figures state around 70% of those with bipolar disorder or schizophrenia regularly smoke.
However, these behaviors “can lead to the development of conditions like hypertension, hyperlipidemia, or diabetes mellitus, all of which are risk factors for heart disease,” said Tadwalkar.
Around 16% of those with mental health disorders take prescription drugs to help manage their condition.
But “[these] can have side effects that impact cardiovascular health,” said Tadwalkar.
For instance, “some psychotropic medications, such as certain antidepressants or antipsychotic agents, can lead to weight gain, metabolic changes, and an increased risk of cardiovascular complications,” he said.
Lifestyle choices to reduce heart disease risk
The researchers noted that, among young patients with mental health disorders, “CVD risk prevention efforts are needed.”
As with many health concerns, engaging in healthy lifestyle behaviors can potentially aid in reducing heart disease risk — while simultaneously aiding mental health.
Orfanos said that “those with diagnosed mental disorders should not despair at this study or feel a great amount of fear for their cardiovascular health. Take it as inspiration to continue making healthy choices every day.”
Some beneficial steps to consider adopting include:
- Exercise regularly. “The American Heart Association advises engaging in at least 75 minutes of intense activity or 150 minutes of moderate exercise each week,” Segal said. This could involve anything from brisk walking to cycling to swimming.
- Follow a healthy diet. Segal recommended eating a diet rich in fruit and veg, whole grains, healthy fats, and lean proteins. He also suggested limiting your sugar, salt, and processed food intake.
- Cut down on alcohol. “For those who have difficulty moderating their alcohol consumption, cessation is best,” said Tadwalkar. “Otherwise, individuals should aim for 1 to 3 drinks per week if they choose to consume.”
- Don’t smoke. Smoking significantly increases risk of heart disease — with the habit linked to a quarter of CVD deaths.
- Get a good night’s rest. Quality sleep is vital for mental and heart health. Aim for 7 to 8 hours each night, said Orfanos, and put screens away an hour before bedtime.
- Reduce stress. Segal said that engaging in yoga, meditation, or deep breathing activities can help manage stress and reduce CVD risk.
- Stick to your treatment plan. Check in regularly with your healthcare provider and take prescribed medication as recommended, said Tadwalkar, so you can “more swiftly and effectively manage mental health issues and cardiovascular risk factors simultaneously.”
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