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Psychological Health – Good or Bad – Plays an Important Role in Heart Disease

CardioSmart News

When treating heart disease, the focus is traditionally on blood pressure and cholesterol levels. These are well-known risk factors for heart disease and relatively easy to measure.

But there is growing evidence that mental health and well-being, which is not routinely talked about during medical visits, can play a harmful or protective role when it comes to one’s heart health and should be addressed, according to a scientific statement from the American Heart Association.

The authors carefully reviewed more than 120 studies that evaluated the relationship between psychological health – both good or bad – and heart heath. Their findings, which they summarize in the report, underscore the urgent need for patients and clinicians alike to be aware of and have an open dialogue about the connection between mental health and physical health.  

“Wellness and well-being involve not only physical factors but also psychological ones. Clinicians should strive to treat not just the disease state but the patient and the person as a whole,” the authors wrote. “Cardiovascular disease 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.”

In studies, depression was linked to a 30% higher chance of having a heart attack and a more than 40% greater risk of stroke or high blood pressure, which is among the strongest risk factors for heart disease. Similarly, work-related stress was associated with a 40% higher risk of heart disease and related events. Stress from other sources – for example, financial hardships, difficult relationships, discrimination, stressful experiences in childhood, or exposure to other traumatic events – was also associated with a higher risk of heart disease.

On the other hand, people who reported feelings of optimism, gratitude, mindfulness and other positive psychological traits were less likely to have a stroke, heart disease or related risk factors.

Negative psychological health, according to the statement, includes things like depression, anxiety, work-related stress, loneliness, angry or hostile feelings, and expecting the worst or seeing the glass as half empty. Positive emotional health included factors such as happiness, optimism, having a sense of purpose in life, gratitude, being tuned into one’s thoughts and emotions (mindfulness), and generally content.

Mental health may directly and indirectly affect heart health

Conditions such as depression, ongoing stress, anxiety, and anger have been associated with greater inflammation, higher blood pressure, changes in heart rate, more blood clotting, stiffness in the arteries and reduced blood flow to the heart. All of these can set the stage for heart disease or related events.

Mental conditions or traits can also promote behaviors known to increase your chance of heart disease; for example, smoking, lack of exercise, poor eating, weight gain, and not taking medications as prescribed.

Those who were mentally healthy were more likely to engage in heart-healthy behaviors and had lower blood pressure, blood sugar and cholesterol.

Time to tune into mental health

In their statement, the authors call for clinicians to ask about and use simple screening tools for depression and anxiety to be able to assess the psychological health of patients who have or are at high risk for heart disease or stroke.

“There is a substantial body of good-quality data showing clear associations between psychological health and cardiovascular disease and risk. … [These data] suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health,” the authors concluded.

These may include referral to a mental health professional, medication, stress management, exercise therapy, and other types of self-care that can benefit mental health and heart health; for example, meditation, starting a gratitude journal, or finding hobbies or activities that bring someone joy and a deeper connection to others.

Nearly 1 in 5 U.S. adults had a mental illness in 2019, according to the National Institute of Mental Health. A year into the COVID-19 pandemic, it’s likely that more people are suffering given the stress and ongoing worry and isolation many of us have felt. Tuning into one’s mental health is as important as ever. So be sure to talk openly with your care team if you have been feeling particularly down, depressed or anxious.

For more information, visit CardioSmart.org/HealthyLiving

Psychological Health, Well-Being, and the Mind-Heart-Body: A Scientific Statement From the American Heart Association,” Circulation, Jan. 25.

Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.
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