Young and middle-aged adults who reported having severe psychological distress, such as depression or anxiety, after a heart attack were more than twice as likely to suffer a second cardiac event within five years compared with those who had mild distress,
according to research presented at the American College of Cardiology’s 70th Annual Scientific Session.
The study – the first to assess how mental health influences outcomes for younger heart attack survivors – bolsters evidence that psychological health plays an integral role in a person’s recovery after a heart attack.
“Our findings suggest that cardiologists should consider the value of regular psychological assessments, especially among younger patients,” said Mariana Garcia, MD, a cardiology fellow at Emory University in Atlanta and the study’s
lead author. “Equally importantly, they should explore treatment modalities for ameliorating psychological distress in young patients after a heart attack, such as meditation, relaxation techniques and holistic approaches, in addition to traditional
medical therapy and cardiac rehabilitation.”
The researchers analyzed health outcomes in 283 heart attack survivors between the ages of 18 and 61, with an average age of 51 years. Study participants completed a series of validated questionnaires measuring depression, anxiety, anger, perceived stress
and post-traumatic stress disorder within six months of their heart attack. Based on these questionnaires, the researchers established a composite score of psychological distress for each participant and grouped patients based on experiences of mild,
moderate and high distress.
Within five years after their heart attack, 80 of the 283 patients suffered a subsequent heart attack or stroke, were hospitalized for heart failure or died from cardiovascular causes. These outcomes occurred in nearly half (47%) of patients experiencing
high distress compared with 22% of those experiencing mild distress.
How does distress affect the heart? Previous studies suggest inflammation is one mechanism through which psychological distress may lead to heart problems. In this study, patients who experienced high distress were also found to have higher levels of
two inflammatory markers – interleukin-6 and monocyte chemoattract protein-1 – in their blood during rest and after mental stress. These markers, which increase during times of mental stress, are known to be associated with plaque buildup
in the arteries and adverse cardiac events.
“It is thought that those who have had a heart attack may be particularly vulnerable to plaque rupture as a result of these inflammatory mechanisms at play,” Garcia said. Further, the research suggests that these mechanisms of the body’s
response to stress may play a role in the likelihood of another cardiac event.
The researchers also found that patients with high distress were more often Black, female and from a disadvantaged socioeconomic background. They were also more likely to smoke or have diabetes or high blood pressure.
“[It] highlights the importance of socioeconomic status in regard to higher distress and raises important questions about the role of race, sex and other factors,” Garcia said.
The researchers plan to further investigate how socioeconomic and demographic factors may influence mental health among people who suffer a heart attack at a young age. Recent studies have suggested younger adults, especially women, account for an increasing
proportion of the heart attacks occurring each year in the U.S, Garcia said, calling attention to the need to improve outcomes in this population.
While there is greater awareness about traditional heart disease risk factors and the heart-healthy benefits of diet and exercise, many people – particularly younger people – may not know about the importance of mental health. “Our study
offers a strong message to people recovering from a heart attack that ameliorating psychological distress is equally important,” Garcia said.
Because this was an observational study, it only establishes a relationship between mental health and outcomes and can’t say one causes the other. It also relied on patients self-reporting distress.
For resources on managing stress, visit CardioSmart.org/Relax.