The Links Between Heart Disease and Mental Health

Research shows veterans, people with PTSD and their partners, racial minorities and women are at higher risk of developing heart conditions resulting from poor mental health.

Mental health is an important part of overall health and refers to a person’s emotional, psychological, and social well-being. Mental health involves how we think, feel, act, and make choices.

Mental health disorders can be short- or long-term and can interfere with a person’s mood, behavior, thinking, and ability to relate to others. Various studies have shown the impact of trauma, depression, anxiety, and stress on the body, including stress on the heart.^(1-3)

What mental health disorders are related to heart disease?

Some of the most commonly studied mental health disorders associated with heart disease or related risk factors include the following:

• Mood Disorders: People living with mood disorders, such as major depression or bipolar disorder, find that their mood affects both psychological and mental well-being nearly every day for most of the day.
• Anxiety Disorders: People respond to certain objects or situations with fear, dread, or terror. Anxiety disorders include generalized anxiety, social anxiety, panic disorders, and phobias.
• Post-Traumatic Stress Disorder (PTSD): People can experience PTSD after undergoing a traumatic life experience, such as war, natural disaster, or any other serious incident.
• Chronic Stress: People are in a state of uncomfortable emotional stress—accompanied by predictable biochemical, physiological, and behavioral changes—that is constant and persists over an extended period of time.

What is the connection between mental health disorders and heart disease?

A large and growing body of research shows that mental health is associated with risk factors for heart disease before a diagnosis of a mental health disorder and during treatment. These effects can arise both directly, through biological pathways, and indirectly, through risky health behaviors.⁽⁴⁾

People experiencing depression, anxiety, stress, and even PTSD over a long period of time may experience certain physiologic effects on their bodies, such as increased cardiac reactivity (e.g., increased heart rate and blood pressure), reduced blood flow to the heart, and heightened levels of cortisol. Over time, these physiologic effects can lead to calcium buildup in the arteries, metabolic disease, and heart disease.

Evidence shows that mental health disorders—such as depression, anxiety, and PTSD—can develop after cardiac events, including heart failure, stroke, and heart attack.⁽⁴⁾ These disorders can be brought on after an acute heart disease event from factors including pain, fear of death or disability, and financial problems associated with the event.⁽⁵⁾

Some literature notes the impact of medicines used to treat mental health disorders on cardiometabolic disease risk. The use of some anti-psychotic medications has been associated with obesity, insulin resistance, diabetes, heart attacks, atrial fibrillation, stroke, and death.⁽⁶⁾

Mental health disorders such as anxiety and depression may increase the chance of adopting behaviors such as smoking, inactive lifestyle, or failure to take prescribed medications.⁽⁵⁾ This is because people experiencing a mental health disorder may have fewer healthy coping strategies for stressful situations, making it difficult for them to make healthy lifestyle choices to reduce their risk for heart disease.⁽⁴⁾

Who is most at risk from higher rates of heart disease from mental health disorders?

Specific populations, such as the following, show higher rates of heart disease as a result of pre-existing mental health disorders:

• Veterans. Studies found that veterans are at a higher risk for heart disease, mainly due to PTSD as a result of combat.
• Women. Studies exclusively focused on women found that PTSD and depression may have damaging effects on physical health, particularly with increased risk for coronary heart disease (CHD)–related morbidity and mortality.^(7,8)
• Couples with someone who has PTSD. Comparative studies found that couples where one or both partners had PTSD experienced more severe conflict, greater anger, and increased cardiovascular reactivity to conflict discussions than couples where neither partner had PTSD. Anger and physiological stress responses to couple discord might contribute to CHD and heart disease risk within these relationships.^(9,10)
• Racial and ethnic minorities. Studies focused on racial or ethnic minority groups found that depression, stress, and anxiety due to disparities in social determinants of health,⁽¹¹⁾ adverse childhood experiences,⁽¹²⁾ and racism/discrimination⁽¹³⁾ could place certain subpopulations at a higher risk for hypertension, cardiovascular reactivity, heart disease, and poor heart health outcomes.

How to reduce your risk if you fall into one of these categories

Recognize the signs and symptoms of mental health disorders and heart disease. For mental health you can make yourself aware of the following conditions and be on the lookout for any symptoms you may be experiencing.

Anxiety Disorders: People with anxiety disorders respond to certain objects or situations with fear and dread. Anxiety disorders can include obsessive-compulsive disorder, panic disorders, and phobias.

Behavioral Disorders:Behavioral disorders involve a pattern of disruptive behaviors in children that last for at least 6 months and cause problems in school, at home and in social situations. Examples of behavioral disorders include Attention Deficit Hyperactive Disorder (ADHD), Conduct Disorder, and Oppositional-Defiant Disorder (ODD).

Eating Disorders: Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Eating disorders can include anorexia, bulimia, and binge eating.

Mental Health and Substance Use Disorders: Mental health problems and substance abuse disorders sometimes occur together.

Mood Disorders: Mood disorders involve persistent feelings of sadness or periods of feeling overly happy, or fluctuating between extreme happiness and extreme sadness. Mood disorders can include depression, bipolar disorder, Seasonal Affective Disorder (SAD), and self-harm.

Obsessive-Compulsive Disorder: If you have OCD, you have repeated, upsetting thoughts called obsessions. You do the same thing over and over again to try to make the thoughts go away. Those repeated actions are called compulsions.

Personality Disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and may cause problems in work, school, or social relationships. Personality disorders can include antisocial personality disorder and borderline personality disorder.

Psychotic Disorders: People with psychotic disorders experience a range of symptoms, including hallucinations and delusions. An example of a psychotic disorder is schizophrenia.

Suicidal Behavior:Suicide causes immeasurable pain, suffering, and loss to individuals, families, and communities nationwide.

Trauma and Stress Related Disorders: Post-traumatic stress disorder (PTSD) can occur after living through or seeing a traumatic event, such as war, a hurricane, rape, physical abuse or a bad accident. PTSD makes you feel stressed and afraid after the danger is over.

Heart Related symptoms to be on the lookout for include

• Chest pain or discomfort that doesn’t go away after a few minutes
• Pain or discomfort in the jaw, neck or back
• Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat.
• Pain or discomfort in the arms or shoulder
• Shortness of breath

If you think that you, or someone you know, is having a heart attack, call 9-1-1 immediately. Lastly, here are a few more things you can address to ensure both your mental and heart health.

• Talk with your health care professionals about potential heart conditions in relation to your mental health disorder and treatment options.
• Know that your family history and genetic factors likely play some role in your risk for heart disease.
• Know which conditions increase the risk of heart disease.
• Maintain a healthy lifestyle. Regular exercise and access to fresh food and a balanced diet are key for both mental and heart health.

References

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2. Del Gaizo AL, Elhai JD, Weaver TL. Posttraumatic stress disorder, poor physical health and substance use behaviors in a national trauma-exposed sample. Psychiatry Res 2011;188(3):390–5.
3. Sowden GL, Huffman JC. The impact of mental illness on cardiac outcomes: a review for the cardiologist. Int J Cardiol 2009;132(1):30–7.
4. Abed MA, Kloub MI, Moser DK. Anxiety and adverse health outcomes among cardiac patients: a biobehavioral model. J Cardiovasc Nurs 2014;29(4):354–63.
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7. Kubzansky LD, Koenen KC, Jones C, Eaton WW. A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women. Health Psychol 2009;28(1):125–30.
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9. Caska CM, Smith TW, Renshaw KD, Allen SN, Uchino BN, Birmingham W, et al. Posttraumatic stress disorder and responses to couple conflict: implications for cardiovascular risk. Health Psychol 2014;33(11):1273–80.
10. Troxel WM, DeSantis A, Germain A, Buysse DJ, Matthews KA. Marital conflict and nocturnal blood pressure dipping in military couples. Health Psychol 2017;36(1):31–4.
11. Belgrave FZ, Abrams JA. Reducing disparities and achieving equity in African American women’s health. Am Psychol 2016;71(8):723–33.Lehman BJ, Taylor SE, Kiefe CI, Seeman TE. Relationship of early life stress and psychological functioning to blood pressure in the CARDIA study. Health Psychol 2009;28(3):338–46.
12. Lehman BJ, Taylor SE, Kiefe CI, Seeman TE. Relationship of early life stress and psychological functioning to blood pressure in the CARDIA study. Health Psychol 2009;28(3):338–46.
13. Moody DLB, Chang YF, Pantesco EJ, Darden TM, Lewis TT, Brown C, et al. Everyday discrimination prospectively predicts blood pressure across 10 years in racially/ethnically diverse midlife women: study of women’s health across the nation. Ann Behav Med 2019;53(7):608–20.