Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention. It’s obvious that the heart is a very important part of the body to monitor, but many people may not realize there is also a connection between good heart health and good mental health.
While the most commonly noted ways to prevent heart disease, according to the Mayo Clinic website, include exercising consistently, not smoking or using tobacco, eating healthy, and keeping fit, the American Heart Association website states there is a strong connection between heart and mental health. For the most part, heart health was only thought to be linked to mental health through behavior. For example, someone with depression might try to cope with their feelings by engaging in unhealthy habits like drinking, eating junk food, or smoking. However, it is becoming clear that the connection between the mind and the heart is more than behavioral.
Researchers think that the changes in body chemistry and biology that can lead to mental health problems could also predispose people to heart disease. Anxiety, depression, and stress are just a few mental health issues that can be associated with heart problems. Also, having heart problems could lead to depression or anxiety, due to lifestyle changes that occur with this type of chronic illness; and if these conditions are not treated, it can lead to more physical and mental health issues over time.
Jennifer Sanner, an assistant professor of nursing at the University of Texas Health Science Center at Houston School of Nursing, has personally worked on research linking depression and heart disease.
“Studies have already shown that individuals experiencing stress, anxiety, depression, along with other psychological disorders or symptoms (diagnosed or even mild symptoms considered sub-threshold) tend to develop heart disease at an earlier age, with greater severity, and experience worse cardiovascular long-term outcomes,” Sanner said in an e-mail.
These people also tend to have a lower quality of life, higher use of health-care services, and other comorbid conditions like insomnia and other physical health problems like stroke and diabetes, she added.
Sanner said that some factors that could link heart disease and mental health are “inflammatory responses,” “heightened blood clotting responses to imbalanced platelet serotonin levels,” and genetics.
It’s still uncertain whether, in general, heart issues directly lead to mental health issues, or the reverse, but it appears for now that it can go both ways. “Individuals with heart disease often report higher rates of depression, anxiety, stress, insomnia perhaps in response to their heart condition (change in quality of life, impact on activities of daily living, dealing with health care expenses, side effects from medications), while individuals with mental health issues often report higher rates of heart disease, high blood pressure, stroke [and] diabetes,” Sanner said.
She said it’s important to understand that the body and mind aren’t isolated.
“Mental illness is now being viewed as not just disorders of the brain or mind but disorders of the entire body system,” Sanner said. “Depression has been associated with lifestyle factors that are also traditional cardiovascular risk factors. For example, some research has shown that individuals with depression exercise less, smoke cigarettes, [have] poor compliance to health care regimens, etc., placing them at risk for or [making them] more prone to developing heart disease.”
Elizabeth Somer, a registered dietitian and author of Eat Your Way to Happiness and Food & Mood, said in an email that the connection between the brain and heart is so close that there are certain nutrients that benefit the health of both. She suggests consuming antioxidants and omega-3 fats like EPA and DHA to improve mental and heart health.
Dr. Michael W. Smith, the medical director and chief medical editor at WebMD, said in an email that the relationship between mental and heart health is close. Mental disorders or even stress from everyday life can affect heart health.
“Stress can directly damage the lining of blood vessels, including those that supply blood to the heart,” Smith said. “With stress, our blood vessels constrict, decreasing blood and nutrients that are delivered to the heart (as well as the other organs in the body). On top of that, hormonal changes associated with stress increase the likelihood that plaque buildup in the heart blood vessels will rupture, causing a heart attack. Indirectly, stress increases blood pressure, heart rate, and even cholesterol levels, all of which increase the chance of developing heart disease.”
Depression is a specific mental health issue that can harm heart health. “Depression and the heart hold common pathways, largely driven by hormonal influences,” Smith said. “With depression, cortisol, often called the stress hormone, increases. This in turn leads to increases in a whole host of other hormones that both constrict blood vessels (decreasing blood flow) and set off a series of events that can lead to blood clot formation (the cause of a heart attack). All this culminates in an increased risk of suffering a serious heart condition, including sudden cardiac death.”
However, other mental health issues like schizophrenia and anxiety can also affect heart health by their association with blood pressure and heart rate abnormalities, as well as irregular heart rhythm, which could all eventually lead to sudden cardiac death, he said.
He said it’s also important to note that the more severe the mental health condition, the more likely you are to suffer long term after any initial heart problems. “Even after coronary bypass surgery, those patients who develop depression, which is common, are twice as likely to suffer another heart event,” Smith said. “Major depression (clinical depression) is a significant predictor of subsequent heart problems following a major heart problem, such as a heart attack.”
Unfortunately, even if you treat heart problems with medication, some medications can actually lead to mental health issues. “Many medications can cause depression, including heart medicines,” Smith said. “Medications called beta blockers, which are used to treat both high blood pressure and heart disease, are some of the most common medications that can cause depression. Other blood pressure and heart medications, including calcium channel blockers, are also culprits. Even statins, used to lower cholesterol, may increase the risk of depression.”
Antidepressants could also harm heart health in some cases, although there is not yet much evidence to support this link. “The research points to a possible thickening of the artery walls, the blood vessels that deliver blood and nutrients to our organs, including the heart,” Smith said.
To prevent both mental and heart health issues, it’s necessary to live a healthy lifestyle and have a strong social support network. “While we don’t have the evidence yet to show that treating depression actually helps improve outcome from heart disease patients, when someone is depressed, it makes it increasingly difficult for them to take the necessary steps to help ensure a good recovery,” Smith said.
“When we’re depressed, we’re not as motivated to exercise, to eat right, to stop smoking, et cetera—all things that are so critical for the health of our heart,” he added. “Also, the strong link between mental and heart health only drives home the importance of social support following a heart problem. People with poor social support are more likely to suffer further heart problems and even die from their heart disease. This is true regardless of the severity of the heart disease, which drives home how important social connections are for our emotional wellness.”
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