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Mental Health and Cardiovascular Disease

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For centuries, the mind–body relationship has been postulated. These findings suggest that depression and anxiety are not simply “in the mind.” They are real illnesses, like any other physical illnesses, and can negatively impact the entire body, including the cardiovascular system.

Despite the abundance of investigation and demonstration of a clear relationship between mental health and cardiovascular diseases, patients with coronary disease, myocardial infarction, heart failure, and arrhythmias are rarely assessed for psychological distress or mental illness as a contributor to or resulting from the cardiovascular disorder. Psychological distress and mental distress are terms used to describe a range of symptoms and experiences of a person’s internal life that are commonly held to be troubling, confusing, or out of the ordinary. Mental distress has a wider scope than the related term, “mental illness.” Whereas mental illness refers to a specific set of medically defined conditions, a person in mental distress may exhibit some of the symptoms described in psychiatry, such as anxiety, confused emotions, hallucination, anger, and depression without actually being “ill” in a medical sense. A wide range of life situations, including bereavement, stress, loss of a job, sleep deprivation, alcohol or drug use, assault, abuse or accidents, can induce mental distress. This may resolve without further medical intervention, yet may be a trigger for cardiovascular events.
The overlap of symptoms of cardiovascular disease such as palpitations, chest tightness, and shortness of breath that occur in healthy persons, including those due to stress, makes it very difficult for physicians and their patients to assign a causal or related role to mental health. Primary care physicians and cardiologists focus on treating symptoms and risk factors, which leaves little time to address feelings and emotions. Further, because of the social stigma that has traditionally existed around mental illness, patients and families may be hesitant to discuss mental health. The purpose of this commentary is to underscore the importance of mental health and its associations with cardiovascular disease.

Depression and Cardiovascular Disease

The prevalence of depression in patients with cardiovascular disease is threefold higher than that in the general population. Depression is underdiagnosed in the medical setting.1234 The American Heart Association recommends that depression be recognized as a major risk factor for coronary heart disease, similar to hyperlipidemia, diabetes, hypertension, and smoking. There is about an 80% increase in the risk of developing new or worsening cardiovascular disease (ie, more complications or hospitalizations), as well as death from cardiovascular diseases in adults with depression with or without prior cardiovascular disease.3567 Depression is also common in patients who have angina and can increase the risk of developing myocardial infarction,5stroke, sudden death, and atrial fibrillation.4567 The relationship between depression and anxiety and cardiovascular disease is bidirectional.3 In other words, depression and anxiety can increase the risk of developing cardiovascular disease; cardiovascular disease can increase the risk of developing depression and anxiety, and each may lead to a worse outcome.3

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-Ashish Chaddha, MD, Elizabeth A. Robinson, PhD, MSW, Eva Kline-Rogers, NP, Tina Alexandris-Souphis, BSN, RN, Melvyn Rubenfire, MD

This article originally appeared in the November 2016 issue of The American Journal of Medicine.

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