AHA: Mental Health Plays a Role in Treating and Preventing Heart Disease

Researchers are stressing the important links between your mental health and heart health. And they're calling on clinicians to screen and address mental health when seeking to treat heart conditions.

In a scientific statement published in the journal Circulation on January 25, the American Heart Association (AHA) examined new research about the connection between the two. A team of scientists was assembled by the AHA to summarize and analyze studies on the connections between heart and mental health. The goal was to clarify the links and identify possible preventative measures.

Based on their findings, the researchers are calling for clinicians to consider cardiovascular health and treat heart disease in the context of patients' psychological well-being. In the study, the authors wrote that "cardiovascular disease (CVD) 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."

"It's a kind of evidence that's beginning to accumulate," Darwin R. Labarthe, MD, PhD, MPH, professor of preventive medicine at Northwestern University in Chicago, tells Verywell. "And it says there are ways that people cope with the vicissitudes of life that enable them to be healthier and happier. They seem so simple that you question how can they make any difference?"

The Study

A group of over ten authors with specialties ranging from geriatric psychiatry to epidemiology collected studies on psychological wellbeing and cardiovascular health, risk, and disease. Through their analysis, they identified key trends in the data, including that "specific emotional experiences have distinct neurobiological and behavioral features," that uniquely contribute to the risk for CVD.

More specifically, conditions such as depression, chronic stress, anxiety, anger, pessimism, and dissatisfaction with life are associated with:

• An irregular heartbeat
• Increased blood pressure
• Digestive issues
• Inflammation
• Reduced blood flow to the heart

Mental health conditions can also be associated with behaviors that increase the risk of CVD, such as smoking, unhealthy diet, and lack of exercise.

Recommendations

The authors recommended that mental health screening become integrated into treatment for people with heart disease, as well as those who are at risk for it.

In addition, patients should be able to access treatment that is specifically aimed at improving their mental wellbeing, like psychotherapy, stress reduction therapy, meditation training, and mindfulness-based interventions.

These treatments can foster emotions that were found to lower risk for CVD, such as optimism, gratitude, sense of purpose, and mindfulness—emotional states that have been linked to lower blood pressure, better glucose control, lower cholesterol, and less inflammation.

Understanding the Connection

There are many factors that determine someone's risk for heart disease and it can be difficult to account for all of them. However, Helen Lavretsky, MD, researcher, professor, and geriatric integrative psychiatrist at the University of California, Los Angeles, tells Verywell that the connection between heart and mental health is "bidirectional, clearly."

There are links between heart-related illness, hospitalization rate, mortality rate, and emotional state.

Thinking (and Feeling) Positive

Lavretsky says that positive emotional states, like optimism and resilience, are protective factors from heart-related complications. Even if you have heart disease, "whether or not you're prone to be more negative or positive will affect how you live with the illness," Lavretsky says.

There are plenty of illustrative examples of how your mind can affect your heart; think of the tight feeling in your chest when you're anxious. However, Lavretsky says it's important to recognize these mechanisms are not the only factors at play in someone with anxiety and depression.

Stress and Your Heart

The researchers also studied the heart health links to work-related stress, post-traumatic stress disorder (PTSD), social isolation and loneliness; and anger and hostility. They noted that pessimism (a tendency to "see the glass half empty" in life) ran the strongest risk for heart disease.

Lavretsky studies mindfulness and finds that how you see the world creates your reality. "If you're angry, you're anxious, and you're negative, that will be your reality, which will be disease-driven," she says. "I've been there myself."

On the flip side, if you're positive—"even in very stressful circumstances, like the pandemic, if you make an effort to keep positive, you may be able to avoid getting sick."

While it's intriguing, Lavretsky says that the link between positivity and heart health still needs more research.

The Mind-Body Connection

We see links between heart health and emotions, but what's happening on a molecular level? How do our feelings play out in very tangible ways in the body?

Lavretsky says that negative emotions overstimulate the stress response, leading to the release of excess stress hormones and inflammation. This is what contributes to heart disease as we age, but having even more stress—and earlier in life—can lead to more inflammation at a younger age, and therefore a shorter life.

To prevent early death related to heart complications, Lavretsky recommends activities that generate protective, positive emotions, such as yoga and tai chi. These can be helpful even for people who struggle with mental health and tend to have a pessimistic view of the world.

"Even if you were not born to be positive, there are ways to counteract this," Lavretsky says.

Practicing Joy and Gratitude

If stress-relieving remedies like yoga, tai chi, and meditation make you roll your eyes, Lavretsky says to just focus on joy. "The emotion of joy is what people are born to experience...the pursuit of happiness is the human storyline," she says. "Individuals have to decide what is joyous for them."

When you figure out what brings you joy—be it art, cooking, reading, or any number of activities, the next step is to make it a habit. "Practice joy every day," Lavretsky says. "First thing in the morning, last thing at night."

Gratitude is another emotion that can protect against heart disease. Being grateful, what Lavretsky called "the art of self-regulation," could include trying to focus on what's right instead of what's wrong—even if it's just a little bit every day—and feeling grateful for it.

The Pandemic's Effect

Lavretsky says that the pandemic may have led to an awakening—something like "a global experiment in stress response." If anything, it's shown us that we "have to have tools to deal with stress that we cannot control."

Even if we haven't used them much before, these tools aren't new: Optimism, gratitude, yoga, mindfulness, and breathing exercises have existed since ancient times. Labarthe says that many can even be called intuitive, and it's this "profound interest in intuition that makes science immensely valuable...The main message I take from this work is that there's a lot of science that helps to sort out these intuitions."

How Clinicians Can Help

The authors of the heart and mental health study recommend concrete and simple ways that clinicians can take mental health treatment into account when they are forming disease treatment and prevention for their patients.

"It doesn't involve doing a psychiatric examination," Labarthe says. "The idea is that there are ways that doctors can show interest and learn from patients about how they are thinking."

Examples of sample statements for different situations include:

• To address depression: “It seems like feeling down or even a little hopeless might be affecting the way you are taking care of yourself. Let’s think about how we can tackle this problem together.”
• To support optimism: “I have taken care of many patients with this kind of heart problem before, and many of them have done very well. I think you can, too.”
• To support positive affect: “There is a lot of research finding connections between feeling happy and satisfied with your life and your heart health. I want to really support you in taking time for yourself and engaging in _________ [fill in as appropriate, such as “hobbies” or “meaningful activities”]. Let’s think together about that.”

Even with improvements to clinical practice and an understanding of the connection between mental health and disease, Labarthe says that the ultimate question is, "How can we promote positive psychological health in the beginning?"

The most exciting research yet to come will study how positive psychology and improving mental health in the first place can prevent disease. "The potential is intuitively huge," Labarthe says. "And we need to accelerate the science that will help to bring that about."