Mental health is important to overall health, and heart disease prevention and treatment

Psychological health can positively or negatively impact a person’s health and risk factors for heart disease and stroke, according to “Psychological Health, Well-Being, and the Mind-Heart-Body Connection,” a new American Heart Association Scientific Statement, published today in the Association’s flagship journal Circulation. The statement evaluates the relationship between psychological health and heart health, summarizing ways to help improve psychological health for people with and at risk for heart disease.

“A person’s mind, heart and body are all interconnected and interdependent in what can be termed ‘the mind-heart-body-connection,'” said Glenn N. Levine, M.D., FAHA, master clinician and professor of medicine at Baylor College of Medicine, chief of the cardiology section at the Michael E. DeBakey VA Medical Center, both in Houston, and chair of the writing committee for the Scientific Statement. “Research has clearly demonstrated that negative psychological factors, personality traits and mental health disorders can negatively impact cardiovascular health. On the other hand, studies have found positive psychological attributes are associated with a lower risk of cardiovascular disease and mortality.”

Negative psychological health conditions include depression, chronic stress, anxiety, anger, pessimism and dissatisfaction with one’s current life. These conditions are associated with potentially harmful biological responses, such as:

• irregularities of heart rate and rhythm;
• increased digestive complaints;
• increased blood pressure;
• inflammation; and
• reduced blood flow to the heart.

Negative psychological health is also associated with health behaviors that are linked to an increased risk for heart disease and stroke, such as smoking, lower levels of physical activity, unhealthy diet, being overweight and not taking medications as prescribed.

Due to evidence that connects negative psychological health to heart disease, the statement suggests regular mental health screening for people with or at risk for cardiovascular disease. The authors note that psychological therapy and mind-body programs can lead to better cardiovascular health. Programs that improve psychological health include cognitive behavioral therapy, psychotherapy, collaborative care management approaches, stress reduction therapy and meditation.

The Statement highlights research showing that both the cumulative effect of daily stressors and exposure to traumatic events can also increase the risk of heart disease and stroke. Patients’ self-report of general stress, as well as work-related stress, have been associated with an up to 40% increased risk of developing or dying from heart disease.

“Most studies of psychological health are observational, with many involving self-reporting from patients, which presents challenges to establishing specific cause and effect relationships,” said Levine. “However, a preponderance of such studies is highly suggestive and allows one to make reasonable conclusions about an association between negative psychological health and cardiovascular risk.”

On the other hand, studies have found positive psychological health associated with a lower risk of cardiovascular disease and death. Positive psychological health characteristics include happiness, optimism, gratitude, sense of purpose, life satisfaction and mindfulness. “The data is consistent, suggesting that positive psychological traits play a part in better cardiovascular health,” said Levine.

People with positive psychological health were also more likely to have health factors linked to a lower risk of developing cardiovascular disease:

• lower blood pressure;
• better glucose control;
• less inflammation; and
• lower cholesterol.

Positive psychological health is also associated with beneficial health behaviors such as smoking cessation, increased physical activity, heart-healthy eating, increased medication adherence and regular check-ups and health screenings.

Also, said Levine, social factors may further influence cardiovascular health. People with better mental health tend to have positive social relationships, support and connections, which can facilitate healthier adaptation to life’s challenges.

Levine adds, “Wellness is more than simply the absence of disease. It is an active process directed toward a healthier, happier and more fulfilling life, and we must strive to reduce negative aspects of psychological health and promote an overall positive and healthy state of being. In patients with or at risk for heart disease, health care professionals need to address the mental wellness of the patient in tandem with the physical conditions affecting the body, such as blood pressure, cholesterol levels, chest pain, etc.”

This Scientific Statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Clinical Cardiology; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiovascular and Stroke Nursing; and the Council on Lifestyle and Metabolic Health.

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