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By Maen Nusair, MD, Ashraf Al-Dadah, MD,  and Arun Kumar, MD 

The mind-body interaction has always intrigued humans. Most of us, on the basis of either intuition or personal experience, believe that emotional stress can cause or alter the course of major physical diseases, such as heart disease or cancer. In recent years, there has been tangible evidence for the existence of this interaction — but modern medicine is still trying to unravel its intricacies to explain why and how.

Examining the available research shows that depression, anxiety disorders and hostile personality traits can affect coronary heart disease (a hardening and narrowing of the blood vessels which supply the heart with oxygen and nutrients). Below, we take a closer look at different types of mental stress and their impact on heart disease, including known psychological triggers for heart attack.

Depression and Heart Disease

Heart disease has considerable impact on an individual’s overall health and well-being. Therefore, it is not surprising that depression is the most prevalent psychiatric disease in patients with coronary heart disease (CHD).

There have been studies suggesting that depression and hopelessness may directly contribute to the development of CHD. It has also been found that depression is harmful to patients with existing CHD. Depressed patients who have had heart attacks tend to do worse from a recovery standpoint compared to those who don’t have major depression. Moreover, depressed patients seem to benefit less from coronary artery bypass surgery (a surgery that helps improve blood flow to the heart in patients with CHD) compared to those who don’t have major depression.

The effect depression has on CHD is likely due to a combination of physiologic and behavioral factors. Depression alters the function of certain centers in the brain, such as the hypothalamus, which in turn leads to abnormalities in the function of the blood vessel lining (endothelium) and increases stickiness of platelets (a blood component that plays a role in blood clotting). Behavioral factors linking depression to worse outcomes in CHD patients, such as neglectful self-care, poor compliance with cardiac treatment regimens, continued smoking, low motivation to change lifestyle and low participation in cardiac rehabilitation, are also important to recognize.

In patients with CHD, treatment of depression successfully reduces anxiety and depression and results in meaningful improvement in quality-of-life. The antidepressant drug class serotonin reuptake inhibitors (SSRI) is considered safe and is the treatment of choice in patients with CHD.

Anxiety and Heart Disease

The relationship between anxiety and CHD is not entirely clear. However there have been studies which demonstrated that high levels of worry and anxiety are associated with increased risk of heart attacks and CHD.

Post-traumatic stress disorder (PTSD) is one form of anxiety disorders that has drawn special attention in the last few years as a potential contributor to development of CHD. PTSD affects persons exposed to traumatic events and is associated with re-experiencing, avoidance, and increased arousal symptoms related to such events. PTSD is believed to double the risk for early-age heart disease death.

Hostility and Heart Disease 

Hostility is a personality and character trait characterized by cynicism, mistrust of others and anger.

High hostility level has been shown to be related to increased risk of CHD. This seems to be due to a combination of direct effect on the heart and to unhealthy lifestyle associated with this personality trait. 

Can Psychological Stress Precipitate Heart Attacks?

The answer is yes! Extreme spells of anger or anxiety were found to increase the risk of heart attack by about twofold in the two hours after the anger or anxiety spell. Even bereavement and natural disasters were found to increase the risk of heart attack in the in the first few days after the event.

Psychiatric illness and psychological stressors appear to have a detrimental effect on heart health. Early recognition and treatment of these issues are important to improve overall well-being and health which may include deceasing the risk of developing coronary heart disease.

Arun Kumar, MD, is Assistant Professor of Clinical Medicine and Director of the Cardiac Intensive Care Unit at the University of Missouri School of Medicine. Maen Nusair, MD, and Ashraf Al-dadah, MD, are cardiovascular Fellows the University of Missouri School of Medicine.

Published July 2, 2012.

See also:

• The benefits and side effects of fish oil supplements for heart health
• Is the new drug Dabigatran a better blood thinner than Warfarin?
• Share your experiences and ask questions on our Heart Disease community!
• Would you recognize a heart attack? These are the signs.

Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Medical Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.

This is a summary of the article "The Tale of Mind & Heart: Psychiatric Disorders & Coronary Heart Disease" by Maen Nusair, MD, Ashraf Al-Dadah, MD,  and Arun Kumar, MD, which was originally published in the June/July 2012 issue of Missouri Medicine. The full article is available here.

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