Is There a Connection Between Mental Health Disorders and Heart Problems?

Summary: Yes, research shows a connection between some mental health disorders and heart problems.

Key Points:

Previous research establishes clear connections between mental health disorders and chronic physical health problems.
Studies indicate lifestyle factors associated with mental health disorders increase risk of specific conditions such as heart disease, hypertension, and type 2 diabetes, among others.
A new retrospective analysis of health records for over 20 million subjects examines the connection between mental health disorders and heart problems, specifically acute coronary syndrome (ACS) and acute myocardial infarction (AMI)

Mental Health Problems and Heart Problems: A Bidirectional Relationship

The first thing to understand about the connection between mental health disorders and heart problems is that in some cases, mental health disorders increase risk of heart problems due to a number of physiological and behavioral reasons, and in other cases, experiencing a serious cardiac emergency can act as triggers for the development of mental health disorders.

That’s what we mean by bidirectional.

According to the Centers for Disease Control (CDC), It’s not always clear whether stress and various psychological and emotional factors that appear after a serious coronary event contribute to the development of mental health problems, or that physiological factors associated with mental health problems such as reduced blood flow to the heart, increased cardiac reactivity, and increased levels of circulating cortisol increase risk to the extent they cause cardiac emergencies.

The CDC indicates the following mental health disorders and/or problems are associated with heart disease:

Mood disorders
Anxiety disorders
Post-traumatic stress disorder (PTSD)
Chronic stress

That data is well-established and primarily related to chronic cardiovascular issues. In this article, we won’t attempt to untangle the complex web of bidirectionality that exists between mental health disorders and chronic heart problems, but rather examine a study designed to identify which mental health problems increase risk of the following two acute heart conditions:

Acute coronary syndrome (ACS)
Acute myocardial infarction (AMI)

In this context, acute condition means a condition that requires immediate intervention to prevent severe impairment or loss of life. That’s why this topic has our attention: the stakes are high.

Reviewing Previous Data for New Insights on the Connection Between Mental Health Disorders and Heart Problems

When we say meta-analysis or review paper, it’s important to understand that one purpose of those studies is what we say in the heading above – find new insight on a topic – but another important purpose is to confirm or refute conclusions drawn from previous research.

The publication we discuss in this article, “Mental Disorders as a Risk Factor of Acute Coronary Syndrome: A Systematic Review and Meta-Analysis ,” narrows the scope of the topic to two specific heart issues, but uses a large sample set of over twenty-two million patients drawn from twenty-five separate studies. A sample set of that size should offer data we can use to make accurate generalizations about the relationships they examine and create a benchmark that future researchers will work to meet or surpass.

Here’s what they found.

The Connection Between Mental Health Disorders and Heart Problems: ACS and AMI

Anxiety Disorders:
- Significantly associated with AMI in 6 studies that examined the relationship.
Mood Disorders:
- Depression: significantly associated with ACS in 6 studies that examined the relationship.
- Bipolar disorder: not significantly associated with AMI in 3 studies that examined the relationship.
Psychotic Disorders:
- Not significantly associated with AMI in 2 studies that examined the relationship.
Sleeping Disorders:
- Associated with increased ACS events in 3 studies that examined the relationship.
PTSD:
- Associated with increased incidence of AMI in 2 studies that examined the relationship.

After applying advanced statistical analysis to confirm the associations identified in the 25 studies examined, the research team concluded that across all studies:

Anxiety, depression, post-traumatic stress disorder, and sleep disorders: associated with increased risk of acute coronary syndrome (ACS).
Post-traumatic stress disorder (PTSD): associated with increased risk of acute myocardial infarction (AMI).
The most significant increase in risk for ACS and AMI: associated with patients with post-traumatic stress disorder (PTSD) and sleep disorders.

We’ll discuss these conclusions below.

Mental Health and Heart Health: What’s the Connection?

Post-traumatic stress disorder (PTSD) and sleep disorders are associated with dysfunction in brain areas that regulate the human stress response and levels of circulating cortisol, the stress hormone. Experts from Harvard University report that long-term exposure to cortisol due to PTSD can have a negative effect on the circulatory system, promote neuroendocrine dysfunction, and lead to additional physiological problems that impact heart health. In addition, the American Heart Association (AHA) indicates sleep disorders can increase prevalence of risk factors for heart disease such as increased stress high blood pressure, diabetes, obesity, and inflammation.

Here’s how the study authors describe their findings:

“We found depressive, anxiety, traumatic, and sleeping disorders to be associated with an increased incidence of ACS, highlighting the importance of mental health in cardiovascular outcomes. Genetic predispositions, traditional vascular risk factors, proinflammatory processes, and illness-driven behaviors likely mediate these associations.”

The mediators they identify align with the insight from Havard and the AHA on the relationship between mental health disorders and heart health, all of which combine to confirm previous research: mental health disorders can increase risk of both long-term and acute cardiac issues. This study adds that PTSD and sleep disorders create the most significant risk, which is an important finding.

The takeaway – for us and for our patients – is relatively straightforward: mental health disorders can increase risk of serious heart problems. Therefore, we can encourage patients with mental health disorders – particularly PTSD and sleep disorders – to take proactive lifestyle steps that safeguard their heart health from the increased risk posed by the presence of a mental health disorder.

Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.