In the United States, a person succumbs to heart disease approximately every 34 seconds.
With around half of the populace affected by some form of cardiovascular disease (CVD) and about one in four adults experiencing mental health disorders during their lifetime, there's bound to be significant overlap between these issues.
A recent Emory University study reveals that particular mental health conditions elevate the likelihood of developing heart disease by 50-100%, as well as worsening outcomes for those already suffering from CVD by 60–170%.
The report, featured in The Lancet Regional Health-Europe, highlights disparities in cardiovascular health among patients diagnosed with depression, anxiety, schizophrenia, bipolar disorder, and PTSD. The article is part of a series aiming to increase awareness about CVD-related health disparities in four specific groups: women, elderly individuals, racial minorities, and those with mental health conditions.
The Lancet Regional Health-EuropeLed by Emory University professor Viola Vaccarino, MD, Ph.D., along with co-authors Amit Shah, MD, and Douglas Bremner, MD—both also professors at Emory—the study links mental health with CVD. The following conditions were associated with heightened risks of developing cardiovascular disease:
- Major depression, 72%
- PTSD, 57%
- Bipolar disorder, 61%
- Panic disorder, 50%
- Phobic anxiety, 70%
- Schizophrenia, nearly 100%
The research also indicates these conditions correlate with a poorer prognosis, higher risk of readmission, and increased mortality from existing heart issues. For instance, major depression more than doubles the fatality rate for individuals already affected by CVD.
Furthermore, a bidirectional relationship exists: over 40% of people with cardiovascular disease are also diagnosed with a mental health condition, Vaccarino notes.
Well-established connections exist among depression, schizophrenia, PTSD, and abnormal stress responses in the autonomic nervous system (ANS) and hypothalamic-pituitary adrenal axis (HPA). The ANS manages involuntary bodily functions like heart rate and sweating. Since most major organs have ANS nerve endings, this system influences numerous bodily functions.
The HPA similarly impacts immune response and metabolism, both key factors in cardiovascular health. Dysregulation of these systems can lead to chronic inflammation, metabolic abnormalities, high blood pressure, increased systemic vascular resistance, and autonomic inflexibility, as per the report. These conditions often contribute to both heart disease development and mental health issues.
The role of social determinants in CVD disparities is vital for those with mental health conditions, who may encounter barriers such as affordability and accessibility within the healthcare continuum. Limited health literacy or communication can further hinder access to screenings and treatments.
Clinicians handling patients with certain mental disorders face additional challenges due to stigma and fragmented care models separating mental from physical health. Stigmas in clinical research often exclude participants with mental health conditions.
The report suggests that current predictive models do not reflect the role of mental health disorders when forecasting heart disease risks.
To address CVD disparities among individuals with mental health issues, an integrated approach involving interdisciplinary care for behavioral, mental, and cardiovascular health is recommended by the authors.
"The interplay between cardiovascular and psychological health necessitates system changes that better accommodate patients with multiple conditions," Vaccarino argues.
A clinical team, encompassing specialists, social workers, and nursing staff collaborating on multidisciplinary patient care, would be ideal for such circumstances. The report emphasizes closing the health disparity gap to ensure the rights of those living with mental health issues are preserved, allowing them to achieve optimal health and participate fully in society.