Research Highlights:
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DALLAS, November 2023
The heart and mind are strongly connected, and depression, anxiety, and chronic stress all increase the risk of heart and brain health complications, according to two preliminary studies to be presented at the American Scientific Sessions 2023. Heart Association. The meeting, to be held November 11-13 in Philadelphia, is a global exchange of the latest scientific advances, research and updates to evidence-based clinical practice in cardiovascular science.
Mental disorders such as depression, anxiety and stress are known to increase the risks of poor heart health, according to the American Heart Association, and in two new studies, researchers measured the extent to which one’s mental state affects heart health.
"There are clear links between psychological health and cardiovascular disease risk. These studies add to a growing body of data we have on how negative psychological health can increase the risk of heart and brain disease," said Dr. Glenn N. Levine , FAHA, chair of the writing committee for the 2021 American Heart Association scientific statement on psychological health, well-being, and the mind-heart-body connection.
Depression and anxiety accelerate the rate at which cardiovascular risk factors increase: a mechanism that leads to an increased risk of cardiac events (MDP274)
The first study examined the mechanism by which mental state affects heart health. Researchers found that anxiety and depression accelerated the development of new risk factors for cardiovascular disease.
"Although depression and anxiety are known to increase the risk of cardiovascular diseases, such as heart attack and stroke, the underlying mechanism is not fully understood," said study lead author Dr. Giovanni. Civieri, a researcher at the Cardiovascular Imaging Research Center at Massachusetts General Hospital and Harvard Medical School, both in Boston. "In our study, we identified a mechanism that appears to largely explain the relationship between these psychological factors and cardiovascular diseases."
Dr. Civieri and his colleagues studied data from adults enrolled in the Mass General Brigham Biobank in Boston without prior cardiac events. The time required to develop a new cardiovascular risk factor was measured over 10 years of follow-up.
The researchers found that:
- 38% of all participants developed a new cardiovascular risk factor, such as hypertension, high cholesterol, or type 2 diabetes during follow-up.
- Participants previously diagnosed with anxiety or depression developed a new risk factor on average six months earlier than those without depression or anxiety.
- Depression and anxiety increased the risk of suffering a major cardiovascular event, such as a heart attack or stroke, by approximately 35%.
- About 40% of the relationship between depression and/or anxiety and serious cardiovascular events and stroke was explained by the accelerated development of cardiovascular disease risk factors .
- People with a greater genetic predisposition to stress developed the first cardiovascular risk factor at an earlier age (an average of 1.5 years earlier than those who did not have the genetic marker).
- "Developing cardiovascular risk factors more than six months earlier, for an average of five years, is a lot," Dr. Civieri said. "The fact that the genetic analysis supported the clinical findings was interesting to us and provided greater confidence in our results."
- Researchers suggest that depression and anxiety could induce brain changes that trigger side effects in the body, such as increased inflammation and fat accumulation.
The results underline the importance of detecting cardiovascular risk factors among people with depression and anxiety.
"This study illustrates that healthcare professionals need to be aware that negative psychological health – such as depression or anxiety – not only affects patients’ mental state, but can also impact their physical health and risk of developing heart disease. heart disease. So these are not benign conditions," said Levine, a clinical master and professor of medicine at Baylor College of Medicine and chief of cardiology at the Michael E. DeBakey VA Medical Center, both in Houston. “These are aspects that we want to actively convey to mental health professionals.”
Dr. Civieri also encouraged people with depression or anxiety to undergo more frequent screening of their cardiovascular risk factors, such as hypertension, high cholesterol and type 2 diabetes. "Although we did not investigate this aspect, it is reasonable to assume that treating depression and anxiety can reduce the accelerated development of cardiovascular risk factors," he said.
Background of the study:
The analysis was carried out with data from 71,262 adults, (average age 49 years, 45% men) and the data was collected between December 2010 and December 2020.
16% of the study group were taking medication for depression or anxiety; However, statistical adjustment for those medications did not significantly affect the results, Dr. Civieri explained.
A genetic marker of stress sensitivity (polygenic risk score for neuroticism) was assessed in subjects who provided genetic data.
The observational study design and possible misclassification of depression and anxiety diagnostic codes are limitations of the study.
In a second, unrelated study, researchers explored the effects of cumulative stress on heart and brain health by examining responses to questionnaires completed by adults in the Dallas Heart Study who did not have cardiovascular disease.
"This unique study explored the relationship between our new cumulative stress score and its subcomponents on cardiovascular risk factors as an attempt to better understand this relationship," said lead author Dr. Ijeoma Eleazu, associate of cardiology at the Center Southwestern Physician at the University of Texas at Dallas. "To our knowledge, this is the first study to provide such a multidimensional analysis of the relationships between perceived stress and cardiovascular disease."
Over a period of one month, the researchers integrated generalized everyday stress; psychosocial stress (stress caused by threats to psychological or social functioning); financial stress and perceived neighborhood stress into a score called the "cumulative stress score." This novel score was strongly and significantly associated with the development of cardiovascular disease after adjusting for known cardiovascular disease risk factors such as high blood pressure, type 2 diabetes, smoking, and high cholesterol, as well as adjusting for income. and education, explained Dr. Eleazu.
Even after adjusting for risk factors such as hypertension, high cholesterol, smoking and type 2 diabetes, as well as income and education, the researchers found that higher cumulative stress was associated with a risk:
- 22% increased atherosclerosis, in which plaque builds up in the arteries reducing adequate blood flow.
- 20% more likely to suffer from cardiovascular diseases in general; including coronary heart disease and heart failure.
- It was higher among women, people ages 18 to 45, and people with lower income and education levels, as well as people who self-identified as black or Hispanic adults.
- Additionally, cumulative stress scores were higher among those who reported experiencing racial/ethnic discrimination and lacking health insurance; and higher scores were also associated with hypertension, overweight, physical inactivity, and smoking.
"There are individual-level perceived stress factors that made up our psychosocial component of the score, as well as demographic factors that were represented in the financial stress score component, and even environmental factors that were represented in our neighborhood stress score component. "These individual factors alone appeared to be less correlated with cardiovascular outcomes than the multidimensional cumulative stress score," Dr. Eleazu said. "These findings suggest that we may not be adequately capturing the impact of stress when we only look at one factor or when we evaluate it broadly and/or subjectively. This is especially important among people from diverse or minority populations who may experiencing various types and multiple stressors simultaneously.
The analysis also indicates that ongoing stress raised the risk of poor heart and brain health in two ways: by directly influencing physical well-being, as well as by increasing poor lifestyle behaviors, such as smoking and being sedentary, which, in turn, lead to poorer cardiovascular health.
Previous research has shown that chronic stress can lead to elevated levels of stress hormones such as cortisol, which, in turn, can affect blood sugar levels, inflammation, and other biological chain reactions that impact health. heart, Dr. Eleazu said.
"Indeed, there is a mind-heart connection . Taking care of the mind can also have an impact on physical health," he said. "It would be great to see more patients talking to their doctors about their stress levels and more doctors detecting a high stress burden in their patients. That way, we can work together to combat poor outcomes."
Levine added: "This novel concept of adding up and evaluating someone’s accumulated stress is fantastic, because in some areas of our lives we may not experience much stress, but in others, for example, finances or health, we may experience a lot of stress. "This study concluded that it is best to take into account a person’s overall cumulative stress, and not just ask them about an aspect of their livelihood or life that might be affecting the stress."
Background and details of the study:
The data evaluated were from 2,685 adults who did not have cardiovascular disease and participated in phase 2 of the Dallas Heart Study (2007-2009), a multiethnic population-based group based in Dallas.
The average age of the participants was 48 years; 55% were women; 49% were black adults; and 15% of participants were Hispanic/Latino adults.
Participants were followed for a mean of 12.4 years, and cardiovascular events and deaths were assessed by a panel of cardiovascular specialists.
Limitations of the study include the fact that there may have been unknown conflicting factors that were not taken into account and that the cumulative score is new and has not been fully validated, Dr. Eleazu explained.
