Body-Mind Connection in Heart Disease
January 10, 2023
Joy Stepinski, MSN, RN-BC
An article published in The American Journal of Medicine highlighted the important relationship between the body and the mind, particularly with respect to cardiovascular disease and mental health [1]. Sometimes overlooked when considering the cardiovascular system, mental health plays a large role in a person’s internal environment. Some emotions described are anxiety, anger, and depression, often caused by life situations, such as grief, stress, job loss, lack of sleep, abuse, and alcohol or drug dependency.
Depression and anxiety and cardiovascular disease are considered bidirectional. Depression and anxiety can impact cardiovascular health and cardiovascular health can affect depression and anxiety. Furthermore, the symptoms experienced between a person in mental distress and someone with cardiovascular disease are quite similar, including heart palpitations, chest tightness, and shortness of breath.
According to the article, the prevalence of depression in patients with cardiovascular disease is three times higher than in the general population. A separate meta-analysis [2] investigated the prevalence of depression in patients with a diagnosed myocardial infarction (MI), or heart attack. The authors included 19 eligible studies, consisting of 12,315 patients diagnosed with an MI. Of those, 3,818 patients were diagnosed with depression. The results concluded that depression was prevalent in 28.7% of patients who sustained an MI.
A nursing study [3] compared anxiety, depression, and hostility among 3 elderly patient cohorts diagnosed with cardiac disease and a control group of healthy elders. Their methods included a total of 1,167 subjects with 260 in the control group and 907 in the cardiac group. The patients were three months post hospitalization, with 478 diagnosed with heart failure, 298 with myocardial infarction, and 131 who underwent a coronary artery bypass graft (CABG). Their findings showed that emotional distress experienced by cardiac patients is not a factor of age. Instead, it is more likely a result of cardiac disease.
There were other notable results from this study. Women experienced more anxiety and depression than men. Among the three cohorts with cardiac disease, the highest level of depression was found among patients with heart failure; anxiety was found among patients with heart failure and MI, and people who underwent a CABG showed higher hostility. Although the authors did not discuss the reasons for depression, they did acknowledge that emotional distress among the elderly following a cardiac event is concerning. Anxiety and depression can lead to diminished quality of life, recurrent cardiac health issues, and increased mortality.
Depression is known to directly affect lifestyle factors [1,4], and may lead to increased smoking, physical inactivity, obesity, and higher alcohol intake. Dietary choices may include eating food higher in saturated fat, salt, and calories. Additionally, there is a stress response within the body that is associated with emotional distress. Several hormones play a role, including cortisone and adrenaline [1]. Cortisone is released during stress, which can lead to higher blood glucose levels, weight gain, low HDL cholesterol, elevated blood pressure, and cause in increase in other hormones like adrenaline. Adrenaline increases heart rate and blood pressure. Other mechanisms in response to depression are inflammation and increased platelet activity, which can lead to occlusion of arteries.
Although this news may seem grim, knowledge leads to awareness and increased autonomy. There are many steps that people can take to decrease both risk of depression and heart disease. Chaddha and coauthors [1] recommend participating in exercise, with moderate aerobic activity for 30 minutes for 5 or more days weekly, engaging in mindful meditation, and breathwork. Working with a cognitive behavioral therapist can identify and challenge negative automatic thoughts.
A compelling lifestyle change is diet. Campbell [4] reports that the consumption of a Western diet, which is high in animal protein, added sugar, saturated fat, and processed food, increases LDL cholesterol and can lead to atherosclerosis. In atherosclerosis, unwanted plaque builds up in arteries. This plaque is accumulated cholesterol, fat, and other substances. The arteries consequently narrow and the supply of oxygen-rich blood is reduced to vital organs, including the heart, brain, legs, arm, pelvis, vertebrae, kidneys, and intestines [5].
Campbell [4] discusses that a high-fiber low-fat plant-based diet reduces numerous cardiac risk factors, including high blood pressure, obesity, cholesterol, and systemic inflammation, and has shown to halt or reverse atherosclerosis. Food included is fruits, vegetables, and whole grains while limiting or avoiding meat and processed foods. Furthermore, one interventional study [6] has shown that this diet, along with exercise and stress management, improves depression. In a three-month follow-up study, 341 people with cardiac disease experienced baseline depression. Upon follow-up, 73% of participants stopped being depressed and showed improvement in weight loss, hostility, stress, blood pressure (women), and triglycerides (men).
Through eating an optimal diet, exercising, and decreasing stress, the mind-body connection can flourish. A healthy mind can lead to a healthy heart, and a healthy heart can lead to a healthy mind.
References
Chaddha, A., Robinson, E. A., Kline-Rogers, E., Alexandris-Souphis, T., & Rubenfire, M. (2016). Mental health and cardiovascular disease. The American Journal of Medicine, 129(11), 1145-1148. https://doi.org/10.1016/j.amjmed.2016.05.018
Feng, L., Li, L., Liu, W., Yang, J., Wang, Q., Shi, L., & Luo, M. (2019). Prevalence of depression in myocardial infarction: A PRISMA-compliant meta-analysis. Medicine, 98(8), e14596. https://doi.org/10.1097/MD.0000000000014596
Moser, D. K., Dracup, K., Evangelista, L. S., Zambroski, C. H., Lennie, T. A., Chung, M. L., ... & Heo, S. (2010). Comparison of prevalence of symptoms of depression, anxiety, and hostility in elderly patients with heart failure, myocardial infarction, and a coronary artery bypass graft. Heart & Lung, 39(5), 378-385. https://doi.org/S0147-9563(09)00269-6
Campbell, T. (2017). A plant-based diet and stroke. Journal of Geriatric Cardiology, 14(5), 321–326. https://doi.org/10.11909/j.issn.1671-5411.2017.05.010
National Heart, Lung, and Blood Institute. (2022). What is atherosclerosis? https://www.nhlbi.nih.gov/health/atherosclerosis
Pischke, C. R., Frenda, S., Ornish, D., & Weidner, G. (2010). Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors. Psychology and Health, 25(9), 1077-1100. https://www.ornish.com/wp-content/uploads/lifestyle-changes-related-to-reduction-in-depression-coronary-risk-factors.pdf