The heart and the psyche – Link between heart disease and anxiety-depressive disorders

By Dr. Ananya Mandal, MDJul 5 2010

According to a new report published in the acclaimed journal Archives of General Psychiatry, concomitant anxiety and other psychiatric illnesses in heart patients raise their risk of getting heart attacks, strokes, heart failure and early death.

The researchers came to this conclusion after studying more than 1,000 people with heart disease. There is a 74% increased risk of cardiovascular events in those with an anxiety disorder they write. British experts believe more studies are needed to explore the possible association between psychiatric ailments and heart disease.

These researchers from Tilburg University in the Netherlands studied the patient cohort for an average of five and a half years. They found:

• Yearly rate of cardiovascular events was 9.6% in the 106 patients who suffered from a general anxiety disorder.
• In the 909 patients without an anxiety disorder, the rate was 6.6%.
• 24% to 31% of heart disease patients also had symptoms of anxiety

The actual reason for this association is not yet clear say researchers but it could be that patients with anxiety are more likely to go and see their doctor when they have symptoms and therefore are more likely to receive a diagnosis of stroke or heart attack. On the flip side higher anxiety levels may also prevent patients from visiting their specialists and then be at increased risk of cardiovascular problems.

According to Dr Elisabeth Martens, expert in neuropsychology at Tilburg University and lead author, “Evaluation and treatment of anxiety may also be considered as part of the comprehensive management of patients with coronary heart disease.” Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation explained that, “We know that people with heart disease are often anxious about their future and about how their lives, and the lives of those closest to them, will be affected by the disease… Now we need to spend more time and money understanding the links between poor mental health and heart disease.”

Alyna Turner, a senior researcher with the Heart Research Centre in her independent study at the University of Newcastle found that patients with severe anxiety were more likely to be readmitted to hospital after a heart attack and those with depression stayed in hospital for longer. This work was published in the Australian and New Zealand Journal of Psychiatry.

Dr. Turner said, “I think a lot of patients and their families think the emotional sides of heart disease are being neglected in the health system… We need to make sure people with heart problems are kept emotionally healthy too. ” She explained that there is a link between emotional health and cardiac health saying, “Depression and anxiety will not only impact on their quality of life but may also make patients less likely to do things that can help their recovery, such as exercise.”

Yet another psychiatrist, Chris Stapelberg researching depression and heart disease at Griffith University found that people with depression had thicker blood – a condition that predisposed them to cardiac events. “We are only just discovering all the different [ways] they are linked. We definitely need to see more routine screening for depression in particular,” he emphasized.