Healthcare professionals should consider psychological health in adults with or at risk for cardiovascular disease (CVD), the American Heart Association (AHA) advises in a new scientific statement.
The statement, Psychological Health, Well-Being, and the Mind–Heart–Body Connection, notes that psychological health can positively or negatively impact a person’s health and risk factors for heart disease and stroke.
The AHA previously issued a scientific statement that dealt strictly with depression and one that dealt with meditation, but “this is the first such scientific statement to more broadly address the issue of psychological health,” writing group chair Glenn N. Levine, MD, chief of cardiology, Michael E. DeBakey VA Medical Center in Houston, told theheart.org | Medscape Cardiology.
“This was particularly important to do now given the COVID crisis and all the psychological stress people are under the past year,” said Levine, professor of medicine, Baylor College of Medicine, Houston.
“Irrespective of that, it is clearly time that we recognize that we should strive to treat not only the disease, but the patient and the person as a whole,” he added.
The statement was published online January 25 in Circulation.
Heart, Body, and Mind Interconnected
The task of the writing group was to evaluate, synthesize, and summarize available evidence on the relation between psychological and CV health and to offer simple steps to screen for and ultimately improve the psychological health of patients with or at risk for CVD.
Depression, chronic stress, anxiety, anger, pessimism, and life dissatisfaction are all associated with potentially harmful biologic responses. These include irregularities of heart rate and rhythm; increased digestive complaints, blood pressure and inflammation; and reduced blood flow to the heart, the writing group notes.
“A large body of study data now make it clear that psychological health can impact a patient’s heart health, just as diabetes, hypertension, and hyperlipidemia can, and that improving our patients’ psychological health is likely to lead to reduced cardiac risk down the road,” Levine said.
The cumulative effect of daily stressors and exposure to traumatic events can also increase the risk for CVD. Patients’ self-reports of general and work-related stress have been associated with an up to 40% increased risk of developing or dying from CVD, the writing group notes.
“Most studies of psychological health are observational, with many involving self-reporting from patients, which presents challenges to establishing specific cause and effect relationships,” Levine said in a news release.
“However, a preponderance of such studies is highly suggestive and allows one to make reasonable conclusions about an association between negative psychological health and cardiovascular risk,” he noted.
Negative psychological health is also associated with health behaviors that raise the risk for CVD, including smoking, lower levels of physical activity, unhealthy diet, being overweight, and not taking medications as prescribed.
The writing group advises regular mental health screening for people with or at risk for CVD, and notes that psychological therapy and mind–body programs can lead to better heart health.
Programs that improve psychological health include cognitive behavioral therapy, psychotherapy, collaborative care management approaches, stress reduction therapy, and meditation.
On a Positive Note
Studies have also shown that positive psychological health — including happiness, gratitude, sense of purpose, life satisfaction, and mindfulness — is associated with a lower risk for CVD and a greater likelihood of beneficial health behaviors.
These include smoking cessation, increased physical activity, heart-healthy eating, increased medication adherence, and regular check-ups and health screenings.
People with better mental health also tend to have positive social relationships, support, and connections, which can facilitate healthier adaptation to life’s challenges.
“We hope that clinicians will understand and recognize that we need to consider not only the patient’s specific disease, but the patient’s psychological health as well,” Levine told theheart.org | Medscape Cardiology.
“For example, depressed patients are less likely to take the medications we prescribe. Just as we assess and treat more standard cardiac risk factors, such as hypertension and hyperlipidemia, so should we assess and address psychological factors, which can also impact our patients cardiac risk and prognosis,” he said.
The writing group has no relevant disclosures. This s cientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Clinical Cardiology; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiovascular and Stroke Nursing; and the Council on Lifestyle and Metabolic Health.
Circulation. Published online January 25, 2021. Abstract