Poor mental health increases risk of heart attack, study finds

People in their 20s or 30s who have mental health conditions have three times the risk of heart attack or stroke as those without, a new study has found.

The study by a team of Korean academics, published in the European Journal of Preventive Cardiology, looked at more than six million people between the ages of 20 and 39 in the National Health Insurance Service database, which covers the entire population. The average age was 31, and 58% of participants were 30 years or older. The individuals had all undergone health examinations between 2009 and 2012.

All six million were classified according to whether they had a mental disorder. These included depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. One in every eight person (13%) had some kind of mental health condition. Of those, nearly 48% had anxiety, 21% had depression, 20% had insomnia, nearly 28% had somatic system disorder and more than 2% had substance use disorder. Less than two percent had bipolar disorder, schizophrenia, an eating disorder, personality disorder or post-traumatic stress disorder.

They were then followed up until December 2018 to see if they had experienced either a myocardial infarction (heart attack) or an ischaemic stroke.

Not explained by lifestyle behaviours

During this follow-up period, there were 16,133 cases of myocardial infarction and 10, 509 cases of ischaemic stroke. The researchers concluded that participants with any mental health disorder had a 58% higher likelihood of myocardial infarction, and 42% greater risk of stroke, compared with those who had no mental health condition. The higher risk of myocardial infarction applied to all mental disorders, while the higher risk of stroke applied to all mental disorders other than post-traumatic stress disorder or eating disorder.

The study authors said that the increased risk couldn’t be explained by lifestyle behaviours.

Eue-Keun Choi, a study author and professor at the Seoul National University College of Medicine, said: “Psychological problems were common in young adults and had strong links with cardiovascular health.”

He added: “The findings indicate that these individuals should receive regular health check-ups and medication if appropriate to prevent myocardial infarction and stroke. While lifestyle behaviours did not explain the excess cardiovascular risk, this does not mean that healthier habits would not improve prognosis. Lifestyle modification should therefore be recommended to young adults with mental disorders to boost heart health.”

Dr Ryan Sultan, a psychiatrist and researcher at Columbia University, told the publication Medical News Today that the study builds on decades of evidence showing that mental health conditions affect the rest of the human body.

“The link between mental health conditions and physical health problems is not just due to neglect or poor self-care. It is also due to biological factors such as inflammation and hormonal imbalances that can be caused by chronic stress and other mental health conditions,” he said.

Routine mental health screening

“Healthcare systems should adopt a holistic approach that recognizes the interplay between mental and physical health,” Sultan added. “This could include routine mental health screenings for patients with chronic physical conditions as well as increased collaboration between mental health providers and primary care physicians. Additionally, addressing social determinants of health such as poverty, access to healthcare, and discrimination can help reduce the burden of mental and physical health problems.”

Dr. Rigved Tadwalkar, a cardiologist at Providence Saint John’s Health Center in California, said that the increased risk of heart disease came from the effect of stress on the body: “Stress can trigger dysfunction of the autonomic nervous system, causing the release of stress hormones like cortisol. This leads to higher blood pressure but can also cause other physiologic changes over time that affect blood vessels, including increased oxidative stress, higher inflammatory burden, and endothelial dysfunction, promoting the development of atherosclerosis and heart disease.”