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Probing the link between depression and heart trouble

Kaiser Permanente Northern California’s chief cardiologist talks about how mental health issues are tied to heart health and mortality. Pictured, Howard Dinh, MD.

As the mind goes, so goes the heart.

Research suggests a connection between mental health and a highly elevated risk of death from heart disease.

2023 study that analyzed nearly 2 million people found that those with depression, compared to those without, had increased relative risks of death from congestive heart failure by 220%, a heart attack by 28%, and death from all causes by 43%.

This association between heart and mind affects millions of people. In 2021, 21 million American adults, or 8.3% of the population, had at least one depressive episode, according to the National Institute of Mental Health.

Kaiser Permanente Northern California chair of chiefs of cardiology for the region, Howard Dinh, MD, who is also a fellow of the American College of Cardiology, explains the mind-heart connection.

Can you explain why depression and all the issues that go with it, like anxiety, stress, and reduced sleep, can adversely affect the heart? 

Let’s first be clear that the recent studies point to an association with all these heart problems, and we have not yet proved causality. But one of the hypotheses is that depression and anxiety increase stress and produce the hormone cortisol that can lead to weight gain and elevated cholesterol levels, all risk factors for developing heart disease. We know those hormones increase blood pressure, which add further stress for the heart and can worsen symptoms for people who already have heart failure.

One common scenario is that depression, anxiety, and stress put a person’s body in fight-or-flight mode all the time, whether they recognize it or not. When you are in that mode, hormones are released, you have increased sodium absorption and fluid retention, both of which increase blood pressure. When blood pressure is elevated, our heart is pushing against that pressure and the strain injures the heart. This is the likely explanation on why depression is associated with congestive heart failure.

The body then senses heart injury, it recruits immune cells to fight inflammation and in doing so, can lead to scarring of the heart or plaque buildup in the coronary arteries themselves. Those plaques can rupture and cause a heart attack.

What other factors are at play for heart health in people who are depressed?

Some of my patients are so depressed they stop taking their medications, they may eat horribly, or they start to self-medicate, turning to alcohol and drug use, or they smoke to calm their nerves. All those unhealthy choices are bad for the heart.

Many depressed people are not motivated to exercise, and often they gain weight, which we know is a significant risk factor for heart issues. So, treatment of depression is really, really important!

The insidious thing about it, if you are depressed, you may not even be aware of it. Many of my patients are not aware they are developing depression or that the dangerous things they are doing to cope are bad for them.

For those people who are feeling bad in their life, what do you recommend?

Talk to your primary care physician if you are experiencing depression and anxiety. Or make an appointment with our mental health services. Seeking treatment early on will improve your heart health in the long run.

Lifestyle changes also are important. Walking and exercising 20 minutes a day, five days a week are recommended. We know increased exercise will help your mental health. Be careful about alcohol, smoking, and recreational drugs, which can mask mental health problems. We also know diet is so important for heart health, and a good diet also makes you feel better. Switching over to a plant-based diet may be a very healthful thing. Lastly, make sure you have good social support of friends and family — they can make all the difference.


cardiacHeart Healthmental health

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