Mind-Body Connection: Cardiovascular Disease

by Arthur Luz, Ph.D.

You probably know that depression can follow a heart attack and that depression is strongly associated with second heart attacks (when there is depression the odds of a second heart attack are three to four more times likely) but did you know that:

  • Depression is a risk factor for first heart attack equal to smoking, high cholesterol and high blood pressure

  • Subclinical levels of depression have been implicated in heart disease

  • Excessive levels of all negative emotions (anger, anxiety) and negative cognitive states (hopelessness, rumination, pessimism) may be critical to heart attack and cardiovascular disease.

These are all facts established by recent research.

How can depression be such a powerful factor in cardiovascular disease?

The answer is that depression results in unhealthy heart behavior. These unhealthy behaviors include:

  • Lack of exercise

  • Increased substance abuse

  • Poor compliance with medical treatment

  • Poor eating habits

Furthermore, depression and prolonged or frequent negative emotions impact the body by:

  • Increasing levels of stress hormones cortisol and adrenaline, which in turn:
    • Elevate heart rates and constrict arteries (high blood pressure) causing lesions on coronary arteries contributing to plaque development, and
    • Stimulate the production of inflammatory substances which damage arterial linings.
  • Keeping the sympathetic portion of the autonomic nervous system working excessively which means that:
    •  
    • In an emergency, stress hormones are activated by the hypothalamic pituitary axis to meet the demands of the situation. A feedback mechanism signals the brain to reduce the level of hormones. For some reason, the feedback mechanism doesn't work well in the depressed keeping them hyper-aroused.
    • Makes the heart less sensitive to the signals it uses to adapt its pumping action to changes in the demands made by the body. This is referred to reduced heart rate variability.
    • Reduced heart rate increases the risk for serious rhythmic disturbances including ventricular fibrillation -- the sometimes deadly rapid and uncoordinated contraction of the lower chambers of the heart.
  • Increasing inflammation of arterial walls leading to plaque rupture (the result of infection or could stress result in an excessive immune response contributing to inflammation?)
  • Making blood platelets sticky and adherence to a ruptured plaque easy, which leads to:
    • Thrombosis (clotting)
    • A blocked artery in the heart
    • Restricted blood flow
    • All of which leads to oxygen depletion of heart muscle (which is experienced as chest pain/angina and death of heart muscle -- this is myocardial infarction or the classic heart attack.

Heart health involves managing behavior (eating and exercise), constructively responding to stress and negative emotions. In addition, fostering love in life, optimism, a sense of gratitude, zest and curiosity furthers well being.

 

For more reading, consider:

Can a troubled mind spell trouble for the heart? First printed in the April 2003 issue of the Harvard Mental Health Letter.