Psychological Distress Tied to Elevated Heart Attack, Stroke Risk

Caroline Jackson, PhD

Starting at age 45, people who experience psychological distress face elevated risk for heart attacks and stroke, new research suggests.

Additionally, the absolute risk of these cardiac events rises as distress levels increase, say researchers led by Caroline Jackson, PhD, Chancellor's Fellow at the University of Edinburgh in the UK.

“Our study adds further weight to an increasing body of evidence highlighting the negative impact of poor mental health on subsequent physical health,” said Jackson in an interview with MD Magazine®.

While the combined health burden of cardiovascular disease (CVD) and mental disorders is growing, the interplay between the conditions is poorly understood, Jackson and colleagues wrote. By identifying how distress affects the heart, clinicians may be able to help patients reduce risk, the authors added.

“If psychological distress has a direct physiological effect on the body to increase the risk of conditions such as heart disease, then understanding this mechanism could lead to new preventive measures to reduce the risk of cardiovascular events in this vulnerable group,” Jackson said.

The study included 221,677 participants in Australia’s New South Wales 45 and Up population-based prospective study. The individuals had no previous history of stroke, myocardial infarction, or angina. They reported their distress level by answering such questions as how often they felt depressed, worthless, or tired for no good reason.

The researchers then rated their degree of psychological distress as low, medium, or high/very high. A little more than 7% of the group reported very high distress, while 16.2% reported moderate levels.

Over the next 4.7 years, the participants had a total of 4573 heart attacks and 2421 strokes. Among men, the risk was higher for heart attack while the association for women was stronger for stroke, the study showed.

“The sex differences were intriguing,” Jackson said. In men aged 45 to 79, high/very high psychological distress was associated with a 30% increased risk of myocardial infarction compared to those with low distress. Among women, in contrast, high/very high distress was associated with an 18% increased risk of heart attack.

“The effect of psychological distress on heart attack risk was greater than we would expect and greater than the effect observed in women,” Jackson said.

The team found that being male with high/very high distress levels had a “supra-additive effect” on myocardial infarction risk. In this group, high/very high distress was associated with 60% increased risk of heart attack after adjusting for sociodemographic factors.

The stronger association between distress and heart attacks in males could be due to the greater likelihood of women to seek primary care for mental and physical health problems, Jackson said. Such care might partially negate the possible physical effects of mental health issues.

The difference also might reflect women’s hormonal protection against heart disease, since the study population included a large number of younger women, she said.

“We did however find a strong association between psychological distress and stroke in women, perhaps suggesting different mechanisms exist between psychological distress and different types of cardiovascular disease in women,” Jackson said.

The team reported that high/very high psychological distress was associated a 44% increased stroke risk in women and a 24% increased stroke risk in men.

Until recently much more was known about the link between physical disease and subsequent poor mental health than the link between poor mental health and subsequent physical disease. Further research is needed to identify the underlying mechanisms linking psychological distress to cardiovascular conditions.

“Such work requires long-term follow-up of people from a young age to more accurately capture poor mental health symptoms across the life-course and study their effect on intermediate cardiovascular risk factors,” Jackson said.

Jackson has begun analyzing data from other studies on men and women from early adulthood to middle-age and hopes that these analyses will help clarify the underlying mechanism that connects depression/anxiety and cardiovascular risk.

“Through more effective treatment of these mental health conditions we should be able to reduce the risk of cardiovascular disease,” Jackson said.

The study, “Psychological Distress and Risk of Myocardial Infarction and Stroke in the 45 and Up Study,” was published in Circulation.