Psychological distress doubles the risk of subsequent cardiac events

Organisation: Position: Deadline Date: Location:

Adults who reported severe psychological distress — such as depression or anxiety — after suffering a heart attack were more than twice as likely to suffer a second cardiac event within five years compared with those experiencing only mild distress, according to a study presented at the American College of Cardiology's 70th Annual Scientific Session.

The study is the first to comprehensively assess how mental health influences the outlook for younger heart attack survivors, according to the researchers. The researchers also tracked inflammatory markers that appear to have a role in increasing cardiovascular risk among people experiencing distress. The findings align with previous studies focusing on older adults, bolstering the evidence for mental health as an integral part of a person's recovery after a heart attack.

"Our findings suggest that cardiologists should consider the value of regular psychological assessments, especially among younger patients," said Dr Mariana Garcia, a cardiology fellow at Emory University in Atlanta and the study's lead author. "Equally importantly, they should explore treatment modalities for ameliorating psychological distress in young patients after a heart attack, such as meditation, relaxation techniques and holistic approaches, in addition to traditional medical therapy and cardiac rehabilitation."

The researchers analysed health outcomes in 283 heart attack survivors between the ages of 18 and 61, with an average age of 51 years. Study participants completed a series of validated questionnaires measuring depression, anxiety, anger, perceived stress and post-traumatic stress disorder within six months of their heart attack. Based on these questionnaires, the researchers established a composite score of psychological distress for each participant and grouped patients based on experiences of mild, moderate and high distress.

Within five years after their heart attack, 80 of the 283 patients suffered a subsequent heart attack or stroke, were hospitalised for heart failure or died from cardiovascular causes. These outcomes occurred in nearly half (47%) of patients experiencing high distress compared to 22% of those experiencing mild distress.

Previous studies suggest inflammation is one mechanism through which psychological distress may lead to heart problems. In the new study, patients who experienced high distress were also found to have higher levels of two inflammatory markers — interleukin-6 and monocyte chemoattract protein-1 — in their blood during rest and after mental stress. These markers, which increase during times of mental stress, are known to be associated with plaque buildup in the arteries and adverse cardiac events.

"It is thought that those who have had a heart attack may be particularly vulnerable to plaque rupture as a result of these inflammatory mechanisms at play," Garcia said. "The association we found was independent of known cardiovascular risk factors and suggests mechanisms involving systemic inflammation in response to stress may be implicated in the likelihood of a subsequent cardiac event."

The researchers also found that patients with high distress were more often Black, female and from a disadvantaged socioeconomic background and were more likely to smoke or have diabetes or high blood pressure.

"This finding highlights the importance of socioeconomic status in regard to higher distress and raises important questions about the role of race, sex and other factors," Garcia said.

The researchers plan to further investigate how socioeconomic and demographic factors may influence mental health among people who suffer a heart attack at a young age. Recent studies have suggested younger adults, especially women, account for an increasing proportion of the heart attacks occurring each year in the US, Garcia said, underscoring the importance of improving outcomes in this population.

"Outreach to the community has led to increased awareness of traditional heart disease risk factors and focus on things like diet and exercise, but many people, particularly younger people, may not be aware of the importance of mental health," Garcia said. "Our study offers a strong message to people recovering from a heart attack that ameliorating psychological distress is equally important."

Garcia cautioned that causation cannot be proven with an observational study and noted the possibility of recall bias among people with more severe disease, since psychological distress was self-reported in this study. While the study's sample size was relatively small, it did demonstrate a robust association using a prospective design.


Study details

Psychological Distress and Risk of Adverse Cardiovascular Outcomes in Young and Middle-Aged Survivors of Myocardial Infarction

Abstract not available at the time of publication of this article


See also from the MedicalBrief archives:


Work and social stress put women at significantly higher heart risk


Persistent mental distress linked to higher risk of death in heart patients

Receive Medical Brief's free weekly e-newsletter

Related Posts

Thank you for subscribing to MedicalBrief

MedicalBrief is Africa’s premier medical news and research weekly newsletter. MedicalBrief is published every Thursday and delivered free of charge by email to over 33 000 health professionals.

Please consider completing the form below. The information you supply is optional and will only be used to compile a demographic profile of our subscribers. Your personal details will never be shared with a third party.

Thank you for taking the time to complete the form.