The Psychology of Heart Health: Mental Wellness & Cardiovascular Health

The Link Between Heart Health and Mental Wellness

Most people are aware that there are specific physical biometrics or “numbers” that individuals should monitor to assess their current risk of heart disease. Many of these can measure the heart’s immediate reactivity (such as heart rate and blood pressure at any given moment), as well as other long-term indicators, including HDL (“good cholesterol”), LDL (“bad” cholesterol), and triglycerides. However, there is growing evidence that mental health plays a role, both as a risk factor for heart disease, as well as impacting treatment after a diagnosis has been made. By integrating solutions that impact both mental wellness AND cardiovascular health, a patient can improve their long-term physical, mental, and emotional outcomes.

Cardiovascular Disease: A Global Health Crisis

According to data from the World Health Organization (WHO), cardiovascular diseases (CVDs) are the leading cause of death worldwide. The WHO also estimates that in the United States, CVDs continue to be the predominant cause of mortality, with a reported nearly 1 million deaths in 2020. People with CVDs often experience a decreased Quality of Life (Borkowski et al, 2). The nature of the long-term illness and its management cause chronic stress, which over time can lead to anxiety, disrupting daily routines, sleep patterns, and social interactions. Moreover, some patients with CVDs may experience depression, which arises from a sense of loss - loss of health, loss of independence, and loss of the ability to participate in previously enjoyed activities (Borkowski et al, 2).

The Biological Connection Between Mental Health and CVD

It’s not just the aftermath of a CVD diagnosis that can impair a patient’s mental health; there is a biological connection between existing mental health conditions and the risk for cardiovascular disease. A key factor is the activation of the hypothalamic-pituitary-adrenal (HPA) axis from persistent stress and anxiety, leading to elevated cortisol levels.

High cortisol, along with altered cortisol stress reactivity, are commonly observed in disorders such as depression and anxiety disorders. Persistently high cortisol levels cause dysfunction in endothelial regulation, disbalance of pro- and anti-inflammatory interleukins, and the recruitment of circulating monocytes to the arterial wall (Borkowski et al, 2). In short, high cortisol levels cause an increase in inflammation in the arterial walls, making the threshold to create a blockage smaller, while the body deposits cholesterol in the arteries. This tends to be a silent process, going unnoticed until CVD symptoms (such as angina or heart attack) occur. The effect can go in two directions; symptoms of mental health and stress can affect one’s heart health as well as one’s heart health affecting mental and emotional health.

A Holistic Approach to Heart and Mental Health

With such sobering statistics, it’s hard to believe that much can be done to both prevent the development of a CVD and tend to one’s mental health in today’s fast-paced society. However, by using a multi-faceted, holistic approach, not only can you reduce your overall risk of heart disease, but also improve your mental health! The key is to recognize that both your mental health AND your physical health (specifically, CVD risk factors and contributing biometrics) require treatment plans. When it comes to mental health, it is just like a physical health problem; prevention and early intervention are key in increasing the likelihood of positive outcomes.

Key Areas to Consider for Both Mental and Physical Wellness

• Family History
• Primary symptoms - if they are disrupting your daily activities, seek help from a health professional
• Diagnosis - the sooner you can diagnose the problem, the easier it can be to treat
• Create a treatment plan with your mental health specialist that fits your needs, lifestyle, and most importantly, that can be followed consistently

The Importance of Personalized Treatment Plans

When a patient feels like there is a lack of control in their own life, it leads to feelings of overwhelm and isolation. That is why it is extremely important for a patient to have significant input when creating their treatment plan. Simply handing a list of instructions to follow without discussing the why or how to implement a plan can lead to an increase in anxiety. By working with a health professional, such as a health coach, the patient can thoroughly examine the pros and cons of best practices, have control on where to start making lifestyle changes, and leverage pre-existing strengths that they have already mastered to create a tailored health plan that will produce success. The health professional is also part of the patient’s social support, providing accountability for following through with changing behaviors to positive habits.

Daily Habits to Improve Both Physical and Mental Health

• Regular exercise - The American College of Sports Medicine (ACSM) recommends 150 minutes per week of moderately hard exercise for heart health. While that may sound intimidating, it doesn’t have to be! 3 bouts of 10 minutes of walking per day can help keep the doctor away.
• Eat fresh fruits and vegetables - Eating the rainbow (a variety of colored fresh produce) has been shown to reduce inflammation, as these foods tend to be high in antioxidants. Antioxidants are helpful in reducing inflammation in arteries.
• Practice mindful moments - Mindfulness has been in the news a lot, but what does it mean? When we are able to re-ground ourselves during stressful times, we have better control of our emotions and decision-making skills, thereby reducing our stress and lowering our cortisol levels. Commit to setting a timer and focus on deep breathing for 1 minute anytime you get overwhelmed. As with all new habits, the more you practice this, the easier it becomes to do it naturally!

The Role of Social Support in Health Outcomes

An often underrated or under-discussed area of treatment and prevention is how your environment and social factors impact your ability to follow or stick with a plan. Long-term conditions, whether it is a mental health condition or a CVD, impact your level of stress, as well as the potential to be unable to participate in previously enjoyed activities, daily routines, and impact sleep. All of these stressors can impact our ability to respond appropriately in social situations or at work, which can further increase anxiety.

When patients feel isolated, their risk for experiencing depressive symptoms increases. Having someone to regularly talk to, whether it is a family member or a mental health professional, decreases feelings of isolation. Additionally, having definitive support from not only doctors and health professionals, but also within their social circle (friends, family, colleagues), increases patient self-confidence in following a treatment plan. Simply put, social support at a variety of levels leads to more successful outcomes.

However, it can be difficult to get in to see your doctor or mental health professional in a timely manner. The usage of telehealth services has become increasingly popular and offers several advantages, including removing travel time and reducing hands-on time for the health professional, as these are often short check-in appointments. This can be a great way to reduce the patient’s stress as well, since taking off from work for health appointments can create more stress.

Conclusion

By integrating both your mental and physical wellness plans, you can find yourself a happier, healthier person. Always remember to ask for help if you need it - the sooner you start working with others in the interest of your health, the sooner your risk level can be decreased and you can feel better!

References

Borkowski, Pawal, and Natalia Borkowska. "Understanding Mental Health Challenges in Cardiovascular Care." Cureus, Feb. 2024, pp. 1-7.