How Mental Health Affects Your Heart

There’s stress, and then there’s helping your mother recover from a stroke while caring for your four children — all while nine months pregnant.

This was life for 48-year-old Nefertari Williams of Willingboro, New Jersey, who was 34 at the time. “I was dealing with a mother who had recently suffered a massive stroke which left her unable to move her right side or speak,” Williams said. “I was also a married mother of four.” Stressed didn’t begin to describe what she was feeling as she prepared for the birth of her fifth baby.

Then she had a heart attack.

After a harrowing handful of days when it seemed as though neither she nor her unborn child would make it, Williams gave birth to a healthy baby girl.

“I found the strength to open my eyes, and I saw a smaller version of my face,” she said. “We were both alive — and it was my mother’s birthday.”

Williams is deeply grateful she survived to tell her story, but many others aren’t so lucky. Cardiovascular disease is the number one killer of women, causing one out of every three deaths each year.

Although less well known than risk factors such as smoking and high cholesterol, chronic stress and other mental health challenges are closely linked to cardiovascular disease. Understanding the connection may help you lower your risk.

Stress hits the heart hard

While Williams was exceptionally stressed out at the time of her heart attack, even “normal” levels of stress and anxiety may lead to heart problems. “Anxiety and stress cause increases in blood pressure and heart rate,” said Dr. Nieca Goldberg, medical director of Atria New York City and clinical associate professor of medicine at NYU Grossman School of Medicine and a member of HealthyWomen's Women's Health Advisory Council. “People may also experience heart palpitations when they’re feeling stressed or anxious.”

Goldberg added that anxiety and stress can affect a person’s lifestyle in ways that make it difficult for them to keep up healthy habits, which can further increase their risk of heart problems.

While the Covid-19 pandemic has taken a mental toll on everyone, women have been disproportionately burdened. Juggling the demands of work and family while isolated from their communities and support systems, many women found themselves dealing with an unprecedented level of stress and anxiety — and with far less time for self-care practices like eating well and exercise.

Cases of broken heart syndrome (Takotsubo cardiomyopathy), a type of heart disease triggered by intense stress, surged among women during the pandemic, according to data collected by medical centers across the United States. The data also revealed that cases of broken heart syndrome are increasing up to 10 times more quickly in older women than any other demographic.

Experts predict the effects of pandemic stress on women’s emotional and physical well-being will continue to increase their risk of heart problems, an especially troubling prediction given that heart disease is already the number one killer of women.

Goldberg said anyone who is experiencing cardiac symptoms such as rapid heartbeat, lightheadedness, the sudden onset of chest discomfort or severe shortness of breath should get medical attention right away.

“You shouldn't just write that off as stress. You should call an ambulance,” Goldberg said.

Depression can lead to heart problems, and vice versa

The link between depression and heart problems is so well established that the American Heart Association (AHA) recommends all heart patients be screened for depression. A meta-analysis of 124,509 people across 21 studies found depression was associated with an 80% increased risk for coronary artery disease.

The relationship between depression and heart disease goes both ways; up to 30% of people with heart problems develop depression, which may further impact their heart health. Depression is the strongest predictor of death in the first 10 years after a heart disease diagnosis, and people with heart disease who are diagnosed with depression are twice as likely to die compared to heart disease patients without depression.

Like stress and anxiety, depression can prevent people from maintaining a healthy lifestyle. “So it's not only the physiological effects of depression, but the outside effects of not being able to do the things one needs to do to encourage heart health,” Goldberg said.

For women, postpartum depression seems to pose a unique and startling threat of cardiovascular disease. One study involving almost 2 million women found that those with postpartum depression had a nearly 70% higher risk of heart attack, stroke and heart failure within around five years after giving birth — even after adjusting for other risk factors such as preeclampsia (high blood pressure during pregnancy), smoking and diabetes.

Who’s most at risk?

Certain groups of people may be more affected by heart problems related to mental health, according to the Centers for Disease Control and Prevention (CDC). These include women and veterans who may be experiencing post-traumatic stress disorder (PTSD), which is linked to higher risk of heart disease. Couples that include one partner with PTSD may also be more likely to develop heart problems because of the way PTSD affects the relationship.

The interplay of socioeconomics and mental health affects heart disease risk as well. Disparities in access to healthcare, systemic racism and childhood trauma make ethnic and minority groups more vulnerable to mental health problems such as depression and anxiety — which in turn increase heart disease risk. Poverty poses similar threats to mental and cardiovascular health.

Protecting your heart and mind

An estimated 80% of cardiovascular disease is preventable, and there are steps people dealing with mental health challenges can take to support heart health. Goldberg advises the following:

• Make time for exercise, which has consistently been shown to relieve stress and improve mood while keeping your heart strong. For those of us struggling to find the time (AKA all of us), a mere seven minutes a day may be enough to get physically and mentally fit.

• Make a calming mind-body practice such as meditation or yoga a part of your routine. Just 15 minutes a day can lower your stress and anxiety levels, among other health benefits.

• Prioritize rest. Sleep is essential for heart and overall health, but it can be hard to get enough of it when you’re stressed, depressed or anxious. Focusing on “sleep hygiene” (good sleep habits) and creating a calming bedtime ritual can help keep insomnia at bay.

• Seek support. Whether it’s from a therapist, a friend or an online support group, don’t hesitate to ask for help when you need it. And don’t be afraid to ask people to pitch in when your to-do list threatens to overwhelm you. “Learn how to delegate,” Goldberg said.

Helping others, finding peace

These days, Williams supports her mental health through helping others. “I am a heart health advocate and I find this to be very rewarding,” she said. Grateful that she and her baby were given a second chance, Williams is committed to raising awareness about the importance of protecting your heart.

Resources:
American Heart Association/Go Red for Women