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Traditionally, reports of racing hearts due to panic attacks or grief-induced stress were often dismissed in medical circles compared to physical heart conditions, which triggered immediate concern and intensive treatment.

However, in the emerging field of psychocardiology, healthcare professionals now recognize a profound link between mental and cardiovascular well-being. Anxiety disorders reportedly affect 40% to 70% of coronary heart disease patients, with depression affecting 17% to 44%-triple the rate seen in individuals with healthy hearts. These mental health conditions significantly elevate the risk of cardiovascular illness, complications, and mortality.

Addressing psychological and cardiovascular health in tandem holds potential to bolster recovery and survival among the approximately 128 million Americans grappling with heart disease, according to experts from Cedars-Sinai. Heart disease claims nearly 1 million lives annually, ranking as the nation's leading cause of death.

"We can't just focus on the biology of heart health," said Dr. Janet Wei, cardiologist at Cedars-Sinai's Smidt Heart Institute and associate medical director of the Biomedical Imaging Research Institute. "Many patients develop worse heart symptoms in response to emotional stress."

Research in psychocardiology remains in its nascent stages, yet promises future applications in identifying high-risk individuals prone to heart disease due to mental health issues, potentially averting cardiac complications.

Links Between Mental and Cardiovascular Health

According to Dr. Waguih IsHak, vice chair of education and research in Cedars-Sinai's Department of Psychiatry and Behavioral Neurosciences, prolonged stress strains the heart, heightening susceptibility to severe heart attacks and strokes. Stress triggers inflammatory proteins that impair cell regeneration, elevating cortisol and adrenaline levels, which in turn increase blood sugar, blood pressure, and heart rate.

Furthermore, mental health impacts cardiovascular health reciprocally. Following a cardiac incident like a stroke or heart attack, patients often experience emotional distress, including sadness, exhaustion, and anxiety, compounding recovery challenges. Approximately half of heart failure patients exhibit signs of depression, with many developing anxiety, major depression, or post-traumatic stress disorder within a year of diagnosis, escalating the risk of recurrent emergencies or death. Stroke survivors with these mental health issues face a tripled risk of complications over a decade.

Dr. IsHak highlighted ongoing efforts in psychocardiology to explore the psychological ramifications of heart disease, including how depression impedes patient adherence to treatment regimens, exacerbating unhealthy behaviors like smoking and poor diet.

"They feed into each other," Dr. IsHak noted. "It's a vicious cycle."

At Cedars-Sinai's Barbra Streisand Women's Heart Center, Dr. Wei oversees studies on Takotsubo cardiomyopathy, also known as "broken heart syndrome," which primarily affects women. Triggered by intense emotional or physical stressors such as bereavement or seismic events, this condition weakens the heart, compromising its ability to pump blood effectively.

"We are interested in understanding why certain women have recurrent Takotsubo events and whether mental health conditions such as anxiety, chronic stress and PTSD play a role in their predisposition," said Dr. Wei, who holds the Erika J. Glazer Chair in Women's Cardiovascular Research, Education, and Innovation.

Healing Mental Health in Patients with Heart Disease

Future research is crucial in tailoring effective treatments for diverse patient needs. Dr. IsHak emphasized the complexity of treating mental health alongside heart disease, given patients' preferences to minimize medication burdens. Initial findings published in January 2024 in JAMA Network Open suggest that behavioral activation therapy matches antidepressant medication in reducing depression symptoms by 50% among heart failure patients, while also curbing hospitalizations and emergency visits.

Behavioral activation involves integrating enjoyable or meaningful activities into daily routines under therapeutic guidance, such as walking, volunteering, or socializing.

For people with heart disease experiencing persistent symptoms, experts urge consulting a cardiologist or primary care provider promptly.

"Wellness doesn't have to center on a medication name that is hard to pronounce or some nebulous concept that you can't really grasp," Dr. IsHak emphasized. "Wellness focuses on building joy and meaning to ultimately improve your quality of life."