Psychosocial Perfect Storm: Stress, Depression, and Cardiovascular Health

More research findings in today’s post regarding the effects of stress and depression on cardiovascular health. It's always interesting reading articles that outline the relationship between mental health and physical health.  

According to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, the combination of stress and heavy depression can significantly increase heart patient's risk of death or heart attack.

The study examined the effect of high stress levels and high depressive symptoms among nearly 5,000 heart patients. Researchers concluded that risk is amplified when both conditions are present, thus validating the concept of a "psychosocial perfect storm.”

"The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health risk behaviors," said Carmela Alcántara, Ph.D., lead author of the study and associate research scientist at Columbia University Medical Center for Behavioral Cardiovascular Health in New York.

Study participants included 4,487 coronary heart disease patients, 45 years and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

During in-home examinations and self-administered questionnaires from 2003-07, participants were asked how often during the past week they felt depressed, lonely or sad, or had crying spells. To determine stress levels, participants were asked how often during the past month they felt they were unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems and felt things were going their way.

About 6 percent reported both high stress and high depression.

During an average six-year follow-up, 1,337 deaths or heart attacks occurred. Short-term risk of death or heart attack increased 48 percent for those in the high stress-high depressive symptoms group compared with those in the low stress-low depressive symptoms group.

The elevated risk was most strongly associated with death rather than heart attack; additional result suggest the deaths may have been cardiovascular-related, but more research is needed, researchers said. The risk was significant only during the first two-and-half years from the initial home visit, and wasn't significant for those experiencing either high stress or high depressive symptoms alone, but not both at the same time.

Study findings may challenge traditional research paradigms that only focus on depression and its impact on patients with heart disease, Alcántara said. Behavioral interventions also should be considered to help heart disease patients manage both stress and depression better.

I highly recommend checking out the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. They have many interesting findings regarding stroke risk factors that have been gathered over the past decade. 

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Does an Upbeat Outlook Mean a Healthy Heart?

In my post for today I have very interesting findings from a study, Optimism and Cardiovascular Health, published in the January/February 2015 issue of Health Behavior and Policy Review that state people who have upbeat outlooks on life have significantly better cardiovascular health.

“Individuals with the highest levels of optimism have twice the odds of being in ideal cardiovascular health compared to their more pessimistic counterparts,” said lead author Dr. Rosalba Hernandez, a professor of social work at the University of Illinois (UI). “This association remains significant, even after adjusting for socio-demographic characteristics and poor mental health.”

In this latest study, the UI team looked at the associations between optimism and heart health in more than 5,100 adults. The researchers used seven metrics to assess participants’ cardiovascular health: blood pressure, body mass index, fasting plasma glucose and serum cholesterol levels, dietary intake, physical activity and tobacco use — the same metrics used by the American Heart Association (AHA) to define heart health and targeted by the AHA in its “Life’s Simple 7″ (LS7) public awareness campaign.

Believed to be the first study to examine the association of optimism and cardiovascular health in a large, ethnically and racially diverse population, the sample for the current study was 38 percent white, 28 percent African-American, 22 percent Hispanic/Latino and 12 percent Chinese.

Data for the study were derived from the Multi-Ethnic Study of Atherosclerosis, an ongoing examination of subclinical cardiovascular disease that includes 6,000 people from six U.S. regions, including Baltimore, Chicago, Forsyth County in North Carolina, and Los Angeles County.

Begun in July 2000, MESA followed participants for 11 years, collecting data every 18 months to two years. Dr. Hernandez, who is an affiliated investigator on MESA, is leading a team in conducting prospective analyses on the associations found between optimism and heart health.

Dr. Hernandez said, “They hope their future research will help them sort out exactly how optimism and heart health are related.” For instance, although the evidence clearly suggests a connection, it is not yet known whether optimism or healthy behaviors come first. It could be that happier, more positive people are more likely to engage in healthy behaviors, which in turn improves factors like blood pressure. It could also be that engaging in healthy behaviors and having a better biological profile helps boost psychological well-being. “Longitudinal data will help resolve these questions,” said Dr. Hernandez.

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