Distress boosts heart attack and stroke risk

A new study confirms that having high or very high psychological distress due to depression or anxiety impacts a person's risk of experiencing cardiovascular health problems such as heart attack and stroke.

Researchers from the University of Edinburgh in the United Kingdom and the University of Queensland in Brisbane, Australia have conducted a large study investigating the association between measures of psychological distress and cardiovascular risk.

The idea that mental health status can influence a person's risk of having a cardiovascular health event is not a new one.

In fact, an increasing number of studies have been examining it in an effort to gain a better understanding of how much of a bearing psychological factors actually have on physical health.

In the new study, the team assessed a cohort of 221,677 participants aged 45 and over, focusing on their individual levels of distress and following the evolution of their cardiovascular health over the years.

The investigators' analysis led them to conclude that psychological distress influences the risk of events such as heart attack and stroke independently of other factors.

For this reason, in the paper they recently published in Circulation: Cardiovascular Quality and Outcomes, they advise that people already at risk of cardiovascular health problems should take instances of psychological distress as a serious influencing factor.

Distress and cardiovascular health

The researchers worked with participants recruited via the 45 and Up Study. The volunteers joined the study in 2006–2009, and none of them had experienced a heart attack or a stroke at the time of recruitment.

Of the total number of participants, 119,638 were women (aged 60, on average), and 102,039 were men (aged 62, on average).

After accounting for the impact of other relevant factors — including smoking, diet, regular alcohol intake, and medical history — the research team was able to confirm that the link between high or very high psychological distress and a boosted cardiovascular risk remained in place.

"While these factors might explain some of the observed increased risk, they do not appear to account for all of it, indicating that other mechanisms are likely to be important," explains senior study author Caroline Jackson.

Specifically, the researchers found that women experiencing high or very high psychological distress had a 44 percent higher risk of stroke. As for men, those aged 45–79 who reported high or very high distress had a 30 percent higher risk of heart attacks.

For men, the association appears to become weaker with age, with those aged 80 or over experiencing a lower increase in risk, even with high measures of distress.

Higher distress, higher cardiovascular risk

In order to determine the participants' levels of psychological distress, the researchers used a self-assessment questionnaire, featuring questions such as "How often do you feel tired out for no good reason?" and "How often do you feel so sad that nothing could cheer you up?"

According to the results, 16.2 percent of the participants experienced moderate levels of psychological distress, while 7.3 percent reported high or very high distress levels.

The participants' health developments were followed up for a period of over 4 years, during which time the researchers recorded 4,573 heart attacks and 2,421 strokes.

Importantly, the investigators note that a person's overall risk of heart attack and stroke increased with each measure of psychological distress.

The researchers explain that the results of their study consolidate the notion that severe distress — perhaps tied to conditions such as depression and anxiety — can boost the risk of cardiovascular disease.

'We encourage more proactive screening'

At the same time, the researchers stress the need to conduct further studies addressing the underlying mechanisms that may be at play. They also add that we need to gain a better understanding of the potential differences in risk between women and men.

Jackson further emphasizes that individuals experiencing psychological distress should receive more focused attention and assistance for symptom management, as their mental health status may actually harm their physical health, as well.

"We encourage more proactive screening for symptoms of psychological distress. Clinicians should actively screen for cardiovascular risk factors in people with these mental health symptoms."

Caroline Jackson

In fact, the researchers explain, due to the methodological approach — which required analyzing all modifying factors at the same point in time — they were unable to assess the potential association between measures of psychological distress and other variables, such as dietary habits or smoking.

This, they warn, may mean that the impact of psychological distress on cardiovascular risk may be even greater than they estimated.