As a cardiologist who cares for cancer patients experiencing cardiovascular issues like coronary artery disease and heart failure, Lavanya Kondapalli, MD, regularly sees the stress her patients are experiencing. But in what ways can chronic psychological stress affect — and potentially worsen — a person’s heart health, particularly among women?
It’s one of the questions explored by Kondapalli, an associate professor of cardiology at the University of Colorado Anschutz School of Medicine, and several other physicians in a recently published in-depth review article, “The Impact of Mental Health on Cardiovascular Disease in Women.”
Improving people’s understanding of the risk factors for cardiovascular disease continues to be a pressing challenge. Cardiovascular disease is the leading cause of morbidity and mortality for women in the United States, Kondapalli and her co-authors explain in the article. For more than 30 years, the annual mortality rate for cardiovascular disease has been higher among women than men, they add.
“Psychological stress and mental health conditions have emerged as important non-traditional risk factors for developing cardiovascular disease, but we wanted to know more about how this may affect women given that these mental health conditions disproportionately affect women,” says Kondapalli, director of CU Anschutz’s cardio-oncology program.
The research sparked from the American College of Cardiology’s Sandra J. Lewis Mid-Career Women’s Leadership Institute, which Kondapalli is involved in. One of her colleagues in the institute, D. Elizabeth Le, MD, a faculty member at the Oregon Health and Science University, raised the idea of analyzing the relationship between mental health conditions and cardiovascular disease among women.
“There is a need to better understand women’s cardiovascular disease so we can better prevent it and treat it, because it is different from men’s,” Kondapalli says. “This research was an opportunity for cardiologists of different specialties to work together to analyze how different aspects of mental health — chronic anxiety, post-traumatic stress disorder, and depression, for example — may affect women’s cardiovascular health. Moving forward, mental health is something we need to consider more as cardiologists.”
Connections between the head and heart
Based on their analysis, Kondapalli and her co-authors wrote that chronic psychological stress (meaning any experience that distresses a person almost daily for more than six months), anxiety, depression, PTSD, adverse childhood experiences, and sexual trauma are “strongly associated with a higher prevalence of cardiovascular disease and worse outcomes in women, especially in women veterans.” Women veterans are disproportionately affected by mental health conditions, with higher rates of depression, anxiety disorders, and PTSD than civilian women, the authors explain.
“Certain cardiac conditions that are serious and involve hospitalizations, like stress-induced cardiomyopathy and spontaneous coronary artery dissection, are more prevalent in women and are connected to psychological stress,” Kondapalli says.
Stress-induced cardiomyopathy, often called broken heart syndrome, is a condition that is commonly thought of as happening after a profound emotional event, such as after a person has experienced the death of a loved one. Spontaneous coronary artery dissection, where the wall of an artery suddenly tears, can be associated with emotional stress, she adds.
When a person experiences chronic stress, Kondapalli and her co-authors explain that it can trigger a person’s sympathetic nervous system. This can lead to increased heart rate and blood pressure as well as stress hormones being released. Such a response, often called a fight-or-flight response, can negatively affect the cardiovascular system.
“There is a connection between the head and the heart,” Kondapalli says. “Mechanistically, there is work to be done on understanding how mental health conditions like chronic stress can change the vascular system. Emotional state over time can cause actual vascular changes in the body, which may increase the risk of cardiovascular disease.”
What you can do
Key insights Kondapalli gained from this work were steps women can take to make a positive difference in their heart health.
Research suggests that relaxation techniques, such as meditation practices, may help decrease cardiovascular mortality and improve conditions like hypertension and type 2 diabetes. Stress management approaches like mindfulness and relaxation techniques may decrease stress hormones, and a positive mental health state can potentially decrease a person’s heart rate and blood pressure, reduce inflammation, and eventually diminish the risk of cardiovascular disease, according to the article.
“Small interventions can make a difference. Seeing data that shows interventions like meditation can help improve your cardiovascular health was a main takeaway for me,” Kondapalli says. “It shows me how important mental health is as a non-traditional risk factor and that cardiologists should think about mental health as something that is a modifiable risk.”
In the future, Kondapalli hopes to see more of a focus in the cardiology field on the connection between cardiovascular disease and mental health — a relationship also referred to as psychocardiology — through additional research efforts and potential clinical interventions.
“Just as I’m treating a patient’s blood pressure, I should also be asking them about what they are doing to manage their mental health,” she says. “Looking ahead, I think that cardiologists need to have a better understanding of how we can help foster good mental health practices in our patients. We need more discussions and direction on how we can better support patients.”
In her own practice at the UCHealth Heart and Vascular Center and at the CU Anschutz Cancer Center, Kondapalli asks her patients about ways they manage their stress, hoping to get more patients thinking about steps they can take to improve their mental health.
“Stress is pervasive in our world, and many patients are living under conditions of chronic stress — even if they don’t have a mental health diagnosis. It’s important for me to have these conversations and bring up techniques that may help patients, such as meditation or certain breathing techniques. These steps won’t solve everything, but they’re a step forward,” she says. “Overall, for me, this research was thought provoking on how we may approach more holistic cardiovascular care for women in the future.”
