Mental health may play big role in recovery after a heart attack

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Young and middle-aged adults who reported severe psychological distress such as depression or anxiety after a heart attack were more than twice as likely to have a second heart event within five years than those who only suffered from mild stress, according to a study at the 70th Annual Scientific Session of the American College of Cardiology.

The study is the first to comprehensively examine how mental health affects the outlook for younger heart attack survivors, the researchers said. The researchers also tracked markers of inflammation, which appear to play a role in increasing cardiovascular risk in people who experience stress. The results are consistent with previous studies that focused on older adults and supported the evidence of mental health as an integral part of a person’s recovery from a heart attack.

“Our results suggest that cardiologists should consider the value of regular psychological exams, especially in younger patients,” said Dr. Mariana Garcia, Cardiology Fellow at Emory University in Atlanta and lead author of the study. “It is just as important that, in addition to traditional medical therapy and cardiac rehabilitation, they also investigate treatment modalities for alleviating the psychological stress of young patients after a heart attack, such as meditation, relaxation techniques and holistic approaches.”

The researchers analyzed the health outcomes of 283 heart attack survivors between the ages of 18 and 61, with a mean age of 51. Study participants completed a series of validated questionnaires within six months of their heart attack that measured depression, anxiety, anger, perceived stress, and post-traumatic stress disorder. Based on these questionnaires, the researchers produced a composite rating of psychological distress for each participant and grouped patients based on experiences with light, moderate, and high stress.

Within five years of their heart attack, 80 of the 283 patients suffered a subsequent heart attack or stroke, were hospitalized for heart failure, or died of cardiovascular causes. These results occurred in almost half (47%) of the high-stress patients compared with 22% of the light-stressed patients.

Previous studies suggest that inflammation is one mechanism by which psychological stress can lead to heart problems. The new study also found that two markers of inflammation – interleukin-6 and monocyte chemoattractive protein-1 – are more frequently present in the blood in patients with high stress levels at rest and after psychological stress. These markers, which increase during times of mental stress, are known to be associated with plaque build-up in the arteries and adverse cardiac events.

“It is believed that those who have had a heart attack are particularly prone to plaque rupture because of these inflammatory mechanisms,” Garcia said. “The association we found was independent of known cardiovascular risk factors and suggests that mechanisms involving systemic inflammation in response to stress may be related to the likelihood of a subsequent cardiac event.”

The researchers also found that high-exposure patients were more likely to be black, female, and with a disadvantaged socio-economic background, and more likely to smoke or have diabetes or high blood pressure.

“This finding underscores the importance of socio-economic status in relation to higher exposure and raises important questions about the role of race, gender and other factors,” said Garcia.

The researchers plan to further study how socio-economic and demographic factors can affect the mental health of people who have a heart attack at a young age. Recent studies have shown that younger adults, especially women, have an increasing proportion of the heart attacks that occur each year in the U.S., Garcia said, highlighting the importance of improving outcomes in that population.

“Reaching out to the community has increased awareness of traditional heart disease risk factors and has focused on things like diet and exercise, but many people, especially younger people, may be unaware of the importance of mental health,” Garcia said. “Our study offers a strong message to people recovering from a heart attack that relief from psychological distress is equally important.”

Garcia warned that the cause could not be established with an observational study and pointed out the possibility of creating a recall bias in people with more severe illness, as psychological distress itself was reported in that study. While the study sample size was relatively small, it showed a robust association using a prospective design.

Depression can increase the risk of heart attack and stroke

More information:
Garcia will present the study “Psychological Stress and Risk of Adverse Cardiovascular Outcomes in Young and Medieval Myocardial Infarction Survivors” on Sunday, May 16 at 3:45 pm ET / 7:45 pm UTC.

Provided by the American College of Cardiology

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