An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Mind Over Matter?

Research shows a connection between depression and heart disease

The mind is a powerful thing. If you don’t believe it, just ask the heart.

From depression to broken heart syndrome, what happens in that intricate complex of axons, synapses and neurotransmitters called the brain can affect the heart in ways researchers are still working to understand.

In 2016, Abhijeet Dhoble, M.D., an assistant professor of interventional cardiology at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), was the author of a case study in the New England Journal of Medicine that grabbed attention as it spread through print, broadcast, online and social media.

The focus of the paper was a 61-year-old female patient, who arrived at Memorial Hermann-Texas Medical Center emergency center — where Dhoble is an attending physician — complaining of severe chest pains. However, she wasn’t suffering a heart attack. She had takosubo cardiomyopathy — a broken heart in lay terms. The condition, which can be deadly, may be proceeded by a stressful or emotional event, which in her case was the slow and painful death of a beloved pet. She was treated with medications, the pain resolved and she had experienced no further attacks at a checkup a year later. But she admitted she was working on managing her stress. 

Increased protein levels

Stress, anxiety and depression are all associated with an increased risk of cardiovascular disease and the related culprit might be inflammation on a psychological level, researchers say. Both psychological and physiological factors can increase concentrations of specific proteins in the blood.

“These increased protein levels may cause unstable coronary plaque to rupture, resulting in a heart attack,” says Lorraine Frazier, Ph.D., R.N., dean of Cizik School of Nursing at UTHealth and the John P. McGovern Distinguished Professor and Huffington Foundation Chair for Nursing Education Leadership.

UTHealth research has revealed that people with heart disease who suffered from major depression had significantly higher levels of inflammatory proteins in the blood compared to people who were not depressed.  

Frazier says behavioral factors associated with depression could also play a role. “Typically, depressed individuals may not eat or exercise in ways that enhance health. If they smoke or drink alcohol, they tend to increase either or both as coping mechanisms,” she says. 

Luba Yammine, Ph.D., R.N., assistant professor at Cizik School of Nursing, says depressed individuals are also less likely to take prescribed medications. There could be a bidirectional relationship between depression and heart disease, Yammine says, meaning that people with depression are more likely to develop heart disease, and people with heart disease have a higher risk of developing depression. In addition, patients with heart disease who are also depressed have worse outcomes than those patients who are not depressed. 

Alan Prossin, M.B.B.S., assistant professor of psychiatry at McGovern Medical School at UTHealth, directs the Neuroimmune Interactions in Depression, Addiction and Pain Research Program. His research shows that when patients become sad, certain neurotransmitters become dysregulated. These changes in brain function lead to increased blood concentration of inflammatory proteins implicated in heart disease. He believes “these mind-body connections help explain how our thoughts impact overall health and well-being.”

Future studies needed

Future studies of heart disease could investigate non-traditional risk factors such as depression and anxiety, which we can positively impact if treated, says Jennifer E. Sanner Ph.D., R.N., Nancy B. Willerson Distinguished Professor at Cizik School of Nursing.

“We need to understand non-traditional heart disease risk factors that may impact not only someone’s health status, but also the quality of life of people at risk or already living with heart disease,” says Sanner, who is director of UTHealth’s Center for Clinical and Translational Sciences (CCTS) Biobank. She leads ongoing research looking at the links among depressive and anxiety symptoms, inflammation and heart disease and stroke risk.

A study published in 2016 by Sadie Conway, Ph.D., assistant professor at UTHealth School of Public Health, revealed a potentially stress-filled habit — working long hours — is associated with an increase in cardiovascular disease risk. In particular, working 46 or more per week for many years was identified as the tipping point. Comparing people who averaged 45 hours per week for 10 years or longer to those who worked 55 hours per week, overall risk of heart disease increased by 16 percent. For those who 60 hours per week, it increased by 35 percent.

So what can we do?

Exercise will help, says John Higgins, M.D., associate professor of cardiology at McGovern Medical School, whose areas of expertise include sports cardiology. There are endless possibilities: walking, jogging, running, swimming, hiking, dancing, muscle-strength training, flexibility, relaxation, tai chi and yoga.

“Exercise not only improves your body physically, it can improve your mental toughness and reduce fatigue, anxiety and depression,” explains Higgins, who is chief of cardiology at Harris Health’s Lyndon B. Johnson Hospital and sees patients at UT Physicians. “In the short term, exercise results in release of endorphins, which reduce pain and make you happy, which reduces inflammation. Also, improved vascular function helps blood flow to all the essential organs of the body, as well as improving your ability to remember things, process thoughts and sleep.”

Long-term, he says, exercise helps lower your blood pressure, which makes you feel better, and reduces depression by about 25 percent. “Exercise changes chemicals in your body over time that will result in reducing inflammation, which can translate to less heart attacks, strokes or vascular disease; and boosts your immune system, which means less infections and cancer,” he says.

The result could make both mind and heart happy: a healthier person.

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