Features August 2013 Issue

How Anxiety, Depression Can Affect Heart Health

New research underscores the need to pay close attention to the emotional and mental health of heart patients.

The connection between depression and heart disease has been well-studied, and cardiologists are becoming more aware of the need to screen heart patients for early signs of depression.


But a recent study also casts a light on the cardivascular risks associated with anxiety. Research published in the Journal of the American Heart Association found that heart disease patients with anxiety have twice the risk of dying from any cause, compared to those who don’t have anxiety. Patients with anxiety and depression had triple the risk of dying. Researchers used standard screening tools for depression and anxiety with more than 900 heart patients with an average age of 62.

Leo Pozuelo, MD, section head of Consultation Psychiatry at Cleveland Clinic, and a specialist in the connection between depression and heart disease, says this study is further proof that the potential for anxiety disorders developing in heart patients needs greater attention.

“For years we’ve known about the links between heart disease and depression, but in the last five years or so, there’s been some very good information coming out about anxiety disorders having the same effect,” Dr. Pozuelo explains.

He adds that individuals with elevated anxiety levels also face higher risks of developing cardiac disease. “Then, of course, if you have cardiac disease, you often tend to have anxiety about it,” he says.

Defining anxiety
Anxiety is actually a feeling most people experience at one time or another. Nervousness or worry about big test, or a job interview or before an operation or any major event is normal.

But when anxiety becomes so overwhelming that it interferes with your daily life, it could indicate an anxiety disorder. For example, if constant worry keeps you from getting enough sleep or if feelings of restlessness are prohibiting you from simply sitting still and relaxing, you should consider talking wtih a doctor or therapist.
Dr. Pozuelo lists some of the generalized symptoms of anxiety as physical tension, heart palpitations, difficulty concentrating, stress and feelings of worry or nervousness that are difficult to escape. “Having high levels of anxiety affects quality of life,” he says. “There’s no question about it.”

Diagnosis and treatment
If you find yourself or a loved one exhibiting signs of an anxiety disorder, you can always talk with your doctor or nurse practitioner. You may be given a generalized anxiety disorder screensing tool  (see chart) to help you and your doctor better understand and identify your symptoms. Dr. Pozuelo says cardiologists are becoming more aware of the need to ask about anxiety and depression, but it’s still incumbent on the patient to share symptoms and concerns.

Treating anxiety can often be  done through  cognitive behavior therapy and other non-pharmacological approaches. In some cases, however, medications may be very helpful, particularly in the short term. Dr. Pozuelo adds that just as exercise can have positive effects on pateints with depression, so too can physical activity help reduce feelings of anxiety in many people.

Whatever treatment plan is devised, Dr. Pozuelo says it’s important to integrate that with your overall cardiac treatment program. 

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