Distress can be deadly, especially if you’re a woman

Distress can be deadly. Although rare, cardiologists have identified cases of heart attack that are triggered by bad news or a traumatic event, such as broken heart disease. This syndrome — called takotsubo by the Japanese scientists who discovered it in the 1990s — was considered a rare disease at first, but is now known to occur with some frequency and throughout the world. It is triggered when, in a stressful situation, a large amount of a neurotransmitter called catecholamine, similar to adrenaline, is released, which agitates the heart and can break one of its valves. This type of heart disease affects women in 98% of cases. Among them, 2% of heart attacks are caused by an emotional response.

Recently, a paper published by the American Heart Association identified a mechanism that may be behind the relationship between emotional outbursts and heart disease, in other words, how unexpected bad news or a scare can change the functioning of blood vessels. In the work, a group of young, healthy volunteers were asked to recount experiences that had made them angry, anxious or sad for eight minutes, while various parameters of their cardiovascular health were measured.

Among the individuals who reported experiences that caused them anger, it was observed that their blood vessels’ ability to dilate — which serves as a form of cardiovascular protection — was reduced for about 40 minutes. This is related to an increased probability of suffering a heart attack. Such reduction did not happen among the participants who recalled situations that caused them anxiety or sadness.

The authors, led by Daichi Shimbo, from Columbia University, argue that “repeated episodes of a negative emotion may affect cardiovascular physiology over time, causing delayed recovery and eventually irreversible damage.” The results follow on from earlier research that found that a person who has a heart attack is twice as likely to have experienced some type of emotional distress in the hour before the health emergency than during the same period of the previous day.

“The results give clues about how stress alters the protection mechanism of the arteries against the risk of developing atherosclerotic obstructions,” says Manuel Anguita, spokesperson for the Spanish Society of Cardiology. According to the cardiologist at the Reina Sofía University Hospital in Córdoba, this knowledge can be used to develop pharmacological approaches for people with an elevated risk profile due to stress. This solution would be combined with a psychological approach on managing stress. “We recommend patients speak with a clinical psychologist to learn how to modulate this reaction to stress. In fact, cardiac rehabilitation units offer not only physical rehabilitation, but also psychological rehabilitation,” says Anguita, although he notes that collaboration between cardiologists and psychologists or psychiatrists still has a way to go.

The study published by Shimbo and his collaborators offers an explanation for a phenomenon that has been observed for some time. Mental illnesses worsen cardiovascular health, and adopting a psychological approach can be very useful in preventing these effects.

“Scientific studies have shown that patients with untreated chronic depression or chronic anxiety have a significantly increased risk, between 15% and 20%, of suffering from cardiovascular diseases such as myocardial infarction, angina, hypertension and stroke,” points out José Luis Carrasco, director of the Personality Disorders Unit at the San Carlos Clinical Hospital in Madrid. This is also due to factors such as diet, as people with anxiety and depression may be more prone to unhealthy eating habits that increase the risk of high cholesterol, diabetes and metabilic syndrome.

Mental health and cardiovascular risk

In turn, heart problems also increase the risk of suffering from mental illness. “It is well known that patients with cardiovascular disease, without a history of mental illness, once they have been diagnosed, are two to three times more at risk of being diagnosed with a mental illness,” says Jorge Pla, psychiatrist at the Clínica Universidad de Navarre Hospital. “People who develop a mental illness also have a higher risk of dying from a cardiovascular cause and a worse evolution of this type of illness if they already had it,” he continues.

This increased risk, explains the specialist, suggests that they could share pathophysiological mechanisms that would explain the possibility of developing both diseases. “In the case of depression, it is known that the psychological stress that comes from having a serious illness such as cardiovascular disease, and all that is involved in the stress reaction (hypothalamic-pituitary-adrenal axis), can influence the psychological health of the vulnerable patient,” says Pla.

In addition, inflammatory changes, which may be present in arteriosclerotic or thrombotic processes, are also detected in patients with major depression. “Changes in the vascular endothelium have also been proposed as a mechanism shared with forms of depression that begin in advanced age and have been called vascular depression,” he concludes.

“Patients with cardiovascular diseases also often develop depression, especially those who were previously active, because they have a feeling of loss and are afraid that it will happen again. This can lead to a decrease in physical activity and an increase in negative thoughts,” agrees Carrasco, who points out that in these cases, intervention is necessary, and psychiatry units team up with cardiology units for this purpose. They carry out a psychological evaluation of these patients and treat them, generally with psychotherapy, but “also with anxiolytics or antidepressants, which can relieve blood pressure and improve the patients’ quality of life,” he says.

Just as there are people who are prone to metabolic diseases, some individuals are prone to cardiovascular ailments. This includes people who are very active, addicted to work, and who experience high levels of stress.

“This emotional stress can be transformed into blood pressure, affecting the fibers of the arteries and the endothelial layer of the blood vessels. There are studies that have shown that chronic stress causes high levels of inflammation and oxidation, especially in endothelial cells, which can lead to the formation of thrombi and, ultimately, cardiovascular diseases,” explains Carrasco.

For these individuals, techniques to deal with stress, such as relaxation or improving interpersonal relationships, are effective in reducing the level of risk. But time needs to be set aside for these techniques, which can be a challenge for busy people. As in other cases, cooperation between cardiologists and psychiatrists, together with the drugs that help to reduce anxiety and positive lifestyle changes, can reduce the mortality rate from heart attacks.

Sign up for our weekly newsletter to get more English-language news coverage from EL PAÍS USA Edition