Heart and Soul

Anxiety causes heart attacks, according to the “Heart and Soul Study” published in the 2010 Archives of General Psychiatry, in which over 1000 people with generalized anxiety disorder were examined and found to have a 74% increased risk for cardiovascular events, defined as “stroke, heart failure, heart attack, transient ischemic attack, and death.”

The authors write that possible reasons for the associations include that anxiety may be associated with surges in adrenalin, or that anxious patients may avoid preventative medical care or only seek medical services once they have developed symptoms.

Two studies from the June 29, 2010 issue of the Journal of the American College of Cardiology reach the same conclusion – that anxiety increases the risk factor for heart disease – with one study showing double the risk.

Other research uncovers a link between depression and heart disease.  The SADHART study from September 2009 issue of the Archives of General Psychiatry found that people who became depressed, for the first time, after a cardiac event were twice as likely to die in the following 7 years.  A somewhat surprising finding of the study was that patients who developed depression only after their heart attack were just as likely to die as patients with a history of depression.

The SADHART study found no difference in anti-depressant medication vs placebo in improving depression.  What they did find was overwhelming success in the treatment of depression by utilizing a nurse-facilitator system for follow-up care after hospitalization.

Another study, published in the August 2010 issue of the Journal of Sexual Medicine, found depression and erectile function to be independent predictors of heart disease.  Post Traumatic Stress Disorder (PTSD) was found to double the risk for heart disease according to a study in November 2008 issue of Archives of General Psychiatry.

A stressful work environment and working overtime are also risk factors for heart disease.  In one study, reported in the May 2010 issue of Occupational and Environmental Medicine, female nurses who felt they were under “too much” pressure at work also had a significantly increased risk of developing angina or heart attack, independent of traditional coronary risk factors.  In a second, published online May 11, 2010 in the European Heart Journal, people who worked three or more hours of overtime per day had a significantly increased risk of coronary death, nonfatal heart attack, and angina.

The four conventional risk factors for heart disease include high blood pressure, high cholesterol, diabetes, and smoking.  Yet, approximately 19% of individuals already diagnosed with heart disease present with no risk factors, and 45% present with only 1 risk factor.  The Adult Treatment Panel III national cholesterol guidelines acknowledge this, explaining that the major risk factors “account for only about half of the variability in coronary heart disease risk in the US population.”

Treating the most common cause of death in America, cardiovascular disease, is not as simple as taking a pill for high cholesterol, another for high blood pressure, and another for high blood sugar, and so on…  With the established risk factors as the only guide, we are missing about 50% of the people dying from heart disease!  And, the standard treatments are putting a bandage on a symptom complex that is caused by more fundamental problems, such as being overweight, poor diet, lack of exercise, poor sleep, unmanaged stress and untreated mood disorders.

What the Heart and Soul Study should remind us of is that there are many pieces to the puzzle that create heart disease.  The reasons are not clear as to why anxiety and depression would increase cardiovascular disease risk.  Maybe it is related to social behaviors leading to lower compliance with medications and medical care.  Or perhaps elevated levels internal chemicals such as adrenalin, cortisol or inflammatory chemicals are responsible.  At any rate, recognition of the problem is the first step towards the solution.

I found it heartening, pun intended, that the SADHART study showed depressed patients did much better with a simple phone call and several house-visits by nurses with special training in heart-failure, psychiatric evaluation and follow-up.  The application of the human touch proved more powerful than medication.

Treatment of mood disorders such as anxiety and depression is complex.  While medications can help, I recommend a more fundamental approach for starters.  First, focus on excellent nutrition, regular exercise, and plenty of good sleep.   Simple, but powerful medicine – don’t underestimate the basics and the effect on brain chemistry.

Second, learn to manage stress – we can’t avoid it, so manage it.  An activity such as focused relaxation, even for 5 minutes, a few times during the day, is shown to lower blood pressure and levels of the stress hormone, cortisol.  Take a 20 minute walk over the lunch hour.  Try calming exercises such as yoga or tai chi.

Third, get medical care.  Behavioral counseling by a licensed counselor or psychologist is often the cure, especially when treating PTSD and anxiety.  I often recommend acupuncture and massage therapy.  Medical conditions, such as an underlying hormone imbalance can cause serious mood disturbances.  So can inflammation caused by chronic infections, poor gut health, or delayed food allergies.

Have heart, for there is a better way to treat and prevent heart disease.  Addressing the soul is just as important as working on any other risk factor.  Consider the fundamentals, including the psyche, before resorting to supplements or medication.


Author

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).   Call (970) 245-6911 for an appointment or more information.

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