Every 34 seconds, someone in the United States dies from heart disease.
As nearly half of the country suffers from some form of cardiovascular disease (CVD), another 1 in 4 adults experience a mental health disorder in their lifetime, signaling an inevitable overlap.
Now, a new report from Emory University shows that certain mental health conditions escalate the risk of developing heart disease by 50-100%—and adverse outcomes from existing heart conditions by 60-170%.
The report, published in The Lancet Regional Health-Europe, summarizes cardiovascular health disparities among those diagnosed with depression, anxiety, schizophrenia, bipolar and post-traumatic stress disorders (PTSD).
It is part of a series aiming to raise awareness around disparities in CVD health in four populations: women, the elderly, racial minorities and those with mental health conditions.
Emory University professor Viola Vaccarino, MD, PhD, led this metareview along with co-authors Amit Shah, MD, and Douglas Bremner, MD.
The report associated the following mental health conditions with increased risk of developing CVD:
- Major depression: 72% increased risk
- PTSD: 57% increased risk
- Bipolar disorder: 61% increased risk
- Panic disorder: 50% increased risk
- Phobic anxiety: 70% increased risk
- Schizophrenia: nearly 100% increased risk
These conditions are also associated with poorer prognosis, greater risk for readmission, and higher mortality from existing heart conditions. Major depression more than doubles the mortality rate in people with CVD. More than 40% of individuals with CVD also have a mental health condition.
The report outlines a well-documented link between depression, schizophrenia, PTSD, and abnormal stress responses in both the autonomic nervous system (ANS) and hypothalamic-pituitary adrenal axis (HPA).
ANS manages involuntary responses like heart rate and inflammation, while HPA influences immune response and metabolism. Dysregulation in these systems contributes to increased inflammation, metabolic issues, high blood pressure, and vascular resistance—key risk factors for CVD.
Mental health conditions may lead to disruptions in care access due to affordability, communication issues, or stigmatization. These challenges are compounded by health systems that separate mental and physical health care.
Current risk prediction models often exclude mental health disorders, and clinical trials frequently exclude people with such conditions.
To reduce these disparities, the authors call for integrated, interdisciplinary care that includes behavioral, mental, and cardiovascular health professionals.
“A clinical team would be ideal for the care of these patients,” says Vaccarino, “with specialists, social workers, and nurses collaborating to provide coordinated care and support.”
The report concludes that addressing health disparities affirms the rights of those with mental health conditions to achieve full participation in society and the highest level of health.
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The study is published in The Lancet Regional Health Europe.
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