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High Stress May Double Risk of Second Heart Attack in Younger Survivors

A young adult woman wearing a blue tank top clutches her chest.
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Key Takeaways

  • New research shows that high levels of distress may double the risk of future cardiovascular problems in younger heart attack survivors.
  • Heart attack survivors who were women, Black, or from disadvantaged socioeconomic backgrounds were more likely to have high distress.
  • Managing mental health after a heart attack may be an important step to reducing the risk of future cardiovascular problems.

The trauma of a heart attack is more than just physical—it’s a life-changing event that leaves many people feeling overwhelmed, depressed, and stressed out. And just how well a person manages those emotions may make a major impact on their recovery and the future of their heart health, new research shows.

An American College of Cardiology study, which is set to be presented at the organization’s 70th Annual Scientific Session later this month, evaluated the health outcomes of nearly 300 young adult and middle-age heart attack survivors. The results showed that those with high distress levels experienced more than double the risk of another serious heart problem within five years, compared with participants with lower distress.

Here’s what the research showed about the role of mental health in heart attack recovery, along with ways survivors can reduce their stress levels.

The Study

In a study led by Mariana Garcia, MD, a cardiology fellow at Emory University in Atlanta, a team of researchers recruited 283 heart attack survivors to figure out how their mental health may affect future cardiovascular problems

The group consisted of adults younger than people typically are at the time of their first heart attack. They ranged in age from 18 to 61 years old, with an average age of 51. For comparison, the first heart attack in men tends to occur around age 66, and for women it happens at about 72 years old, according to the American Heart Association.

Half of the participants were women, and nearly two-thirds were Black.

Within six months of their heart attack, the survivors answered a series of questionnaires about their symptoms of anxiety, anger, depression, perceived stress, and post-traumatic stress disorder (PTSD). That allowed the researchers to determine whether participants had mild, moderate, or high distress.

The data showed that women, Black participants, those from disadvantaged socioeconomic backgrounds, smokers, and people with diabetes or high blood pressure were more likely to have high distress. 

Researchers also ran blood tests on participants and found that those with high distress also tended to have increased levels of two inflammatory markers that have been linked to a build-up of plaque in the arteries and heart problems. 

The researchers then tracked serious heart problems that occurred within the next five years. Eighty of the participants experienced a second heart attack, stroke, hospitalization for heart failure, or death from another cardiovascular issue. 

The researchers found that 47% of the participants with high distress levels after their first heart attack experienced another major heart issue during the study period, compared with just 22% of the participants who had mild distress. 

Russell Kennedy, MD

The mind and body are intimately connected, so if your mind is troubled, it makes perfect sense your body will also be at the effect of that stress.

— Russell Kennedy, MD

“Psychological distress, like any distress, diverts the energy needed for healing the heart and recovering from heart attack,” explains Russell Kennedy, MD, a neuroscientist, anxiety and trauma specialist, and author of “Anxiety Rx.” “The mind and body are intimately connected, so if your mind is troubled, it makes perfect sense your body will also be at the effect of that stress.”

According to the study authors, this research is the first of its kind “to comprehensively assess how mental health influences the outlook for younger heart attack survivors.” 

The Link Between Stress and Heart Health 

More research may be needed to determine whether the high levels of distress were the direct cause of subsequent cardiovascular issues in young heart attack survivors, or whether other factors were involved, says Jennifer Wong, MD, cardiologist and medical director of non-invasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.

Jennifer Wong, MD

These findings are similar to prior studies with older adults. However, this is an observational study and thus does not prove causation.

— Jennifer Wong, MD

“These findings are similar to prior studies with older adults. However, this is an observational study and thus does not prove causation,” she says. 

Dr. Wong adds: “Given that the degree of psychological distress was based on a self-reported survey, there may have been unintentional bias. For instance, participants may have reported more severe psychological distress among those with worse cardiovascular disease and higher likelihood of another cardiovascular event.”

With that said, a large body of research has found consistent links between stress and heart disease.

According to the Centers for Disease Control and Prevention (CDC), long periods of stress, anxiety, depression, and other mental health problems can take a toll on heart health.

People with those conditions may experience an increase in their heart rate and blood pressure, a boost in levels of the stress hormone cortisol, and a reduction in blood circulation to the heart. That, in turn, can often lead to heart disease and other health problems.

“Stress interferes with hormonal pathways, leading to elevated levels of adrenaline and cortisol, higher blood pressure, faster heart rates, poorer sleep,” says Luiza Petre, MD, assistant clinical professor of cardiology at The Mount Sinai School of Medicine in New York.

Stress may also make it more difficult for people to follow through with healthy behaviors, like eating nutritious foods and exercising consistently, which may further increase their risk of heart problems.

Reducing Stress After a Heart Attack

The latest research highlights the importance of incorporating mental healthcare and stress-reductions strategies into a heart attack recovery plan. Ideally, the healthcare system could provide interventions to improve the emotional wellbeing of heart attack survivors, says Dr. Petre.

Luiza Petre, MD

For many, this might be their first health scare. From brushing with mortality to understanding one’s fragile existence, it can be a traumatic event, mostly for someone who never had medical history before.

— Luiza Petre, MD

“Screening for depression should be mandatory, as many patients suffer from [it after] their first heart attack,” she says. “For many, this might be their first health scare. From brushing with mortality to understanding one’s fragile existence, it can be a traumatic event, mostly for someone who never had medical history before.”

But there are also other ways that people can work to improve their mental health and reduce their stress levels on their own after a major heart issue. That may include meditating, gentle exercise, getting plenty of rest, and spending time in nature, experts say.

It may also be helpful to tap into external sources of support, such as a support group for heart attack survivors, or simply connecting with loved ones.

“Engaging family in the recovery process can help,” says Dr. Petre. “Emotional support is a cornerstone in the process of recovering from a heart attack.”

You don’t have to wait for a heart attack to actively try to reduce your stress levels, though. Managing your mental wellbeing and taking care of your body now can protect your heart health—and help you feel your best throughout your life.

What This Means For You

A heart attack is a life-changing experience that can make an impact on both your physical and mental health. But while recovery often focuses on physical health, it may be beneficial to incorporate emotional support, as well. New research has found that heart attack survivors with high distress are more than twice as likely to experience another major heart problem within five years.

Experts say that hospitals should screen heart attack survivors for depression and other mental health conditions, and connect them to support, to help reduce the risk of a second heart attack. You may also be able to reduce stress by tapping into support groups, meditating, engaging in physical activity, and spending time in nature. 

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