Negative Mental Health Outlook Can Lead to Heart Disease, Causing Concern in COVID-19 Pandemic

Pharmacy Times® interviewed Caroline Carney, MD, MSc, FAPM, CPHQ, chief medical officer of Magellan Health, a board-certified internist, and a board-certified psychiatrist, to discuss the correlation between heart health and mental health.

Alana Hippensteele: Mother’s Day is coming up, so joining me is Caroline Carney, the chief medical officer of Magellan Health, a board-certified internist, and a board-certified psychiatrist.

She’s joining me to discuss the correlation between heart health and mental health, especially in light of heart disease being the leading cause of death in the US and the number one killer of women aged 65 years and older, with approximately 1 woman dying every minute of this disease.

So, Dr. Carney, how are heart health and mental health connected?

Caroline Carney: Heart health and mental health are very closely connected. Let's start on the front end of heart health conditions leading to stress, conditions where we may not be taking care of ourselves through exercise and through diet the way we should, whether those are depression, anxiety, or social determinants of health that prevent people from doing the right kind of preventive care, ultimately lead to heart health issues.

We know that depression demotivates people and someone may be less likely to exercise or may be more likely to snack on the wrong kinds of foods. Those contribute ultimately to heart disease.

The second factor is living a very stressful life leads to elevated cortisol levels and stress hormones that also affect blood pressure, which downstream has an effect on heart health.

Finally, those conditions that may contribute to weight gain. Weight gain is also a predictor of heart disease and heart outcomes, as well as the development of diabetes, which is very closely linked to heart health as well.

On the back end is the whole phenomenon around what happens after someone develops a cardiac event. If someone has an arhythmic event or has a heart attack, the likelihood of fear of developing another episode occurs and the anxiety related to that occurs, as well as the depression or feelings of guilt about not having taken care of oneself perhaps or the fear of continuing to have another event. The epidemiology shows that congestive heart failure and coronary artery disease have a high relationship to the development of depression and anxiety after an event like that.

Then finally, one thing I have to mention is that smoking is usually highly affiliated with mental health conditions. As we all know, smoking is directly linked to poor outcomes with our hearts.

Alana Hippensteele: How can a positive or a negative mental health outlook potentially impact heart health?

Caroline Carney: So, like I have suggested, the outlook that one has toward caring for oneself leads to all of those kinds of preventive factors. So, if I can have a positive outlook and feel like I'm caring for myself—doing the right things, not smoking, not over-drinking, getting the right kind of exercise, controlling my blood pressure, making sure that my preventive care is getting done—that kind of positive outlook is really highly associated with the positive kinds of behaviors we need to have to take care of our heart health.

On the back side, outlook affects everything. If I have a dismal outlook, I may not get the cardiac rehab that I should be getting. I might not participate again in those same kinds of preventive attitude or activities that I should.

The important thing to know is that someone with that negative outlook can be treated. There are all sorts of things we can do to support those individuals.

Alana Hippensteele: Right, absolutely. Why has there been a greater emergence more recently on the importance of clinicians treating patients more holistically within the context of their psychological well-being instead of treating mental health concerns as an isolated health concern?

Caroline Carney: I think across the whole field of medicine we're recognizing that. Whether it's in heart health, whether it's in neurologic health, whether it's in diabetes, or any other condition really, the effects of depression and anxiety primarily on a person's medical outcome have now been well-described and are highly accepted.

The kinds of interventions we need to do to help improve an individual's outcome also have been researched and are becoming more and more highly accepted. Whether that is a medication therapy, whether that's psychotherapy, whether that's mindfulness-based stress reduction—these are things that all work in supporting our overall health and health professionals get it. They now are really understanding and supportive of it.

Alana Hippensteele: Absolutely, and how has the COVID-19 pandemic influenced our understanding of heart health and mental health, and specifically how they're connected?

Caroline Carney: So, again, around the kinds of things that we know can contribute to a poor outcome or poor heart health, COVID-19 has really accelerated some of those. COVID-19 in and of itself has increased social isolation, which is a predictor of death, actually. So, loneliness and social isolation predict an early death, and so we have seen that accelerating.

The epidemiology that the CDC has been publishing would suggest that individuals across the United States in all age groups, but particularly in individuals who are caring for dependents and caring for others in need, are experiencing higher levels of anxiety, depression, and other stress-related symptoms. So those may be contributing to the heart disease that we're seeing.

In times of COVID-19, we all have heard the COVID 10, right? So, those individuals who used to go to the gym but couldn't go to the gym anymore, and didn't compensate to exercise in another way, or folks who just weren't as active as they used to be, gaining weight and not taking care of themselves in the same way that they did before. Again, developing the kinds of behaviors that can lead to heart disease.

One final thing that COVID-19 did that I think is critically important is that people stayed out of the emergency departments and they didn't get the kind of preventive care that they typically could get. So, perhaps hypertension went untreated, or perhaps that symptom of chest pain that someone could say it's just indigestion really was a cardiac event taking place, and that individual may not have sought the appropriate care because of fears around COVID-19.