Being depressed or anxious in middle-age increases the risk of having a heart attack or stroke, a new study warned.
Women over 45 who experience the greatest psychological distress are at greater risk of stroke while men are at greater risk of heart attacks
The interplay between mental and physical health remains poorly understood so scientists investigated whether psychological distress was associated with risk of myocardial infarction (MI) and stroke.
In a study of 221,677 Australians who had not had a stroke or heart attack, researchers found among women, high or very high psychological distress was associated with a 44 per cent increased risk of stroke.
In men aged 45 to 79, high or very high versus low psychological distress was associated with a 30 per cent increased risk of heart attack, with weaker estimates in those 80 years old or older.
And the association between psychological distress and increased cardiovascular disease risk was present even after accounting for lifestyle behaviours such as smoking, drinking and diet, and disease history.
Chancellor’s Fellow Dr Caroline Jackson at the University of Edinburgh said: “The findings from our study, along with those from the broader literature, suggest that psychological distress might operate partly through lifestyle behaviours but also support the view that other mechanisms may exist.
“Disorders such as depression and anxiety are thought to induce pathophysiological changes, including alteration of the hypothalamic-pituitary-adrenal axis of the neuroendocrine system, activation of inflammatory processes, platelet hyperactivity, and endothelial dysfunction.
“It is reasonable to postulate that symptoms of psychological distress might operate through the same mechanisms to increase CVD risk.”
She added: “Although common mental disorders and psychological distress are more common in women than in men; women are more likely than men to seek primary care for mental (as well as physical) health problems.
“Women might therefore address their mental health concerns more constructively than men, thereby partially negating the physical disease consequences of
psychological distress.
“Somewhat paradoxically, we did not find the same sex difference for stroke, with the risk perhaps slightly stronger in women than in men.
“Effect estimates in women were, however, certainly larger for stroke than MI, raising the possibility of different pathways between psychological distress and types of CVD
in women.
“Alternatively, these findings might reflect divergent protective effects of hormone levels on coronary heart disease as compared with cerebrovascular disease
risk in women.
“The apparent moderating effect of older age on the association between psychological distress and CVD risk in men may be more likely to be because of survival bias rather than a true counteraction of risk by older age.
“Men who survive into their 80s (and with symptoms of psychological distress) are perhaps a somewhat selected resilient subgroup.”
The study involved 102,039 men with an average age of 62 and 119,638 women with an average age of 60 in the New South Wales 45 and Up Study recruited between 2006 and 2009.
Psychological distress was categorised as low, medium and high/very high using a standard psychological distress scale which asks people to self-assess the level.
The 10-question survey asks questions such as: “How often do you feel tired out for no good reason?” How often do you feel so sad that nothing could cheer you up?” How often do you feel restless or fidgety?”
A sixth – 16.2 per cent – reported having moderate psychological distress and a twelfth – 7.3 per cent – had high/very high psychological distress.
During follow-up of more than four years there were 4,573 heart attacks and 2,421 strokes.
The absolute risk – overall risk of developing a disease in a certain time period – of heart attack and stroke rose with each level of psychological distress.
Dr Jackson said: “Psychological distress has a strong, dose-dependent, positive association with CVD risk in both men and women, but possible sex differences exist which deserve further investigation and replication in future studies.”
She added people with symptoms of psychological distress should be encouraged to seek medical help because, aside from the impact on their mental health, symptoms of psychological distress appear to also impact physical health.
Dr Jackson added: “We encourage more proactive screening for symptoms of psychological distress.
“Clinicians should actively screen for cardiovascular risk factors in people with these mental health symptoms.”
The study was published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.
By Ben Gelblum and Tony Whitfield