Heart Disease & Mental Health
The Overlooked Connection: Heart & Mind
(Based on WHO, 2017, pp. 8–13)
Heart disease does not only affect the body. It also changes how people think, feel, and recover. The World Health Organization shows that the relationship between heart disease and mental health is one of the most important and most overlooked intersections in care.
The scope of the problem
Heart disease is the leading cause of death in the WHO European Region, responsible for more than half of all deaths. It causes 46 times more deaths and 11 times more disease burden than AIDS, tuberculosis, and malaria combined. Up to 80% of premature deaths from heart disease and stroke are preventable.
Among people already living with heart disease, about one in five has depression. The presence of depression or anxiety at least doubles the risk of a poor outcome after a cardiac event.
A two-way relationship
The connection between heart disease and mental health runs in both directions. Depression and anxiety increase the risk of developing heart disease, and heart disease itself increases the risk of mental-health symptoms.
Meta-analyses show that:
Depression increases the risk of developing coronary heart disease by 1.6 to 1.9 times.
Depression increases the risk of a poor cardiac outcome by 2.4 times.
Anxiety disorders are independent risk factors for coronary heart disease and for adverse events after a heart attack.
People with severe mental disorders such as schizophrenia or bipolar disorder die 15 to 20 years earlier than the general population, most often from heart disease.
Even after accounting for confounding factors like smoking, medication effects, or lifestyle, a clear association between common mental disorders and heart disease remains. Research points to shared inflammatory and immune processes that may help explain the link.
The hidden costs
Depression in people with heart failure is associated with higher health service use and costs. Treating patients who have both depression and heart failure costs about double compared with treating heart failure without depression. Rehospitalization rates are two to three times higher among patients with heart disease and depression.
The challenge of care
For many patients, the pressure to change diet, exercise, and substances lands on top of fatigue, hopelessness, or poverty-related stress. People with severe mental disorders are less likely to access preventive services or cardiac risk management, even though their risk is higher.
Why integrated care matters
WHO recommends that every person with a severe mental disorder have their cardiovascular risk measured annually with a recognized risk algorithm. This works best when mental and physical health teams are connected. Integrated care allows shared medication decisions, coordinated risk tracking, and real-time support for motivation and self-care.
The bigger picture
Standard treatments for depression, including therapy and antidepressants, are effective and safe for depression that co-exists with heart disease. At the same time, current evidence does not show that treating depression or anxiety by itself improves cardiac outcomes. Treating mood symptoms is still essential because emotional stability helps people stay engaged in care and follow treatment. Primary care is a great place to look at whole body care when coordinating with cardiology.
Takeaway
Heart disease and mental health are two sides of the same story. When depression or anxiety go untreated, recovery slows and complications rise. When integrated teams address both together, survival and quality of life improve.