Matters of the Heart: Mental Health and Cardiovascular Health- A Policy Perspective by Dr. Urvashi Priyadarshini

 The concept of being “healthy” is usually associated with physical health, and mental health

is usually overlooked. It has been regarded as taboo in the past and people with mental health

problems were usually stigmatized or discriminated against. However, in recent years, the

importance of Mental Health is being globally acknowledged and it has even been included

as a target in the Sustainable Development Goals (SDG 3.4).

According to the World Health Organization (WHO), cardiovascular diseases are the primary

cause of death worldwide. [1] In 2016, approximately 17.9 million people died due to

cardiovascular disease- related deaths. [1] These account for almost 31% of deaths across the

globe. [1] Of these, over three- quarters of these cardiovascular disease- related deaths occur in

low- and middle- income countries. [1]

Chaddha et al, advise the usage of the term “mental distress” instead of “mental illness,” as

the latter restricts its scope to a particular subset of medical conditions. [2] On the other hand,

“mental distress” includes other signs and symptoms such as, confused emotions,

hallucination, anger, depression, and anxiety. [2]

In spite of an abundance in evidence through researches that establishes a direct relation

between mental health (MH) and cardiovascular disease (CVD), patients with cardiovascular

diseases such as, coronary disease, myocardial infarction, arrythmias, heart failure, are rarely

screened for mental illnesses. [2] The relationship between MH and CVD is bidirectional, i.e.,

these psychological illnesses can either be a result of or cause for cardiovascular disease in

the patient. Numerous studies outline the relationship between mental health problems that

are associated with CVD or risk factors for CVD (e.g. smoking, alcohol consumption,

obesity, diabetes, etc.). [3] They list various social determinants of health (SDH) as causative

factors for MH problems, consequently leading to CVD, and these are: “social gradient,

stress, early life experiences, social exclusion, work, unemployment, social support,

addiction, food and transport.” [3] Depression is common in patients who are suffering from

angina and can subsequently cause myocardial infarction, stroke, atrial fibrillation and even

sudden death.

According to the American Heart Association, depression can cause acceleration in

development of artherosclerosis and onset and severity of coronary risk factors of

hypertension, diabetes mellitus, etc. [4] It can also cause increase in the risks of practising

unhealthy lifestyles such as smoking, consumption of a high-calorie, saturated fat and

cholesterol diet, decreased total exercise and decrease in adhering to the prescribed medical

regimen. [4] Anxiety, fear, stress and extreme negative emotions have been known to result in

the release of the hormone adrenaline. [5] This leads to the temporary increase in blood

pressure and may result in the constriction of arteries leading to a myocardial infarction. In

people with weak atrial and ventricular walls, the repeated increase in blood pressure may

lead to a dissection or rupture. [6]

In India, there exists a health programme for cardiovascular diseases called National

Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and

Stroke (NPCDCS). Parallelly, a separate programme exists for mental health called National

Mental Health Programme (NMHP). Neither NPCDCS takes into account mental distress as a

causative factor nor does NMHP have any consideration for cardiovascular diseases. Since

there has been a considerable shift of the burden of disease from communicable diseases to

non-communicable diseases (NCDs), the integration of both programmes is the need of the

hour to address the rising burden of NCDs. The ongoing COVID-19 pandemic has further

accelerated the rise in mental disorders due to the various isolation/ quarantine measures. It

has also caused physical inactivity due to stay at home measures which may potentially give

rise to CVD. Since they are interrelated, with the rise in either one conditions, a rise in the

other can also be expected.

As previously mentioned, MH is closely related to cardiovascular health. Therefore, there

needs to be a provision for intersectoral collaboration so as to have a holistic approach to the

rising incidences of psychological disorders as well as that of cardiovascular diseases. The

pandemic has made apparent that a provision needs to be made while screening for

cardiovascular diseases and vice versa. This may be a possible way to curb the exponential

rise in morbidity and mortality due to mental health disorders and cardiovascular diseases.

References:

1. World Health Organization. Cardiovascular diseases (CVDs) [Internet]. Who.int.

2017 [cited 26 September 2020]. Available from: https://www.who.int/en/news-

room/fact-sheets/detail/cardiovascular-diseases-(cvds)

2. Chaddha A, Robinson EA, Kline-Rogers E, Alexandris-Souphis T, Rubenfire M.

Mental health and cardiovascular disease. The American journal of medicine. 2016

Nov 1;129(11):1145-8

3. Wilkinson RG, Marmot M, World Health Organization. Social determinants of health:

the solid facts. Copenhagen: WHO Regional Office for Europe; 1998.

4. Riba M, Wulsin L, Rubenfire M, Ravindranath D. Psychiatry and heart disease: the

mind, brain, and heart. John Wiley & Sons; 2012 Jan 31.

5. Association, American Psychiatric. Diagnostic and statistical manual of mental

disorders. American Psychiatric Publishing; 2013.

6. Hatzaras IS, Bible JE, Koullias GJ, Tranquilli M, Singh M, Elefteriades JA. Role of

exertion or emotion as inciting events for acute aortic dissection. The American

journal of cardiology. 2007 Nov 1;100(9):1470-2.