Depression and anxiety independently increase the risk of major adverse cardiovascular events (MACE), according to a study published in Circulation: Cardiovascular Imaging. Depression was linked to a higher risk of MACE with a hazard ratio of 1.24 (95% CI, 1.14-1.34), remaining statistically significant following adjustments for confounders. A stronger association was observed for concurrent anxiety plus depression, with a hazard ratio of 1.35 (95% CI, 1.23-1.49).
The research analyzed 85,551 study subjects, of which 3,078 (3.6%) developed MACE over a median of 3.4 years of follow-up. The study used data from participants in the Mass General Brigham Biobank between 2010 and 2020. Depression was linked to higher amygdala-to-cortex activity ratio, lower heart rate variability, and higher C-reactive protein (CRP). High levels of C-reactive protein in the blood and lower heart rate variability were linked to cardiovascular events in patients with depression, anxiety, or both.
Biological Mechanisms
The research demonstrates specific pathophysiological changes that link emotional stress to cardiovascular risk. Dr. Shady Abohashem, study investigator and head of Cardiac/PET/CT Imaging Trials at Massachusetts General Hospital, explained: “When the brain’s stress circuits are overactive, they can chronically trigger the body’s ‘fight or flight’ system, leading to increased heart rate, blood pressure, and chronic inflammation. Over time, these changes can damage blood vessels and accelerate heart disease.”
The amygdala is a brain region associated with stress, whereas reduced heart rate variability indicates an overactive nervous system, and high blood CRP levels are linked to inflammation. According to Abohashem: “These findings give us a clearer biological picture of how emotional distress ‘gets under the skin’ and affects cardiovascular health. For clinicians, it’s a reminder to view mental health as an integral part of cardiovascular risk assessment. For patients, it’s encouragement that addressing chronic stress, anxiety, or depression is not just a mental health priority; it’s also a heart health priority.”
The authors cautioned that the data were observational in nature, requiring further research to determine conclusively if depression and anxiety cause cardiovascular disease or if there is a simple association. Current investigators are exploring whether interventions like stress-reduction therapies, lifestyle modifications, or anti-inflammatory medications could normalize the key immune and brain markers involved in cardiovascular risk.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.pharmacytimes.com/view/stress-signals-drive-cardiovascular-disease-risk-in-patients-with-depression-anxiety