Heartfelt: emotion and heart disease

Heartache, heartbroken, heartsick. Heart of gold, heart of stone. Tugging at the heart strings, wearing your heart on your sleeve. We speak the language of the heart with dozens of everyday expressions.

Jealous? Eat your heart out. Sad? Cry your heart out. Terrified? Your heart stands still or skips a beat. We don’t talk about the kidneys or the liver in quite the same way.

We know that the function of the heart is to pump oxygen-rich blood throughout our bodies, but we often tend to talk about it as the seat of emotion. So is all this heart talk just metaphorical, or do emotions really play a role in heart disease?

There’s actually quite a bit of evidence linking emotional states and heart function. Numerous studies have looked at the association between depression and heart disease. It wouldn’t be surprising to realize that a person might feel depressed after having a heart attack or heart surgery, but it also has been found that healthy people who suffer from depression are at increased risk for developing heart disease. Several years ago, the journal Circulation recognized the growing evidence of this link along with the fact that depression among patients with existing heart disease is predictive of a worse outcome.

What’s the link?

There is no definitive answer to the question of what mechanisms account for the relationship between depression and heart disease. Some of it is likely physiological; we know that depression has some associated conditions (such as higher levels of the stress hormone cortisol and increased inflammatory markers) that can contribute to heart disease. But behavior plays a role as well. Depressed individuals may be less prone to eat healthy and exercise. They may be less likely to take their medication as directed and to take advantage of the social support that is available to them. All of these factors serve to increase cardiac risk.

Lonely Hearts Club member?

Having a good network of friends and family is protective when it comes to health. People who are socially isolated tend to not take as good care of themselves. However, living alone and feeling alone are two different things, so assessing loneliness as a risk factor has been refined. Loneliness is more the feeling of having no one to turn to, no one who understands you. It’s a gap between the person’s actual social relationships and what they would want in that regard.

Some Swedish researchers found that among 1,300 patients undergoing heart bypass surgery, those who answered yes to the statement “I am lonely” were 2.5 times more likely to die within 30 days of their surgery; five years later their mortality rate was still nearly twice as high. And these were not all patients who were living alone — nearly half of them were married or living with another person.

Broken heart syndrome

This may sound like something out of a Victorian romance novel, but there really is a condition called broken heart syndrome. It was originally called Takotsubo cardiomyopathy (but that’s so much less poetic). This temporary condition was first described in 1990 in Japan. It involves a weakening of the left ventricle, the heart’s main pumping chamber. This usually happens in reaction to severe emotional or physical stress, such as the loss of a loved one, a natural disaster, or sudden, intense fright. The main symptoms are chest pain and shortness of breath, so it could easily be mistaken for a heart attack. Experts believe that a reactive surge of stress hormones “stun” the heart and trigger changes that impair the contraction of the left ventricle. Fortunately, broken heart syndrome does not involve blockages of the coronary arteries as we see with a heart attack, and most people recover within a period of a few months. Physicians may treat this syndrome with medications that are commonly used for heart failure. In rare cases, this syndrome can be fatal, where a patient is literally “scared to death,” for example during a mugging or break-in where the person was not physically assaulted.

Venting anger: healthy release or risky reaction?

We all get angry at times — that’s just part of being human. But does blowing off steam by yelling or getting irritated serve as a release valve that reduces stress, or does it have a negative impact on heart health? Dr. Redford Williams is chief of Behavioral Medicine at Duke University Medical Center and has spent decades looking at the influence of hostility, social isolation and depression on the course of coronary artery disease. Dr. Williams views the hostile personality as a modifiable risk factor for heart disease, one that we can take control over just as we do when we give up smoking or start regular exercise. I first learned of Dr. Williams’ work many years ago when I saw him on “Oprah” talking about his book “Anger Kills.” Rather than suggest that we learn to never get angry, Dr. Williams and his co-author and wife Virginia Williams, PhD, offer strategies for recognizing things that “push your buttons” and developing skills for cutting it short before the full force of the body’s physiological stress response kicks in.

The big picture

The culture of medicine has changed a lot over the years that I’ve been working in the field of health psychology. The diagnosis and treatment of so many illnesses and conditions now integrates psychological and behavioral components, recognizing the influence that mind and body have on each other. If I were diagnosed with heart disease, I would want to find a highly skilled cardiologist who is up on all the latest medical treatments and procedures that might help me. But I’d also want my physician to recognizes that my mood, my social connections, and my ability to cope with stress should be factors that are assessed and considered in my treatment plan as well. While there is no hard proof that reducing depression would lead me to live longer after a cardiac event, I feel pretty safe saying that my quality of life would be better if I’m in better spirits. My social connections help to give life meaning and my ability to not let anger get the best of me will make me happier and more pleasant person to spend time with. And in my heart of hearts, I know that it all matters — body, mind and spirit.