American Heart Month: The Heart-Head Connection

Cardiovascular health and mental illness have been linked through numerous research studies. And this heart-head connection is a two-way street, meaning both conditions simultaneously affect each other.

Many still see physical and mental wellbeing as separate aspects of health. But the close association between cardiac and mental illness is a compelling reason to promote integrated care for both types of conditions.

Here we’ll review how mental health is connected with heart disease, focus on specific mental health conditions, and finally look at interventions that benefit both heart and mental health.

How is Heart Disease Related to Mental Health?

Cardiovascular disease and mental health conditions have a two-way relationship. Both conditions create more risk for each other and can create a worse overall outcome if either is neglected.

Impact of mental health on heart disease

Mental health conditions are a real and present concern for many individuals, especially in the wake of the pandemic. According to the National Alliance for Mental Illness (NAMI), in 2020 1 in 5 U.S. adults experienced a mental illness and 1 in 20 experienced a serious mental illness. The pervasive presence of mental health issues can put stress on a person’s body and add to their risk of developing heart disease.

Overactive stress response

When a person endures long-term mental health issues, they cope with ongoing emotional distress. A person’s sympathetic nervous system becomes overactive, leading to frequent episodes of elevated heart rate, blood pressure, and cortisol levels. Over time, these numerous stress responses take a toll on the cardiovascular system.

High sympathetic activity is a risk factor for heart failure, a condition where the heart muscle cannot pump enough blood to support the body’s needs. It also increases the chance of developing hypertension and having strokes. In the end, these conditions make death from heart disease more likely.

Lifestyle factors

People with mental health conditions are also less likely to exercise, eat a healthy diet, or use substances with caution. Adopting healthy habits can be challenging anyway, and disruptive mental health symptoms can make it even more difficult.

Low mood, poor sleep, and uneven appetite can make it hard for a person to get through the day at work or school. They may have no interest or energy to plan healthy meals or take daily walks. And if they use substances like alcohol or drugs to self-medicate, they could eventually be at risk for a substance use disorder.

Impact of Heart Disease on Mental Health

Cardiac events like a heart attack or stroke can be life-changing. Understandably, a person may feel overwhelmed by the aftermath of a serious health concern. Many people find ways to adjust and resume some normal life activities after a while. But for some, the distress and change can feel like an overload to their system.

People who are prone to worries or low moods may eventually develop anxiety or depression. And if a person’s cardiac event was intense or shocking, they may experience post-traumatic stress disorder (PTSD).

Mental Health Disorders Linked to Heart Disease

Severe mental illness carries the greatest chance for poor outcomes, but even conditions less clearly linked to heart disease can be harmful.

Severe Mental Illnesses

Severe mental illnesses are long-term conditions that impair a person’s ability to function with daily activities and self-care. People with chronic and serious mental health issues often die ten to twenty years earlier than the general population. 

Major Depression

Bipolar Disorder


  • Schizophrenia is linked with a higher risk for coronary heart disease and cerebrovascular disease.
  • Antipsychotic medications used to treat schizophrenia affect the autonomic nervous system, which regulates heart rate and blood pressure. This impact can cause irregular functioning, increasing the risk of heart disease.


  • Stress related to anxiety can cause the release of adrenaline and cortisol, which temporarily raise blood pressure (hypertension).
  • Repeated episodes of hypertension may lead to plaque disruption, also known as hardening of the arteries. This may lead to strokes, heart attacks, and a weakened aorta.

Post-traumatic stress disorder (PTSD)

  • Several studies show that the chance of people with PTSD developing heart disease increases with a higher number of symptoms and with more severe symptoms.
  • People with PTSD are more likely to have plaque buildup and less blood flow through tissues.
Steps to Improve Heart Health and Mental Health

Since heart health and mental health have close ties, interventions can have double the benefit. Here are some important steps for reducing risk in both areas of health.

Following treatment plans for heart and mental health conditions, including medication and therapy:

  • Improves symptoms.
  • Reduces the risk of negative outcomes.

Staying physically active with exercise, walking, and other recommended activities:

  • Strengthens the heart muscle.
  • Creates a natural mood boost.

Eating a healthy balanced diet with regular meals:

  • Keeps blood sugars more stable, helps regulate mood.
  • Improved nutrition helps the mind and body function better.
  • Helps maintain healthy weight.

Relaxation techniques including meditation, yoga, and breathing exercises:

  • Helps manage heart rate and blood pressure.
  • Coping method for emotional distress.

Reducing substance use and cigarette smoking:

  • Promotes more stable moods.
  • Reduces smoking-related risks for heart disease.
Heart Disease and Mental Health Go Hand-in-Hand

The risks of heart disease and mental illness are closely related. And treating one type of condition without addressing the other leaves the door open for harmful outcomes. Many people start talking about depression symptoms in primary care, often before seeking counseling. Counseling therapists also have an opportunity to ask about physical health issues at the initial evaluation.

When medical and mental health professionals work together, they can provide a more complete treatment approach for both heart and mental health.

Read more population health articles on the AIHI Blog