An interesting finding that research has uncovered is the fact that diseases interact just the way drugs are known to interact with one another. These interactions in most cases lead to worsening of diseases hence the need to understand how these diseases interact so that it is easy to understand how to approach the management of these diseases. Cardiovascular diseases and mental health disorders are among the leading causes of mortality and morbidity worldwide (Mensa et al, 2015) and therefore, my research question aims to identify the link that exists between cardiovascular diseases and mental health diseases. My research question also aims to investigate how treatment of other medical conditions can contribute to worsening cardiovascular diseases. With this understanding in mind, it is possible to approach the management of these diseases differently in an effort to promote cardiovascular health.
Relationship between cardiovascular diseases and mental health diseases.
After reviewing various articles that explore the topic, they all seem to agree that mental health diseases contribute to the development and worsening of cardiovascular diseases. They also agree that mental health diseases affect prevention, treatment and rehabilitation of cardiovascular diseases. Mensa et at (2105) state that mental health issues such as chronic anger, chronic stress, poor social support, loneliness, social isolation all which contribute to the development of depression have all been shown to contribute to the development of cardiovascular diseases especially coronary heart disease. Stewart et al (2017) found that persistent psychological distress over a period of 4 years is likely to increase the likelihood of dying from cardiovascular diseases by 2-4 times. Research suggest that the relationship between mental health illnesses and cardiovascular diseases shows a dose-response association which means that the higher the amount of stress that one is exposed to, the more severe the symptoms of cardiovascular disease they are likely to develop. This is also to mean that severity of symptoms is also dependent on how long has been exposed to stress. In their review, they also explain that mental health diseases are associated with risks that are likely to lead to the development of cardiovascular diseases. For example in a study by Carliner et al, (2014) which aimed to investigate the relationship between mental health issues and cardiovascular diseases, they found out that patients suffering from schizophrenia and bipolar disorders are likely to be obese and have other compounding factors such as diabetes that are all risk factors for the development of cardiovascular diseases. Patients suffering from mental health diseases are also likely not to take their cardiovascular medications which directly leads to worsening of cardiovascular symptoms. A study by Gehi et al (2017) involving 940 patients suffering from mental illnesses showed that those who exhibited severe symptoms of depression also exhibited cardiovascular symptoms of unstable angina since. This was in complete contrast to patients whose depressive symptoms were well controlled since they displayed no cardiovascular symptoms. The explanation was that those with active depressive symptoms were more than 3 times likely not to take their medications in comparison with those who displayed no active depressive symptoms as they were taking their medications in time. An interesting finding that they also uncovered in their study is that health care provider factors play an important role in that most providers were reluctant to treat patients with mental health issues suffering from other conditions and this leads to worsening of their symptoms. Patients suffering from mental health issues are also not likely to engage in exercises which are well-known to prevent the occurrence of cardiovascular diseases. Exercises have been shown to improve the cardiovascular health in healthy people and also prevent progression of symptoms of cardiovascular symptoms in people already suffering from cardiovascular diseases. People suffering from mental health issues are likely not to engage in physical exercises due to severity of their symptoms or lack of understanding of their importance because of lack of insight and this deprives them the benefits of exercises against cardiovascular diseases.
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Most of the studies that have examined the relationship between the cardiovascular diseases and mental illnesses focus on how mental illnesses contribute to worsening cardiovascular diseases but it is important to note that the reverse also occurs whereby cardiovascular diseases are known to contribute to the development of mental illnesses. Hert et al (2018) in their study describe that patients living with coronary heart diseases have a higher prevalence of depression as opposed to the general population. A vicious cycle then arises from this whereby depression leads to poor prognosis of of CHD. The high prevalence of depressive symptoms in patients suffering from CHD could be explained by the high tension levels that these patients live with for the fear of recurrence of the heart attack which puts them at risk of death.
It is important to note that the relationship between mental illness and cardiovascular diseases is not only restricted to patients with depressive and anxiety symptoms. A positive association has been found to exist between cardiovascular diseases and any kind of mental health disorders including mental diseases such as alcohol related disorders, personality disorders, substance use disorders.
Pathophysiology of mental illnesses and cardiovascular diseases
Various mechanism have been proposed for the development of the cardiovascular diseases in patients with mental illnesses. These mechanisms can be broadly classified into Biological mechanisms and Behavioral mechanisms, genetic mechanisms and psychological mechanisms (Hert & Detraux, 2018) . Biological mechanisms include dysregulation of hypothalamic-pituitary-adrenal (HPA) axis, dysfunction of the autonomic nervous system, hypertension, and increased inflammation among other physiological processes. With regards to dysfunction of the autonomic nervous system, it has been observed that people with mental illnesses especially those with depression have high levels of circulating catecholamine that stimulation of the sympathetic nervous system leading to chronically elevated blood pressure, increased cardiac load, raised heart rate all which adverse effects on the heart. Heart failure and heart attacks are the likely cardiovascular outcomes (Hert & Detraux, 2018) . With regard to the HPA axis, it has been observed that people suffering from mental illnesses have increased amounts of cortisol in circulation. The role of cortisol in the formation of atheroma’s is well document and when the atheromas clog the major blood vessels of the heart particularly the coronaries, the risk of suffering from coronary heart disease is greatly increased.
In terms of behavior, people living with mental illnesses have been shown to indulge in a number of unhealthy behaviors that greatly increases their risks of suffering from cardiovascular diseases. For example, these patients are known to have poor adherence to medications, they are known to engage in heavy drinking and smoking, fail to exercises contributing to obesity (Hert & Detraux, 2018) . All these behaviors count as the modifiable risk factors for cardiovascular diseases hence these people are at more risk.
In terms of genetics, studies involving identical twins have shown that those who develop mental illnesses later develop cardiovascular diseases. This points to a suggestion that some mental illnesses share the same genes with cardiovascular diseases.
Psychological factors are also known to contribute in the development of cardiovascular diseases and mental illnesses. For example, people with CHD have been shown to have higher anxiety levels as compared to the general population without the disease as they fear recurrence of symptoms (Hert & Detraux, 2018). The high levels of anxiety can easily lead to anxiety disorders. If these patients go ahead to develop mental illnesses, it then becomes a vicious cycle as the mental illness is likely to contribute to worsening cardiovascular symptoms.
In terms of inflammation, patients with mental illnesses have been shown to have higher amounts of circulating inflammatory biomarkers. The role of inflammation in the development of cardiovascular diseases such as the formation of atheromas is well documented (Hert & Detraux, 2018) . Hence, it is true to say that the increased inflammatory biomarkers found in cases of mental illness contribute to cardiovascular diseases.
How treatment of other medical conditions worsen cardiovascular issues
Treatments of other diseases can have a toll on cardiovascular health. These treatments can be categorized into drug therapy and behavior therapy. In terms of drugs, a host of drugs used in the treatment of various conditions have well documented cardio toxic effects. Among the well-known cardio-toxic drugs is the chemotherapy agents. Drugs such as chlormethine, cisplatin, cyclophosphamide, teniposide among others are well known to cause various cardiac events. Some of the cardio toxic events that are associated with these drugs include thrombosis, arrhythmias, myocardial infarction, myopathies just to name a few. Hence, in addition to helping resolve the spread of malignant disease, these drugs poison the heart and can contribute to development of cardiovascular diseases. Some antibacterial drugs are also known to have card toxic effects. For example, Painkillers especially NSAIDs are also known to cause heart failure through encouraging water retention. Antipsychotic drugs for example carbamazepine are also known to be cardio toxic since carbamazepine is known to have negative inotropic effects. Anti-malaria drugs for example chloroquine are known to be cardio toxic by causing ST elevation and QPR elongation. In terms of behavioral treatment, some conditions are best treated through total bed rest which increases the risk of cardiovascular disease. For example, PPROM in pregnancy is treated through total bed rest and this can increase or worsen the symptoms of cardiovascular diseases.
Conclusion
In summary, cardiovascular diseases don’t occur in isolation most of the times as they are closely related to other diseases. The link between cardiovascular diseases and mental health diseases is a well-established fact. Mentally ill people have various factors that act as risk factors for the development of cardiovascular diseases. The mechanisms through which mental illness cause mental illnesses can be classified into biologic, behavioral, genetic, psychological and through inflammatory processes. It is important to be aware of this fact so that when treating mental illness, the cardiovascular system can be monitored closely for timely diagnosis and management of any arising diseases. Treatment of other diseases also poses as risk to the development of cardiovascular diseases as most medications are cardio toxic. It is therefore critically important to assess the side effects of a drug on the cardiovascular system before prescribing.
References
Carliner H, Collins PY, Cabassa LJ, McNallen A, Joestl SS, Lewis-Fernandez R. Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: a critical literature review. Compr Psychiatry. 2014 Feb;55(2):233–47
Correction to: Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. (2016). Circulation , 134 (12). doi: 10.1161/cir.0000000000000449
Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med. 2005 Nov 28;165(21):2508–13
Hert, M. D., & Detraux, J. (2018). The intriguing relationship between coronary heart disease and mental disorders. Dialogues in Clinical Neuroscience , 20 (1), 31–40.
Mensah, G. A., & Collins, P. Y. (2015). Understanding Mental Health for the Prevention and Control of Cardiovascular Diseases. Global Heart , 10 (3), 221. doi: 10.1016/j.gheart.2015.08.003
Stewart RAH., Colquhoun DM., Marschner SL., et al. Persistent psychological distress and mortality in patients with stable coronary artery disease. Heart. 2017;103(23):1860–1866
