BOSTON — Young women are generally considered a low-risk demographic when it comes to heart disease, but new research now shows that certain mental health conditions may increase the risk of heart disease among young and middle-aged women. More specifically, the study found both anxiety and depression may accelerate the development of cardiovascular risk factors among younger women.
This work shines a renewed light on the importance of cardiovascular screening and preventive care; rates of cardiovascular risk factors continue to rise, and heart attacks are more common nowadays in younger people. Depression and anxiety rates have also increased in recent years, especially since the COVID-19 pandemic.
The study found younger women with anxiety or depression were close to twice as likely to develop high blood pressure, high cholesterol, or diabetes over a 10-year period when compared to women with no such mental health conditions. This is just about equal with men of the same age in terms of heart disease risk.
“We often feel that young women are the ‘safe group’ with regards to cardiovascular disease because the incidence of cardiovascular disease is quite low due to the protective effects of estrogen in this group,” says Giovanni Civieri, MD, a cardiologist and research fellow at Massachusetts General Hospital and Harvard Medical School, in a media release. “But this study suggests that if a younger woman has depression or anxiety, we should start screening for cardiovascular risk factors to reduce the incidence of cardiovascular disease.”
💡What To Know About Heart Disease:
- Prevalence and Risk Factors: Heart disease is one of the leading causes of death worldwide. Major risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and a sedentary lifestyle.
- Types and Symptoms: There are various types of heart disease, including coronary artery disease (the most common), arrhythmias, heart failure, and congenital heart defects. Symptoms can vary but often include chest pain, shortness of breath, fatigue, and palpitations.
- Prevention and Treatment: Lifestyle changes such as a healthy diet, regular exercise, and quitting smoking can prevent or manage heart disease. Medical treatments can include medications, procedures like angioplasty or surgery, and, in severe cases, heart transplantation.
The study authors analyzed the health records of 71,214 people participating in the Mass General Brigham Biobank, a research program by the Mass General Brigham health system. Researchers excluded anyone diagnosed with heart disease or with anxiety or depression after the study began.
Over the course of the decade-long follow-up period, a total of 38 percent of participants developed high blood pressure, high cholesterol, or diabetes. According to the analysis, people showing a history of anxiety or depression before the study period were roughly 55 percent more likely to develop one or more relevant risk factors in comparison to others without anxiety or depression. This was especially true among women younger than 50 diagnosed with anxiety or depression; researchers estimate they were nearly twice as likely to develop cardiovascular risk factors in comparison to any other cohort.
Regarding absolute risk, young women generally displayed the lowest overall rates of cardiovascular risk factors among any group – which is exactly what researchers expected to find judging from prior studies and modern science’s understanding of the protective effects of estrogen in pre-menopausal women. However, anxiety and depression still showed an association with a much higher relative risk among young women than among other groups.
“Once a young woman has depression or anxiety, her absolute risk is comparable to a young male,” explains Dr. Civieri, who is also a doctoral student at the University of Padua in Italy and the study’s lead author. “There is a sort of a catch-up phenomenon where depression and anxiety increase the risk that would otherwise be very low.”
To investigate and identify the potential drivers behind this relationship, researchers examined the metabolic activity of stress-related brain regions among a subset of participants who also underwent brain scans. The ensuing results suggest younger women with anxiety or depression show relatively large increases in stress-related neural activity.
“The question is: Why are anxiety and depression associated with heightened gains in risk among younger females? This is something we are continuing to study,” Dr. Civieri concludes.
While anxiety and depression are clearly separate conditions, study authors chose to group them together for this study because they both show an association with an elevated heart disease risk and share neurobiological pathways. In other words, they are thought to influence health in similar ways.
As of now, researchers cannot say if mental health treatments, such as antidepressant medications or psychotherapy, may help reduce cardiovascular risk. Still, Dr. Civieri notes once a patient develops high blood pressure, high cholesterol, or diabetes, well-established treatments like statins and blood pressure-lowering drugs can effectively reduce the risk of a serious cardiac event.
Researchers will present this study at the American College of Cardiology’s Annual Scientific Session.