Anxiety, depression, and PTSD can increase heart attack risk in people under 40

May 16, 2023

According to a new study, certain mental conditions such as anxiety, depression, and insomnia may increase heart disease risk.

In the United States, cardiovascular disease (CVD), which accounts for one in five deaths, is the leading cause of death.

Smoking and inactivity are among the factors that increase a person’s heart disease risk.

Prior studies have also examined the impact of mental disorders on heart disease.

The results of a new, extensive analysis published in the European Journal of Preventive Cardiology on May 8 suggest that there could be a significant correlation.

Researchers in this study found that heart disease was associated with not only the elderly but also those in their 20s or 30s.

Heart disease and mental health disorders are linked.

The study’s authors searched for people aged 20-39 in the Korean National Health Insurance Service. After excluding individuals with a history of myocardial ischemia (also known as a heart attack) or stroke, they had 6.557.727 adults who all underwent health exams between 2009 and 2012

Nearly half of this group (47.9%) had anxiety. A high proportion of participants (21.2%) had insomnia. Other concerns include bipolar disorderseating disorderspost-traumatic disorder(PTSD); and drug use disorder.

All participants’ health status was monitored on average for 7.6 years until December 2018. In this period, there were 16,133 myocardial ischemias and 10,509 ischemic strokes.

The team looked at other risk factors, such as age and sex. They also considered smoking, drinking, and physical activity.

Participants with mental health issues were three times more likely to suffer a stroke or heart attack than those without mental health issues.

Mental health disorders differ in their level of increased heart disease risk. For example, people with PTSD are 213% more likely than those without it to suffer a heart attack, while those with Schizophrenia are 161% more likely. Most mental disorders were anxiety-related, but this only equated to a 53% increase in risk.

Researchers found that despite those with PTSD having the highest CVD risk, their stroke risk was not increased. The same was true for those with eating disorders.

Dr. Majid Baseit, a Houston cardiologist at Memorial Hermann, has pointed out that these results contradict previous studies. The researchers didn’t explain but stated that further investigation was needed.

Associations between risk profile and gender and age

Researchers also looked at how results varied by age and gender. The risk of heart attacks was higher for those in their 20s who had anxiety, depression, or personality disorders.

Why might age be an issue?

Dr. Rigved TADWALKAR, a board-certified cardiologist from Providence Saint John’s Health Center Santa Monica.

He told Healthline that those of this age are “often in a transitional period, such as beginning a job, enrolling at a different educational institution, or moving to a brand new city.” This can be stressful, and it may worsen mental health symptoms.

He added, “Individuals in the 20s are more likely to adopt unhealthy coping strategies and engage in riskier behavior, increasing their cardiovascular risk.”

Basit said that older patients are more mature and more likely to seek mental health support and counseling from family and friends.

Women with depression or insomnia are more likely than men to suffer a heart attack or stroke.

Dr. Wafi Mumin, a cardiologist at UTHealth Houston Heart & Vascular and Memorial Hermann, said women’s heart disease is unrecognized. Women are also more likely to be diagnosed than men with anxiety and depression.

He told Healthline that “naturally, these two occurrences tend to produce a statistic showing a higher rate of heart disease among women than men.”

Dr. Trent G. Orfanos is the director of integrative cardiology and functional cardiology for Case Integrative Health, Chicago, Illinois. He highlighted that hormonal differences between men and women could also play a part. Mental health issues can cause physiological problems (such as inflammation), affecting estrogen’s protective properties.

He noted that this potential association would “need further investigation by additional studies.”

How mental health can affect heart disease

There’s been a lot of discussion in recent years about the link between the brain and the gut. Momin said the connection between the brain and the heart was also essential and often overlooked.

Experts say that poor mental health can affect heart health in different ways. It’s important to note that “while a mental illness may increase your risk of heart disease, this does not guarantee you will develop it,” explained Dr. Robert Segal, a board-certified cardiologist and founder of Manhattan Cardiology Medical Offices of Manhattan. He’s also the co-founder of LabFinder.

Oxidative stress

Orfanos said that those with mental disorders have higher oxidative stress markers.

He explained that an imbalance between the free radicals in your body and the antioxidants causes oxidative stress. When free radicals and antioxidants aren’t balanced, they can cause damage to your body. This leads to chronic diseases such as high blood pressure or heart disease.


It is possible that the relationship between mental illness and inflammation can be cyclical. Mental disorders may lead to inflammation, while increased inflammation has been associated with an increased riskTrustedSource of developing mental health concerns.

Segal also said, “Chronic inflammation is a risk factor for heart diseases.”

He told Healthline that chronic stress can cause inflammation in the body. Cortisol is the body’s stress hormone and plays a significant role in inflammation.

Autonomic nervous dysfunction

Segal explained that “some mental disorders can affect the autonomic nervous system (ANS).” This system regulates uncontrollable processes in the body, such as blood pressure and heartbeat.

He said that when the ANS does not function properly, it can lead to “heart rhythm abnormalities and a greater risk of heart disease.”

High cholesterol and blood pressure

Mental health issues are associated with high blood pressure and cholesterol, which are significant in heart disease.

Researchers have linked anxietyschizophreniaTrusted source, and post-traumatic stress disorderTrusted source with increased blood pressure.

Unhealthy behavior

Mental health issues can lead to unhealthy behavior.

The 2018 National Survey on Drug Use and Health revealed that 9,3 million Americans suffered from a concurrent mental health disorder and substance abuse disorder. Government figures show that approximately 70% of those with Schizophrenia or bipolar disorder smoke regularly.

Tadwalkar said that these behaviors can lead to conditions such as hypertension, diabetes, and hyperlipidemia.


About 16% of people with mental disorders use prescription drugs to manage their conditions.

Tadwalkar said, “[these] side effects can impact cardiovascular health.”

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