Anxiety is a prevalent issue among individuals with cardiovascular disease.
As many as four in 10 patients with coronary artery disease report symptoms of anxiety during hospitalization or immediately post event.
Dr. Heather Tulloch, a clinical, health, and rehabilitation psychologist, and scientist at the University of Ottawa Heart Institute, says to feel anxious following a cardiovascular disease diagnosis is perfectly normal.
“I believe anxiety is a human response to what can be a scary event for many people,” says Dr. Tulloch, who directs the Cardiovascular Health Psychology and Behavioural Medicine Laboratory at the Heart Institute.
“We’re hardwired to keep ourselves safe, and a cardiovascular disease diagnosis brings about new things that make you think about your health.”
Understanding anxiety
Generally, anxiety is described as an emotion characterized by an unpleasant state of inner turmoil, centred around feelings of dread over anticipated events.
Dr. Tulloch and her colleagues at the Heart Institute say the effects of anxiety can permeate into multiple facets of patients’ lives.
It may indicate a more serious problem if an individual experiences excessive worry that is difficult to control and a combination of at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
“If you’re experiencing any of those symptoms and you're having a difficult time functioning in your day-to-day, that's when it's more problematic,” she says.
Anxiety and cardiovascular disease
There are behavioural and physical mechanisms of anxiety that psychologists believe may lead to a worsening of cardiovascular health.
To explore this question further, Dr. Heather Tulloch and her colleagues at the University of Ottawa Heart Institute completed a review of the available literature on the effects of anxiety on cardiovascular disease prognosis among women with a heart condition. Their related commentary is published in the European Journal of Preventative Cardiology (EJPC).
Studies of individuals who have experienced a heart attack have found that post-event anxiety was associated with a 71% increased risk of a recurrent heart attack and a 23% increased risk of cardiac mortality.
More research – especially in women – is necessary
“Our review highlights the need to better understand the links between anxiety and cardiovascular disease, especially among women,” says Dr. Karen Bouchard, an associate scientist and director of the Cardiovascular Health Promotion, Education, and Social Determinants Laboratory at the University of Ottawa Heart Institute, and an author of the paper published in the EJPC.
“The prevalence of anxiety in women is about two to three times higher than in men,” she said. “But we’ve only started scratching the surface on understanding the effects of this anxiety. The sample sizes are too small and disproportionate to discern how anxiety affects women versus men.”
More research, Dr. Bouchard says, is clearly needed.
“What we know about the connections between mental health and cardiovascular disease risk are predominantly informed by studies that have been performed on men,” she said. “I believe what we currently understand about anxiety in women is just the tip of the iceberg. There is a lot more we can learn if we leverage data that includes larger female samples.”
Drs. Tulloch and Bouchard are among a team recently funded by the Canadian Institutes for Health Research to investigate the impact of anxiety on cardiovascular outcomes in women with cardiovascular disease.
Dr. Bouchard says a sex-specific analysis of data from the Canadian Longitudinal Study of Aging will help researchers identify how anxiety affects women specifically.
In another project, funded by Heart & Stroke, Dr. Tulloch will investigate the relationship between psychological distress and major adverse cardiovascular events in patients with spontaneous coronary artery dissection to better understand the impact of mental health on cardiovascular outcomes in these patients.
Mental health matters
“What’s clear is that we need to focus more on mental health as a critical factor that can impact patients for better or for worse,” said Dr. Karen Bouchard.
“Research will yield important insights that inspire innovative programming and new approaches to bolster these facets of people's lives and improve health outcomes.”
At the Heart Institute, every cardiac rehabilitation patient is screened for depression and anxiety. Those with elevated scores are referred to a clinical psychologist for assessment to determine whether they may benefit from one or more resources available.
For example, there’s an online workshop in which participants log in to learn about the signs and symptoms of stress and how to set practical strategies for managing it effectively. There’s a stress management class and managing emotions program designed to help patients cope with anxiety related to their heart health and other difficult emotions. There’s also a list of top tips to improve emotional health, which includes advice for sleeping well and exercising safely.
Dr. Tulloch says the little things go a long way.
“There are things people can do to reduce stress and anxiety in their daily lives so when stressors do come or new stressors arise, you feel like you can handle it," she said. Breathing and mindfulness exercises and positive self-talk, she says, can help.
“We're all at different stages in our life, and whether we meet the diagnostic criteria for an anxiety disorder or not, we're all going to experience stress and anxiety at times, and that’s okay,” said Dr. Tulloch. “There’s support for those who need it.”
Resources
- Download our top ten tips for emotional health and managing stress.
- Access more of our top ten tips for cardiovascular health, including advice to help you enjoy a stress-free holiday season.
- Talk to your family doctor or visit AccessMHA.ca to get support or advice about your mental health.
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