Heart attack distress: Ongoing psychological distress in the year after a heart attack may raise the odds of another cardiac event by about 1.3 times, according to a scientific review from American Heart Association (AHA) experts published in Circulation.
Analysing prior studies of myocardial infarction and acute coronary syndrome alongside depression, anxiety, stress and PTSD, the authors found a clear gradient of risk. Over an average of 4.7 years of follow-up, people with moderate distress faced a 28% higher risk of future heart attack, while high or very high distress was linked to a 60% increase compared with those reporting low distress.
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“Psychological distress after a heart attack is quite common but often goes unrecognised,” said lead author Glenn N. Levine, professor of medicine at Baylor College of Medicine. “We often focus on the physical aspects of heart disease, yet psychological health is linked to physical health, so emotional recovery is just as important.”
The review notes that damage to heart muscle can spark inflammation and hormonal shifts, which in turn may drive changes in the brain associated with depression, anxiety or PTSD. Acute mental stress itself can constrict coronary arteries, reduce blood flow to the heart and trigger arrhythmias, even in people without prior cardiac disease.
The AHA estimates 33%–50% of heart-attack survivors experience depression, anxiety or PTSD. Anxiety and stress may affect up to half of patients during hospitalisation and persist in 20%–30% for months after discharge. Distress can also undermine recovery through lower physical activity, smoking or alcohol use, poor sleep and diet, weaker social support, and reduced medication adherence. A history of mental-health conditions or chronic illness further heightens risk.
