Study Reveals Brain-Heart Connection in Depression and Anxiety
In This Article
- New research from Mass General Brigham showed about 35% increased risk of cardiovascular disease in people with both depression and anxiety
- Study results suggest that stress-related brain activity may increase the risk of heart and vascular disease in people with depression and anxiety
- Brain scans and biomarkers show higher stress-related brain activity and C-reactive protein, and lower heart rate variability in people with depression and anxiety
- By screening for mental health conditions, clinicians can play a key role in helping patients access early treatment to minimize heart risks
New research from Mass General Brigham suggests that heightened stress-related brain activity in people with depression and anxiety may increase the risk of cardiovascular disease.
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“What we’re seeing is not a single pathway, but a coordinated biological stress response—starting in the brain and extending through the nervous and immune systems—that helps explain the cardiovascular risk in people with depression and anxiety,” says study first author Shady Abohashem, MD, MPH, head of Cardiac PET/CT Imaging Trials at the Cardiovascular Imaging Research Center of Massachusetts General Hospital and the Mass General Brigham Heart and Vascular Institute.
The findings, published in Circulation: Cardiovascular Imaging, may help explain how mental stress translates into damage to the heart and blood vessels over time. They also suggest that stress reduction and related therapeutic targets may help prevent cardiovascular disease.
The Connection Between Anxiety, Depression, and Heart Disease
Investigators analyzed data from 85,551 people enrolled in the Mass General Brigham Biobank research program. Out of the participants, 14,934 had depression and anxiety, 15,819 had one condition, and the remainder had neither.
The researchers followed the participants for an average of 10 years. During that time, 3,078 suffered a heart attack, heart failure, or stroke. People with multiple mental health conditions had the greatest risk. Depression and anxiety combined increased risk by 35%, while each condition alone increased risk about 25%.
These findings held even after adjusting for common risk factors like smoking, diabetes, and hypertension or health behaviors like sleep and exercise, Dr. Abohashem adds.
Why Depression and Anxiety Increase Risk of Heart Disease
Previous studies have also found an increased risk of heart attack and stroke in people with depression or anxiety, but the mechanisms behind this association were unclear.
“That motivated us to delve deeply into the mechanism that could explain the increased heart disease risk we see for those patients,” Dr. Abohashem says. “By understanding what’s happening biologically, we open the door to more precise and effective interventions.”
To investigate further, researchers gathered additional data from a subset of participants. They took brain scans to measure metabolic activity in the amygdala and prefrontal cortex—regions of the brain that are involved in stress response and stress perception.
In addition, they measured heart rate variability as a marker for autonomic nervous system regulation and C-reactive protein (CRP) as a marker for inflammation.
“What we found is that people with anxiety and depression tend to have higher stress-related brain activity, autonomic nervous system dysregulation, and inflammation,” Dr. Abohashem says.
These biological changes suggest that anxiety and depression chronically keep the brain’s stress circuits switched on. When that happens, the body gets stuck in “fight or flight” mode, Dr. Abohashem explains. The result: increased heart rate, blood pressure, and chronic inflammation that damage blood vessels and accelerate heart disease over time.
Implications for Cardiovascular Risk Assessment
The study has implications for cardiovascular risk assessment and prevention.
“The risk from depression and anxiety is very comparable to traditional cardiovascular risk factors like diabetes, hypertension, or smoking,” Dr. Abohashem says. This is why it’s important to recognize mental health conditions early.
Clinicians can play a key role by screening for depression and anxiety and referring patients to mental health specialists for targeted interventions. “If depression and stress are not addressed early, they can take a real toll on heart health over the long run,” Dr. Abohashem warns.
Preventing Heart Disease in People With Depression and Anxiety
Clinicians can also share preventive lifestyle strategies that target both stress-related mental health conditions and cardiovascular risk. “Lifestyle changes are powerful because they simultaneously support mental well-being and heart health,” Dr. Abohashem says.
Recommended approaches include meeting guideline-based physical activity targets—at least 150 minutes of moderate-intensity aerobic exercise per week combined with two full-body strength-training sessions—along with daily stress management through mind-body practices such as mindfulness meditation or yoga. Attention to sleep is also important, with an emphasis on consistent sleep-wake schedules and an environment that supports restorative sleep, including a cool, dark bedroom.
The key is to integrate mental health care into cardiovascular prevention. “Treating cardiovascular health in isolation from mental well-being is not ideal,” Dr. Abohashem says.
Stress and Cardiovascular Disease: Next Steps
While the findings are compelling, Dr. Abohashem acknowledges the study’s limitations.
“Because this is an observational study, we can’t prove that these biological changes directly caused a heart attack or a stroke,” he says. “The next step is to test these pathways in randomized clinical trials to determine whether targeting them can reduce cardiovascular risk.”
Researchers at Mass General Brigham are uniquely positioned to move from observation to intervention. “The integration of large biobank data, cutting-edge imaging, and clinical trial infrastructure allows us not only to uncover mechanisms, but to test strategies that could ultimately improve patient care.”
In the meantime, Dr. Abohashem and colleagues are studying potential interventions to lower cardiovascular risk in people with depression or anxiety. For example, stress-reduction therapies, anti-inflammatory medications, and lifestyle changes may help normalize the brain and immune markers of stress.
“The earlier we intervene, the more likely we are to reduce the long-term burden of cardiovascular disease,” Dr. Abohashem says.