February is American Heart Month.
A few weeks ago, as I was completing my exam, my doctor asked, “When was the last time you had an echocardiogram?”
I had had a super stressful year and didn’t want to think about dealing with one more thing. But my family had a history of heart disease and I knew that taking this simple test was the right thing for my health.
With the script in hand, I went downstairs to the radiology department. When the radiologist called me without a long wait, I assumed that at least I would be out of there quickly. But the echo lasted much longer than usual. Fortunately, after about 45 minutes we were finished. I didn’t think about the test.
That evening, when the results appeared in my portal, I was shocked to see that the Echo detected an anomaly. I immediately wondered if this could be related to the excessive anxiety-related stress I had been experiencing over the past year while making a major change in my life.
It turns out that a 2025 American Heart Association Journal study, Circulation, showed that people living with depression and anxiety are more likely to experience a cardiovascular event than people without depression.
I wanted to know more, so I turned to the experts for answers.
The connection between mental health, stress and heart disease
According to the results of the 2025 study, participants with depression and anxiety had higher activity in the amygdala, the region of the brain associated with stress. They also showed signs of an overactive nervous system and higher levels of CRP, a protein linked to inflammation in the body. All of these stress-related symptoms increase the risk of heart disease.
“When people are stressed, they have higher levels of stress hormones like adrenaline, norepinephrine and cortisol, so heart rate and blood pressure can increase,” said Nieca Goldberg, MD, FACC, a cardiologist at NYU Langone and a member of HealthyWomen’s Women’s Health Advisory Council.
Elevated cortisol, also called the stress hormone, can cause belly fat, which can then lead to higher triglyceride and glucose levels, higher blood pressure and other risk factors for heart disease. Stress also causes inflammation in the body, which promotes plaque buildup in your arteries. Simply put, a mental health disorder such as depression or anxiety can increase stress, which in turn affects heart health. It’s like a domino effect.
And the more psychological problems you have, the more likely you are to suffer a cardiac event. The Circulation study found that people who suffer from both depression and anxiety have a 32% higher risk of a major cardiovascular event than those who only suffer from depression.
This is partly because when we struggle with multiple mental health issues such as anxiety, depression, and PTSD, it becomes really difficult to cope. Goldberg said when we can’t cope, we tend to make poor lifestyle choices, such as smoking, drinking alcohol, being sedentary, eating highly processed foods or not feeling motivated to take prescribed medications. Over time, this can lead to increased heart rate and blood pressure, reduced blood flow to the heart, and increased cortisol levels. These symptoms eventually cause calcium buildup in the arteries, metabolic disorders, and heart disease.
Women and heart disease
During perimenopause and menopause, estrogen, a hormone that helps protect your heart, drops. Hormonal changes and the physical symptoms of menopause can impact your emotions, and women are more prone to anxiety and depression during this time. Add to that the pressures of caregiving and careers, and it’s no wonder women in midlife are often overwhelmed. In fact, middle-aged women are 84% more likely to suffer from anxiety and 41% more likely to suffer from depression than men of the same age.
But these statistics become even more worrying. Women who struggle with depression are twice as likely to suffer sudden cardiac death. And black and brown women, who often suffer from uncontrolled high blood pressure and diabetes, are even more likely to suffer from cardiovascular disease than white women overall.
It’s important to note that not all heart disease is related to mental health or stress. Some of these are genetic or can be caused by environmental factors or other medical conditions. Still, Goldberg said, “No matter what form of heart disease or condition you have, reducing stress and improving mental health attitudes actually contribute to outcomes.”
Here’s what you can do to reduce your risk of stress-related heart disease
Samuel Sears, Jr., Ph.D., psychologist, professor and department head of innovation research at the East Carolina Heart Institute, suggested cognitive behavioral therapy to treat depression and anxiety, which in turn can lower your stress levels. “Therapy allows patients to talk about emotions, identify thoughts and change actions that cause distress,” Sears said.
In addition to depression and anxiety, lack of sleep can also increase stress because your brain isn’t functioning as well as it should. That’s why Goldberg emphasized that getting a good night’s sleep is one of the best things you can do for your health. “People with sleep disorders or sleep apnea syndrome have higher blood pressure and more heart rhythm problems,” she said. These symptoms often lead to heart disease.
Goldberg also recommended downloading meditation apps to improve your overall mood and relax your breathing. Eating a healthy diet that includes fresh fruits and vegetables, staying hydrated, quitting smoking, and getting 150 minutes of aerobic exercise per week are other ways to reduce stress-related heart disease.
Tai chi, qigong and yoga are gentler options that combine physical, mental and spiritual benefits to improve your overall health.
If you’re still having trouble managing your stress, it may be time to talk to your doctor about taking antidepressants, including SSRIs, to relieve symptoms. Research shows that taking antidepressants reduces the number of emergency room visits and hospitalizations due to heart disease.
It’s important to talk about your mental health
Unfortunately, mental health is still stigmatized and people often fear that they will be judged if they express their feelings during a doctor’s visit. But Sears emphasized that it’s important to talk about our feelings. “Emotions are part of the human process and they should be welcomed and open,” he said. If left untreated, they persist and can potentially cause further health problems down the road.
Goldberg acknowledged that cardiologists don’t typically deal with mental health issues because they’re pressed for time. However, if you are struggling, it is important that you be proactive and advocate for yourself.
Both Sears and Goldberg suggest starting the conversation with these opening statements:
- I worry about the fear I have and how it might affect my heart.
- I’m looking for a comprehensive plan. What advice do you have for me when it comes to managing stress?
- What other specialists can I involve in my care to complete my health plan?
Build a team to care for your mind and body
In addition to hiring your cardiologist, consider building your own mind and body team that includes the following healthcare providers:
- Nutritionist
- psychologist
- Physiotherapist
- Exercise physiologist
Once you’ve assembled your team, make sure they’re talking to each other. Communication is the best way to create a comprehensive health plan.
The bottom line is that talking about your mental health can improve your heart health. “Emotions are human. Just let them rip,” Sears said.
