Your Heart and Mind Are Connected: Understanding Mental Health and Cardiovascular Disease

A Message From Dr. Lewis

If you’ve been struggling with depression or anxiety, I want you to know something important: your mental health and your heart health are deeply connected.

I’m Dr. Bliss Lewis, a psychiatrist who specializes in integrative medicine. Over my years in practice, I’ve watched too many patients focus on treating their depression while their cardiovascular risk goes unnoticed. I’ve also seen the opposite—people managing heart disease without addressing the stress and depression that may be making it worse.

Here’s what most people don’t know: depression increases your risk of having a heart attack by 28% and your risk of dying from heart disease by 44%. That’s about the same risk increase you’d get from smoking or having high cholesterol.

But here’s the good news: when we treat depression and anxiety effectively, we’re not just helping you feel better emotionally—we’re actually protecting your heart.

On this page, I’ll explain how your mental health affects your cardiovascular health, why I assess heart disease risk as part of comprehensive psychiatric care, and what you can do to protect both your mind and your heart.

What You’ll Learn on This Page

• How depression and anxiety increase your heart disease risk (and why heart disease makes mental health worse)
• The science behind the connection – explained in plain language
• Why comprehensive cardiovascular assessment matters for people with depression or anxiety
• Evidence-based treatments that help both your mental health and your heart
• What comprehensive testing looks like and who needs it
• My integrative approach to treating the whole person
• Practical steps you can take starting today

How Depression and Anxiety Affect Your Heart (And Vice Versa)

Depression Increases Your Heart Disease Risk

The research is clear: if you have depression, anxiety, bipolar disorder, or PTSD, you’re at higher risk for heart disease. This includes heart attacks, strokes, and heart failure.

How much higher? Studies involving hundreds of thousands of people show that:

• Depression increases your heart attack risk by 28%
• Depression increases your risk of dying from heart disease by 44%
• These risks are similar to having high blood pressure or high cholesterol

Here’s another surprising fact: 1 in 5 people with heart disease also have depression. Among people with heart failure, it’s 1 in 4. Yet most of these people never get treatment for their depression.

Heart Disease Can Make Depression Worse

This connection works both ways. When someone has a heart attack or gets diagnosed with heart disease, they often develop depression or anxiety. This creates a dangerous cycle:

1. Depression increases your risk of heart disease
2. Heart disease makes depression worse
3. Untreated depression speeds up heart problems

Each one feeds into the other, making both conditions harder to manage.

Major Medical Organizations Agree

The American Heart Association and American College of Cardiology—the leading organizations for heart doctors—now tell cardiologists to screen their patients for depression and anxiety. They recognize that treating mental health can improve heart health outcomes.

If heart doctors are checking for depression, it makes sense that psychiatrists should check for heart disease risk, right? That’s exactly what I do in my practice.

Why This Connection Exists: The Science Made Simple

You might be wondering: How exactly does depression affect my heart? Let me explain the main pathways in a way that makes sense.

Inflammation: The Link Between Your Brain and Your Heart

Think of inflammation as your body’s alarm system. When you get a cut or an infection, inflammation helps you heal. But with depression, this alarm system gets stuck in the “on” position.

Depression causes chronic inflammation throughout your body—including in your blood vessels. This same inflammation contributes to heart disease by:

• Damaging the lining of your arteries
• Making plaque buildup more likely
• Increasing your risk of blood clots

Here’s an interesting finding: research in The Lancet showed that inflammation increases heart disease risk even when cholesterol is perfectly controlled with medication. This tells us that inflammation is its own separate problem—and it’s one that often comes with depression.

Stress Hormones: When “Fight or Flight” Never Turns Off

When you’re stressed or anxious, your body releases cortisol and other stress hormones. This is helpful in the short term—it’s your “fight or flight” response. But when you have chronic depression or anxiety, these hormones stay elevated for months or even years.

Long-term high cortisol levels damage your cardiovascular system by:

• Raising your blood pressure
• Increasing belly fat (which is particularly bad for heart health)
• Making your blood vessels less flexible
• Contributing to insulin resistance and diabetes risk

The patient in my office dealing with chronic work stress isn’t just feeling overwhelmed—their body chemistry is literally changing in ways that affect their heart.

Your Nervous System: The Heart-Brain Highway

Your heart and brain are in constant communication through your nervous system. When you’re depressed or anxious, this communication system gets disrupted.

One way we measure this is through heart rate variability (HRV)—how much the time between your heartbeats varies. A healthy heart has high variability, which shows your nervous system is working well. Depression and anxiety reduce this variability, and low HRV predicts higher risk of heart problems and even sudden cardiac death.

The good news? Many treatments for depression—including certain medications, therapy, and mindfulness practices—can improve your HRV and potentially protect your heart.

Lifestyle Factors: The Daily Impact

Depression and anxiety also affect your heart through daily behaviors:

• Less physical activity: When you’re depressed, it’s hard to find energy to exercise
• Poor food choices: Depression affects appetite and what foods sound appealing
• Trouble taking medications: Depression makes it harder to stick to any treatment plan
• Smoking or substance use: Often used to cope with emotional pain
• Social isolation: Withdrawing from people is common in depression, and loneliness itself increases heart disease risk

Early Life Stress: Long-Term Effects

Research shows that childhood stress and trauma increase the risk of both mental health problems and heart disease later in life. The American Heart Association has reviewed this evidence and confirmed that difficult childhood experiences have lasting effects on both emotional and physical health.

Why I Check Your Heart Health as Part of Psychiatric Care

The Problem I See Too Often

In my practice, I meet many people who have significant heart disease risk that nobody has fully addressed. Traditional psychiatry often focuses only on mental health symptoms, while physical health concerns get less attention. This approach leaves people vulnerable.

Think about a typical patient coming to see me for depression:

• They might have a parent who had a heart attack at age 50
• Their chronic stress has been triggering inflammation for years
• They’re less active because depression makes them exhausted
• They’re not sleeping well, which affects heart health
• Their nervous system is out of balance in ways that increase cardiac risk

If I only focus on their mood and don’t ask about these other factors, I’m missing half the picture.

What the Research Shows

Here are some facts that changed how I practice psychiatry:

• People with severe mental illness die 10-25 years earlier than average, mostly from heart disease
• Depression affects heart health as much as smoking does
• Many psychiatric medications can affect metabolism and weight, adding to cardiovascular risk
• Standard cholesterol tests miss important risk factors that might be especially relevant for my patients

Why Comprehensive Assessment Makes Sense

As a psychiatrist, I often see patients more frequently than their primary care doctor—sometimes every week or two during important phases of treatment. This gives me a unique opportunity to:

• Notice patterns in blood pressure over time
• Understand how stress is affecting their whole body
• Choose treatments that protect both mental health and heart health
• Catch warning signs early
• Help coordinate care between different providers

I’m not trying to be your cardiologist—I’m trying to be a better psychiatrist by understanding your whole health picture.

The Good News: Treating Depression Protects Your Heart

Here’s the empowering part of this story: when we treat your depression or anxiety effectively, we’re not just helping you feel better—we’re actually protecting your cardiovascular system.

This isn’t just a theory. It’s backed by solid research, including randomized controlled trials (the gold standard in medical research) and large studies following hundreds of thousands of people over many years.

Antidepressant Medications: More Than Just Mood

Certain antidepressant medications, especially SSRIs (selective serotonin reuptake inhibitors), have shown cardiovascular benefits in multiple studies.

The most impressive evidence comes from a trial called EsDEPACS. Researchers studied people who had just had a heart attack and also had depression. Half received the SSRI escitalopram (Lexapro), and half got a placebo. Over 8 years, the people taking escitalopram had significantly fewer heart attacks, strokes, and other cardiovascular events.

This wasn’t about feeling better—the medication actually protected their hearts.

Other large studies confirm these findings. Research using healthcare records from England showed that people whose depression improved with treatment had 30-40% lower risk of developing heart disease, having a stroke, or dying from any cause.

The benefits seem strongest for:

• People who had a heart attack or unstable angina
• Those with moderate to severe depression (not just mild symptoms)
• People under age 60
• Those who actually get better with treatment

Why SSRIs help your heart:

• They reduce inflammation
• They improve how your nervous system regulates your heart
• They help you feel better, which makes it easier to take care of yourself
• They don’t pose risks to your heart like older antidepressants did

Therapy: Talk Therapy as Heart Medicine

The evidence for therapy’s cardiovascular benefits is equally strong.

Cognitive Behavioral Therapy (CBT) and other evidence-based therapies consistently help both mood and heart health. Research shows that therapy leading to real improvement in depression is associated with 30-40% lower risk of developing heart disease.

How does therapy help your heart?

• Reduces inflammation: Yes, therapy can actually lower inflammatory markers in your blood
• Improves nervous system function: Including that heart rate variability we talked about
• Changes behaviors: Easier to exercise, eat well, and take medications when depression improves
• Teaches skills: Stress management and emotional regulation protect your cardiovascular system
• Improves relationships: Social connection is protective for heart health

The American College of Cardiology and American Heart Association specifically recommend therapy for people with both depression and heart disease, citing benefits for quality of life and heart outcomes.

Mindfulness and Mind-Body Practices: The Heart-Brain Connection

Mindfulness-based stress reduction, meditation, and biofeedback have shown consistent benefits for both mental and cardiovascular health.

Recent research shows these practices produce:

• Large improvements in depression and anxiety
• Significant stress reduction
• Lower blood pressure (typically 3-6 points on the top number)
• Better heart rate variability
• Improved overall quality of life

The American Heart Association recognizes meditation and mindfulness as reasonable complementary approaches for cardiovascular risk reduction. They’re safe, accessible, and can be practiced anywhere.

Combining Approaches: Better Together

Research increasingly shows that combining medication, therapy, and lifestyle changes may work better than any single approach alone. This is why my practice focuses on integrative care—we’re not just adding one medication or suggesting one lifestyle change. We’re creating a comprehensive plan that addresses multiple pathways at once.

What Comprehensive Cardiovascular Assessment Looks Like

Beyond Basic Cholesterol Tests

You’ve probably had a basic cholesterol test—total cholesterol, LDL (“bad” cholesterol), HDL (“good” cholesterol), and triglycerides. These are important, but they don’t tell the whole story.

In my practice, when appropriate, I look at a more complete picture:

Advanced Lipid Testing:

• Lipoprotein(a) or Lp(a): This is a genetic risk factor that about 1 in 5 people have. Standard cholesterol tests don’t measure it. It’s tested once in your lifetime because it doesn’t change much with diet or most medications. If it’s high, we can talk about newer treatment options.
  
• LDL particle number and size: Not all LDL cholesterol is equal. Small, dense particles are more dangerous than large, fluffy ones—even at the same LDL number.
  
• Remnant cholesterol: Another type of fat in your blood that contributes to heart disease risk. 

Inflammation Markers:

• High-sensitivity C-reactive protein (hs-CRP): Measures inflammation in your body. Remember how we talked about depression causing inflammation? This test helps us see it.
  
• Other inflammatory markers: Sometimes we check additional inflammation markers depending on your situation. 

Metabolic Health:

• Hemoglobin A1c: Shows your average blood sugar over 3 months
• Fasting insulin: Helps identify insulin resistance early
• Homocysteine: An amino acid that, when elevated, is linked to heart disease risk

Functional Measurements:

• Heart rate variability (HRV): Can be measured with some consumer devices or medical equipment. Shows how well your nervous system is functioning.
  
• Blood pressure patterns: Including checks for white-coat hypertension (high only in the doctor’s office) or masked hypertension (normal in the office but high at home). 

Nutritional Status:

• Omega-3 index: Measures omega-3 fatty acids in your blood. Low levels are linked to higher risk of heart disease and death.
  
• Vitamin D: Deficiency is common in both depression and heart disease. 

Who Needs This Comprehensive Testing?

Not everyone needs all these tests. I consider comprehensive cardiovascular assessment for people with:

• Moderate to severe depression or anxiety
• Family history of early heart disease (before age 55 in men, 65 in women)
• Multiple risk factors (high blood pressure, diabetes, smoking, obesity)
• Depression that hasn’t responded well to treatment
• Medications that affect weight or metabolism
• Unexplained fatigue or trouble with physical activity
• Specific concerns about heart health

Understanding Your Results

When we get results, we’ll look at them together in the context of your whole health picture.

For example, high inflammation markers might be partly due to active depression, not just heart disease risk. Weight changes might reflect medication side effects rather than an underlying problem.

The goal isn’t to worry you with numbers—it’s to understand your unique situation so we can create the best possible treatment plan.

My Integrative Approach: Treating the Whole Person

When I work with patients, I don’t just focus on one thing. I look at multiple factors that affect both mental health and heart health. Here’s what that looks like:

1. Optimize Your Mental Health Treatment

Medication choices matter: When choosing antidepressants, I consider which ones have shown cardiovascular benefits. SSRIs like escitalopram and sertraline are often first-line choices because they’re safe for your heart and may actually protect it.

Therapy is essential: I recommend evidence-based therapy like Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, or trauma-focused therapy when appropriate. Therapy doesn’t just help you feel better—it can reduce inflammation and improve how your nervous system functions.

Skills for daily life: I teach practical stress management and emotional regulation techniques that you can use every day.

Sleep matters: Poor sleep affects both mood and heart health, so we address any sleep problems.

2. Address Inflammation

Diet makes a difference: I often recommend a Mediterranean-style diet, which is proven to help both mental health and heart health. This means:

• Lots of colorful vegetables and fruits
• Fish rich in omega-3s (salmon, sardines, mackerel)
• Olive oil instead of other oils
• Nuts and seeds
• Whole grains
• Less processed food

Omega-3 supplementation: High-quality fish oil can help both mood and cardiovascular health. It reduces triglycerides, may help with Lp(a), and reduces inflammation.

Look for hidden inflammation sources: Sometimes we need to check for gut problems, chronic infections, or other issues contributing to inflammation.

3. Support Your Nervous System

Heart rate variability training: I teach patients techniques to improve HRV, which helps both anxiety and heart function.

Mindfulness practices: Regular mindfulness or meditation practice has been proven to reduce stress, lower blood pressure, and improve heart health.

Movement: Regular physical activity is medicine for both depression and heart health. We start where you are and build gradually.

Sleep: Getting 7-9 hours of quality sleep is crucial for nervous system recovery.

4. Smart Supplementation

Based on research and your individual needs, I might recommend:

For cholesterol management:

• Plant sterols and stanols (2-2.5 grams daily): Can reduce LDL cholesterol by 5-15%
• Soluble fiber (psyllium, beta-glucan): Supports both cholesterol and gut health

For overall heart and mental health:

• Omega-3 fatty acids (EPA/DHA): Reduces triglycerides and inflammation, may help mood
• Coenzyme Q10: Especially important if you’re taking a statin medication

For deficiencies:

• Vitamin D, magnesium, B vitamins: Common deficiencies that affect both mood and heart health

5. Lifestyle as Medicine

These aren’t optional extras—they’re foundational:

Physical activity: Benefits both mood and cardiovascular health. Effects can be as strong as medication for some people.

Smoking cessation: Critical for both conditions. I can help you quit.

Alcohol in moderation: Important for mood stability and heart health.

Stress management: Not a luxury—a necessity. We work on practical techniques you can use.

Social connection: Loneliness increases heart disease risk as much as smoking. Building and maintaining relationships is protective.

What the Research Says We Can Expect

I want to be honest about what we know and what we’re still learning:

What works (strong evidence):

• Treating depression improves quality of life and psychological well-being
• SSRIs reduce cardiovascular events in people with depression and heart disease
• Therapy that improves depression lowers cardiovascular risk
• Mind-body practices help both mood and some heart disease risk factors
• Omega-3s reduce triglycerides and inflammation
• Plant sterols and fiber modestly reduce LDL cholesterol

What needs more research:

• Whether everyone with depression gets the same cardiovascular protection from treatment
• Optimal supplement doses for different people
• Best ways to lower Lp(a) (new therapies are in development)

Your Treatment Will Be Personalized

Every person is unique. Your treatment plan depends on:

• How severe your symptoms are
• Your cardiovascular risk factors
• Your family history
• What’s worked (or hasn’t) for you before
• Your personal values and preferences
• Practical factors like access, cost, and time

My goal is to work with you to create a plan that makes sense for your life and addresses your whole health—not just your mood or just your physical health, but both together.

Taking the Next Step

What This Means for You

If you’re reading this page, you might be:

• Struggling with depression or anxiety
• Worried about heart disease because it runs in your family
• Dealing with both mental health and heart health concerns
• Looking for a more comprehensive approach to your care
• Wondering if there’s a connection between how you feel emotionally and your physical health

The answer is yes—there’s a strong connection. And yes—we can address both together.

What You Should Know

Your mental health and physical health aren’t separate: Depression isn’t just in your head, and heart disease isn’t just physical. They’re connected through inflammation, stress hormones, nervous system function, and daily behaviors.

Treatment helps both: When we effectively treat depression and anxiety, we’re doing more than improving your mood—we’re potentially protecting your cardiovascular system.

You have options: Multiple evidence-based approaches exist, which means we can find what works for you. Some people do best with medication, some with therapy, many with a combination, and almost everyone benefits from lifestyle changes.

Small changes add up: You don’t have to do everything at once. Improving your mood, managing stress better, eating more vegetables, moving more—each of these helps both your mental health and your heart health. Together, they’re powerful.

Questions to Ask Your Provider

If you’re currently seeing a psychiatrist or therapist, consider asking:

• Has my cardiovascular risk been assessed beyond a basic cholesterol test?
• Should I have advanced testing given my family history and symptoms?
• Are there medications that might help both my mood and my heart?
• What lifestyle changes would make the biggest difference for my mental and physical health?
• Should we be monitoring specific markers during my treatment?

If You’re Looking for This Kind of Care

In my practice, I offer comprehensive integrative psychiatric care that addresses both mental health and cardiovascular wellness. This includes:

• Thorough assessment of both mental health symptoms and cardiovascular risk
• Advanced testing when appropriate
• Evidence-based psychiatric treatment (medication and therapy)
• Lifestyle medicine and nutritional counseling
• Coordination with other providers
• Ongoing monitoring and adjustment

I believe that the best psychiatric care means understanding and treating the whole person—not just your mood, but your entire health and wellbeing.

The Bottom Line

Here’s what you need to remember:

The connection is real and significant: Depression increases your heart attack risk by 28% and your risk of dying from heart disease by 44%. This is similar to the risk from smoking or high cholesterol.

It goes both ways: Depression increases heart disease risk, and heart disease makes depression worse. This creates a cycle that affects both conditions.

Treatment protects you: When we effectively treat depression and anxiety, we’re not just helping your mood—we’re potentially protecting your heart. Studies show 30-40% lower cardiovascular disease risk in people whose depression improves with treatment.

Standard tests miss important information: Basic cholesterol panels don’t measure things like Lp(a) (affects 1 in 5 people) or inflammation markers that are particularly relevant for people with depression.

Comprehensive care works better: Addressing both mental health and heart health together—through medication, therapy, lifestyle changes, and when appropriate, supplements—gives you the best chance of feeling better and staying healthy.

You have more control than you think: Small improvements in mood, stress management, nutrition, movement, and sleep create benefits that compound over time for both your mental health and your heart.

Major medical organizations agree: The American Heart Association and American College of Cardiology now recognize that mental health and heart health are inseparable. Their guidelines reflect this connection.

A Final Word From Dr. Lewis

If you’ve read this far, thank you. I know it’s a lot of information, but I hope it’s helped you understand something important: you don’t have to choose between treating your mental health and protecting your heart. They go together.

In my practice, I’ve seen too many people suffer unnecessarily because their care was fragmented—treating depression over here, heart disease over there, without anyone connecting the dots. When we bring these pieces together, real healing becomes possible.

If you’re struggling with depression or anxiety, especially if heart disease runs in your family, I encourage you to seek comprehensive care. You deserve a provider who sees you as a whole person and addresses all aspects of your health.

And if you’re already working with a mental health provider, don’t hesitate to bring up concerns about your cardiovascular health. These conversations matter.

Your mental health and your physical health are not separate—and your care shouldn’t be either.

With warmth and hope for your healing,

Dr. Bliss Lewis
Board-Certified Psychiatrist
Integrative Medicine Specialist

Ready to Take the Next Step?

If you’re interested in comprehensive psychiatric care that addresses both your mental health and cardiovascular wellness, I’d be happy to discuss whether my approach might be right for you.

Learn More

References & Further Reading

Everything on this page is based on peer-reviewed research and clinical guidelines from leading medical organizations, including:

• American Heart Association and American College of Cardiology clinical practice guidelines
• Research published in major medical journals like JAMA, The Lancet, Circulation, and the European Heart Journal
• Large-scale studies following hundreds of thousands of people over many years
• Randomized controlled trials (the gold standard for medical research)

Key studies referenced include:

• The EsDEPACS trial showing cardiovascular benefits of treating depression
• Multiple meta-analyses examining the relationship between mental health and heart disease
• American Heart Association scientific statements on psychological health and cardiovascular disease
• Research on inflammation as a common pathway between depression and heart disease

For detailed citations and links to specific studies, please see the individual blog posts linked throughout this page.

Learn More

Want to dive deeper into specific topics? Check out these related articles:

Understanding Your Risk:

• Why Your Psychiatrist Should Ask About Heart Disease
• How Chronic Stress Affects Your Heart
• Inflammation: What Links Depression and Heart Disease

Testing and Assessment:

• Beyond Basic Cholesterol Tests: What You Need to Know
• Lipoprotein(a): The Heart Risk Factor You’ve Never Heard Of
• What to Expect in a Comprehensive Cardiovascular Assessment

Treatments That Help Both:

• How Treating Depression Can Prevent Heart Disease
• SSRIs and Your Heart: Understanding the Benefits
• Why Therapy Is Good for Your Heart
• Using Mindfulness and Biofeedback for Heart Health

Creating Your Plan:

• Evidence-Based Supplements for Heart and Mental Health
• My Integrative Approach: Comprehensive Care for Heart and Mind

About This Page

This resource is designed to help you understand the important connection between mental health and heart health. Everything here is based on published research and clinical practice guidelines from leading medical organizations.

This information is educational and doesn’t replace individualized medical advice. Everyone’s situation is unique, and the best treatment plan for you depends on your specific health history, symptoms, and circumstances.

If you have concerns about your mental health or cardiovascular risk, I encourage you to discuss them with healthcare providers who can evaluate your individual situation.

If you’re interested in comprehensive integrative psychiatric care that addresses both mental and physical health, I’d be honored to work with you.