Psychoneurimmunology researches the mind-body connections, including how the brain, immune and nervous systems influence each other.¹ One of the best-studied connections is how your emotions effect heart health and your heart attack risk. The impact is so profound that people can die from a broken heart when an emotionally devastating event occurs. There’s even a name for this: Tako-Tsubo Syndrome.² But it doesn’t have to be a major life event that damages your heart. Depression doubles the risk of a heart attack and increases your risk for dying from any cause.^3,4

More research is now recognizing stress as a modifiable risk factor for heart disease. And that’s important because in the U.S., one-quarter of all Americans suffer from an anxiety disorder at some point in their lives and cardiovascular diseases are the leading cause of death in the United States.^5,6

Unfortunately, both high stress and heart disease share symptoms—palpitations (feeling like your heart is beating too hard or fast, skipping a beat or fluttering), chest tightness, and shortness of breath. And the type of stress doesn’t seem to matter. Increased heart disease risk is associated with generalized anxiety disorder, phobias, post-traumatic stress disorder, and panic disorder.⁷ Possible mechanisms are emerging, from dysfunction of the autonomic nervous system that regulates heart rate, to molecules that may be involved in mediating anxiety such as adrenaline, serotonin, and inflammation.^8,9,10,11

Most importantly, over time these processes damage blood vessels and are associated with increased risk for coronary heart disease (CHD), high blood pressure, stroke and death. Men with the highest level for anxiety caused by phobias have a 377% increased risk for fatal heart attacks compared with men without anxiety.¹² But even less severe types of anxiety increase risk. Other studies have confirmed the increased risk for heart attacks in both men and women, even when the anxiety is less severe.^13,14

While the American Heart Association (AHA) guidelines don’t yet recognize anxiety as a risk for heart disease, European guidelines acknowledge anxiety as an independent risk for heart attacks, strokes, and angina (chest pain caused by blockages in coronary arteries).¹⁵

Anxiety Increases Heart Disease Risk

When you’re anxious, your heart races and blood pressure goes up. This puts an extra strain on your heart. Even temporary anxiety increases blood pressure. This was recognized as far back as the 1980s when researchers monitored 90 individuals with borderline hypertension (higher than 120/80). Blood pressure was monitored for 24 hours and was higher during both angry and anxious states; the greater the emotional intensity, the larger the blood pressure swing.¹⁶

A 2010 review of twenty studies found that individuals who were otherwise healthy but suffered from high anxiety had an increased risk for severe coronary artery blockages or heart attacks.¹⁷ And another study of over 49,000 young Swedish men entering the military who were then followed for more than 37-years found that any diagnosed anxiety disorder was associated with a 217% increase in coronary heart disease and 251% increased risk for heart attacks.¹⁸

Anxiety can also worsen pre-existing cardiovascular disease. Imaging studies revealed that blood flow to the heart is temporarily reduced in up to 70% of patients with pre-existing heart disease who experience psychological stress, and over time this is associated with a higher risk of dying.¹⁹ A blend of anxiety and depression in response to stressful life events or childhood trauma has been linked to increased arterial stiffness, which is a risk factor for hypertension and cardiovascular disease.²⁰

Panic disorder (a disorder marked by panic attacks, feelings of terror when there is no real danger) is associated with changes in heart structure and function—10% of sufferers have arrhythmia, and overall have lower exercise tolerance and oxygen consumption than those without the condition.²¹ Panic attacks have been linked to heart disease. One review of the Women’s Health Initiative Observational Study, which looked at 3,369 postmenopausal women for an average of about five years, found that a recent history of full-blown panic attacks was linked to a nearly four-fold increased risk of heart attacks.²²

Anxiety and Obesity

Anxiety can derail a healthy lifestyle, leading to overeating, excess alcohol consumption, a poor diet full of unhealthy comfort foods and sweets, as well as lower amounts of exercise. The result, not surprisingly, can be excess weight, which compounds a person’s health risks. It’s a given that weight is a risk factor for cardiovascular disease.²³ And as is becoming apparent, anxiety may be a factor as well. But the two together create a double whammy.

Both anxiety and obesity release inflammatory molecules, creating a harmful feedback loop. Chronic anxiety may stimulate the sympathetic, fight-or-flight nervous system response, with its flood of stress hormones like norepinephrine or cortisol.²⁴ One study of nearly 850 Greek men and women found that higher anxiety scores correlated with higher levels of molecules that cause inflammation, such as C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin-6 (IL6), homocysteine, and fibrinogen, which is a protein that makes the blood stickier and can promote unhealthy blood clotting.

But obesity on its own can also contribute to increased inflammation. Excess fat releases similar inflammatory chemicals such as TNF and IL6.²⁵ Thus, inflammation causes, and is caused by, obesity and anxiety and underlies aspects of cardiovascular disease such as coagulation (sticky blood) and hardening of the arteries (atherosclerosis).

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