Could how we feel about life affect our heart health?

Heart disease is mostly treated as being about numbers, like blood pressure, cholesterol, and blood sugar. But maybe there’s an important dimension we’ve been missing.

A recent American study suggested that could be the case.

It used data from a sample of 312 women — black and white — from Chicago and Pittsburgh. Their average age was almost 51, so most probably weren’t post-menopausal, when low estrogen levels raise the risk of heart disease.

The researchers were investigating whether heart disease might be linked to mental, emotional, and social well-being.

To assess these, they gave the women questionnaires that measured six areas:

• Optimism
• Life engagement (i.e. sense of purpose)
• Vitality (energy)
• Life satisfaction
• Sense of reward from multiple roles (e.g. spouse, parent, employee, caregiver), and
• Positive affect (scoring on a list of 10 positive feelings such as enthusiasm, interest, pride, and determination).

The results were combined, giving each woman a composite ‘well-being score’.

Heart disease was monitored for just over two years using coronary artery calcium (CAC) scores.

The two main coronary arteries provide the heart’s own blood supply. If they block up, the heart’s in trouble. CAC is a measure of how blocked they are.

Calcium is usually associated with bones and teeth, but as we get older it can find its way into soft tissues, such as the walls of damaged arteries.

Plaque builds up where the damage occurs, then calcium is laid down in the fibrous cap that forms over the plaque.

CT scans can detect how much of this hardened plaque is in the coronary arteries.

CAC scoring starts at zero, which indicates no disease, 1-99 is mild, and even up to 399 is considered moderate. Above 400 is severe.

It’s estimated that after age 70, 90 percent of men and almost 70 percent of women will have some level of CAC.

Although none of the women in this study had been diagnosed with cardiovascular disease, 43 percent had some CAC. Over the study period, it increased in 17.6 percent of them — mostly in women who already had some calcification, but also in 5 percent of those who initially had a score of zero.

While we might expect more heart disease to show up as women move through menopause and lose their estrogen protection, the results didn’t show a correlation between menopausal status and CAC.

But they did show a correlation between well-being scores and CAC.

Bear in mind this just means there was a relationship between higher well-being scores and less calcification (and progression of it), and vice-versa. It doesn’t provide proof that well-being affects calcification.

What lends it some weight though is that it comes on top of a mounting pile of evidence linking mental and emotional well-being with heart health.

Many studies have shown a link between stress and heart disease. They haven’t all used CAC as a measurement because heart disease can show up in various ways. For example, tightness and spasm in the smaller arteries is often more typical in women.

We’ve seen that stress, anxiety, and depression can make arteries stiffer, narrower, and more inflamed, increasing blood pressure.

Of course, it’s also probable that stress affects lifestyle, so for example, we might eat poorly, sleep badly, and not exercise, then these behaviours affect our heart and arteries.

This study though looked at the flipside — that positive thoughts and feelings might have a protective effect.

Previous research has shown that some behaviours (e.g. meditation, sex, and thinking joyful or hopeful thoughts) can trigger the production of nitric oxide in the lining of the arteries. This relaxes and opens them, allowing blood to flow more freely.

Last year I also wrote about the work of Yale psychology professor Becca Levy, whose work shows that people with a positive attitude towards ageing live on average seven years longer than those with negative view.

All of which might suggest that we need to think more broadly about heart disease, at least in women.

Perhaps there’s merit in occasionally checking in on the mind side of our health, rather than just dealing in numbers, given that thoughts and feelings have been shown to have a physical impact.

Interestingly, the American Heart Association seems to be thinking along those lines too. In 2021 that body issued a statement noting that while they hadn’t always focused on the patient as a whole,

“…there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease but also in a positive way to better cardiovascular health and reduced cardiovascular risk.”

While some cardiologists are onto this, hell might freeze over before they all are.

But we can take this into our own hands and recognise that our mental, emotional, and social health are probably just as vital as diet and exercise are to managing our health — whether we’re talking about heart disease or any other chronic condition.

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