Younger women are generally thought to have a low risk of heart disease, but new research is urging clinicians to reconsider that assumption, especially for women who suffer from certain mental illnesses. A new study presented at the American College of Cardiology’s annual scientific session found that the presence of anxiety or depression can accelerate the development of cardiovascular risk factors among young and middle-aged women.
The study draws new attention to the importance of cardiovascular screening and preventive care as levels of cardiovascular risk factors rise and heart attacks become more common in younger people. Anxiety and depression have also become more prevalent in recent years, especially since the COVID-19 pandemic.
Researchers report that younger women with anxiety or depression were nearly twice as likely to develop high blood pressure, high cholesterol or diabetes over a 10-year period compared to women who did not have these mental illnesses, putting them almost on par with men of the same age in terms of heart disease risk.
We often think of young women as the “safe group” in terms of cardiovascular disease because the incidence of cardiovascular disease is quite low due to the protective effects of estrogen in this group. But this study suggests that if a younger woman has depression or anxiety, we should start screening for cardiovascular risk factors to reduce the incidence of cardiovascular disease.
Giovanni Chivieri, MD, cardiologist, research fellow at Massachusetts General Hospital and Harvard Medical School, PhD candidate at the University of Padua in Italy, and lead author of the study
Researchers analyzed health records of 71,214 people participating in the Mass General Brigham Biobank, a research program of the Mass General Brigham Health System. People who had heart disease or who were diagnosed with anxiety or depression after the start of the study were excluded.
During the 10-year follow-up period, 38% of participants developed high blood pressure, high cholesterol, and/or diabetes. According to the analysis, those with a history of anxiety or depression before the study period were about 55% more likely to develop one or more of these risk factors than people without anxiety or depression. This finding was most pronounced among women under the age of 50 with anxiety or depression, who were almost twice as likely to develop cardiovascular risk factors as any other group.
In terms of absolute risk, young women generally showed the lowest levels of cardiovascular risk factors of any group, which is expected based on findings from previous studies and what is known about the protective effects of estrogen in premenopausal women . However, anxiety and depression were associated with a much higher relative risk among young women than observed in other groups.
“Once a young woman has depression or anxiety, her absolute risk is comparable to that of a young man,” Civieri said. “There is something of a catch-up phenomenon where depression and anxiety increase the risk that would otherwise be very low.”
To explore the potential drivers behind this link, the researchers examined the metabolic activity of stress-related brain regions in a subset of participants who underwent brain scans. The results showed that younger women with anxiety or depression showed relatively large increases in stress-related neural activity.
“The question is: Why are anxiety and depression associated with increased risk among younger women? That’s something we continue to study,” Civieri said.
Although anxiety and depression are separate conditions, they were grouped together in the study because both are associated with increased cardiovascular risk and share common neurobiological pathways, meaning they are thought to affect health in similar ways.
It is not known whether mental health treatments, such as antidepressants or psychotherapy, can help reduce cardiovascular risk, the researchers said. However, once a person has high blood pressure, high cholesterol or diabetes, Sivieri said well-established treatments such as statins and blood pressure-lowering drugs can effectively reduce the risk of serious heart events.
source:
American College of Cardiology
