While mental health and heart health are often treated as separate issues, the two may be more closely linked than many people realize.
A review published in JAMA Psychiatry that drew data from more than 22 million people across 25 studies found that several mental health conditions were associated with higher rates of acute coronary syndrome (ACS) over time.
The elevated risk was observed across the board. Compared with people without mental health conditions, those with depressive disorders had about a 40 percent higher rate of ACS. For anxiety disorders, the increase was 63 percent. Sleep disorders raised the risk by roughly 60 percent. For post-traumatic stress disorder, the figure climbed to 173 percent.
Bipolar disorder and psychotic disorders such as schizophrenia did not reach statistical significance. The authors suggest this may be due to study design and analytic issues rather than a lack of risk.
Clinicians recognize the strong link between mental and cardiovascular health, Dr. Nissa Keyashian, a board-certified psychiatrist, told The Epoch Times. “If a patient has heart disease as well as a mental health disorder, their heart outcomes are better if you treat the mental health disorder than if you don’t,” she said.
What Sleep Has to Do With ACS
Post-traumatic stress disorder (PTSD) and sleep disorders showed the strongest associations with ACS, even after accounting for traditional heart risk factors such as high blood pressure, diabetes, and cholesterol. The authors suggest that sleep disturbances may be a key, and largely overlooked, driver of cardiovascular risk seen in PTSD and sleep disorders.
Cardiovascular risk management typically focuses on lifestyle changes and control of conditions such as diabetes and hypertension, Dr. Arnav Gupta, a medical resident and researcher in the Department of Medicine at the University of Calgary and the study’s corresponding author, said. The findings, he said, highlight the need for formal studies examining sleep problems in people with mental health disorders and considering sleep as a potential target for risk assessment and intervention.
Poor sleep can keep the body’s stress response switched on, raising cortisol levels, heart rate, and blood pressure. Over time, this can disrupt blood sugar control, increase cellular stress, and damage blood vessels—changes that promote plaque buildup, reduce blood flow, and raise the risk of heart disease. In people with PTSD, sleep disturbances may worsen psychiatric symptoms and accelerate metabolic and vascular changes simultaneously, further amplifying cardiovascular risk.
Mental Illness Can Magnify Traditional Heart Risks
Sleep is not the only pathway.
Traditional cardiovascular risk factors affect people with mental health conditions more severely than the general population.
Nearly one in three people with psychiatric disorders has undiagnosed hypertension, and Type 2 diabetes is also common. People with schizophrenia are three to five times more likely to have obesity, Type 2 diabetes, and high cholesterol.
Some people with mental disorders may also have stronger stress responses even in ordinary, non-threatening situations, adding further chronic strain on the heart.
Lifestyle factors also play a large role. People living with mental health conditions are more likely to struggle with unhealthy habits, such as poor diet, physical inactivity, inadequate sleep, excessive alcohol use, smoking, and substance misuse. Some psychotropic medications—particularly certain antipsychotics—can raise cardiovascular risk over time through effects such as weight gain, elevated blood sugar and cholesterol, and, in rare cases, heart rhythm disturbances.
“If done recklessly or without expert guidance and monitoring, treatment can result in an increased risk of a cardiovascular event many years down the road,” Dr. Cooper Stone, a clinical assistant professor of psychiatry and behavioral science at the Perelman School of Medicine at the University of Pennsylvania, told The Epoch Times. However, he noted that while it can be a double-edged sword, the benefits often outweigh the risks.
When Mental and Physical Symptoms Blur
While the link between physical and mental health is clear, the two are still often treated separately in clinical care.
Part of the problem is perceptual. Chest tightness, stomach pain, and fatigue are frequently attributed to anxiety or stress—when they may signal something more serious. In a 2018 study of almost 3,000 young adults hospitalized for acute myocardial infarction, many participants said they initially interpreted their symptoms as indigestion, acid reflux, or stress and anxiety rather than a cardiac event.
Stigma can compound the problem. People with mental health conditions may hesitate to seek care or downplay symptoms out of concern they won’t be taken seriously. A recent ethnographic study in emergency departments found that some patients delayed care because they anticipated their symptoms would be dismissed or that they would be treated differently.
Clinicians can face similar challenges. Physical symptoms are sometimes misattributed to a patient’s mental health condition—a phenomenon known as diagnostic overshadowing—rather than fully evaluated as possible signs of physical illness, leading to diagnostic delays or errors.
In a 2024 case report, a 34-year-old woman presented with chest pain that was initially attributed to anxiety, but was later found to have Takayasu’s arteritis, which causes coronary stenosis and myocardial ischemia, narrowing the coronary arteries and reducing blood flow to the heart.
Experts say the findings are a reminder that mental health is not separate from physical health, and that treating one while ignoring the other can leave important risks unaddressed.
For Gupta, the findings are a reminder that mental and physical health are not separate but deeply interconnected. “Rather than being feared, they should be seen as an opportunity, by the physician and patient, to optimize one’s health even further.”