Doctor’s Office Stress Test Could Gauge Your Heart Risk

Evaluating a person’s psychological stress can be a good way to gauge their risk of heart and blood vessel disease, new research suggests.

And a brief questionnaire could help with the assessment, the study findings showed.

“Our study is part of the accumulating evidence that psychological distress is a really important factor in a cardiovascular diagnosis, such as the other health behaviors and risk factors, like physical activity and cholesterol levels, that clinicians monitor,” said co-author Emily Gathright. She is an assistant professor of psychiatry and human behavior at Brown University’s Warren Alpert Medical School, in Providence, R.I.

For the study, the team looked at research published within the past five years that included adults without a psychiatric diagnosis who were screened for depression, anxiety, post-traumatic stress disorder, stress or general mental health symptoms, and followed for more than six months. About 58% were women.

In all, Gathright and her colleagues analyzed findings from 28 studies that included more than 658,000 patients. Those reporting high levels of psychological distress had a 28% higher risk of heart disease, the investigators found.

According to study co-author Carly Goldstein, an assistant professor of psychiatry and human behavior, a brief mental health questionnaire can give clinicians a better idea not only of a patient’s mental health risks, but also their associated risk for heart disease.

Based on the results of the questionnaire, the clinician can immediately advise the patient about how improving their mental health can help them improve their heart health, she added.

“This analysis shows that a patient’s psychological distress is directly associated with their cardiovascular risk, providing opportunities for clinicians to help a patient manage their risks over time, for better overall health, right at the point of care,” Goldstein said in a Brown University news release.

Before the study it was not known whether a brief mental health screening would help predict heart disease risk, she noted.

Most research examining links between psychological health and heart disease has focused on people who have already been diagnosed, said study co-author Allison Gaffey, a clinical psychologist at Yale School of Medicine in New Haven, Conn., who completed her predoctoral internship at Brown’s medical school.

“Certainly we know that psychological health is important within the scope of managing care,” Gaffey said.

The screeners used in the studies were brief and well-known, and could be administered with confidence by any clinical provider, she noted.

“We believe that using these brief screeners, whether in a hospital or a community health care setting, provides feedback that is helpful in understanding risk for cardiovascular disease in a very multidimensional way compared to only using more standard assessments like blood pressure or cholesterol levels,” Gaffey said.

Even without meeting criteria for high psychological distress, patients exhibiting any distress may still benefit from additional support to help prevent heart disease, she added.

The researchers noted that while updated American Heart Association guidelines added “healthy sleep” as an essential aspect of good heart health, they did not include “managing stress and mental health.”

That checklist should be expanded to include good mental health, the team suggested.

Depression was the most common aspect of psychological distress gauged in the studies analyzed, Goldstein said, indicating that screening should also attempt to gauge anxiety.

“I would encourage all providers, cardiovascular and specialty providers as well as primary care providers, to do some kind of brief screening for psychological distress to assess cardiovascular risk,” she advised. “And I would argue that every provider’s office can make brief recommendations to patients who warrant them, which may be as simple as pointing towards free, publicly available mental health resources.”

Mental health support recommendations can also make a difference in the patient’s overall health, Goldstein said.

The findings were published Nov. 7 in the Journal of Cardiopulmonary Rehabilitation and Prevention.

More information

The World Health Organization has more on heart and blood vessel disease.

SOURCE: Brown University, news release, Nov. 7, 2022