Mental health conditions including depression, anxiety, posttraumatic stress disorder, and sleep disorders were associated with a higher risk of acute coronary syndrome, according to a systematic review and meta-analysis published online in JAMA Psychiatry.
The analysis included 25 studies with over 22 million participants and examined incident acute coronary syndrome (ACS) outcomes, including acute myocardial infarction (AMI) and unstable angina, among patients with Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) diagnosed mental disorders prior to the cardiac event. Across pooled analyses, posttraumatic stress disorder (PTSD) for AMI and sleep disorders for ACS showed the largest relative associations, while evidence for bipolar and psychotic disorders was less clear.
In pooled analyses, depressive disorder was associated with 1.4 times the risk, anxiety disorders with 1.63 times the risk, and sleep disorders with 1.6 times the risk of ACS. PTSD was associated with 2.73 times the risk of AMI and was graded as moderate certainty using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, compared with low or very low certainty for most other disorder categories. Substance use disorders were also associated with 2.41 times the odds of AMI, although certainty was rated very low.
By contrast, pooled estimates for bipolar disorder and psychotic disorders did not reach statistical significance in the available studies, although the researchers noted that limited data and heterogeneity constrained interpretation. The review found substantial heterogeneity across analyses and highlighted variable adjustment for cardiovascular risk factors, behaviors, and medications across primary studies.
The researchers discussed multiple pathways that may link mental disorders to ACS, including higher prevalence of traditional vascular risk factors, inflammatory and oxidative stress processes, and disorder-related health behaviors. They also highlighted sleep disturbance as a potential contributor, particularly in PTSD and sleep disorders, writing that "PTSD and sleep disorders emerged as significant risk factors for ACS, indicating the potential impact of sleep quality on cardiovascular outcomes."
In their conclusion, the researchers wrote that they "found depressive, anxiety, traumatic, and sleeping disorders to be associated with an increased incidence of ACS," and noted that integrating mental health screening and management into cardiovascular care may help improve outcomes. They noted, however, that the evidence base remains limited by heterogeneity and potential bias in underlying observational studies.
Disclosures can be found in the study.
Source: JAMA Psychiatry