Optimizing Emotional Health During COVID-19 & Beyond

When it comes to face-to-face (or teleconference) discussions with your physician/health care professional as it relates to risk factors for heart disease, it is likely that they will be centered on your smoking history, blood pressure, cholesterol and glucose levels.  Yet, it has been estimated that ~1 in every 4 cardiovascular events (heart attacks/strokes) is attributable to emotional stress.  So why has such minimal emphasis been placed on a less traditional risk factor that many of us believe should be centralized?  After all, emotional stress can raise all 4 traditional risk factors as well as a host of other factors implicated in cardiovascular risk (poor sleep habits, high triglycerides, inflammation, etc).

There are at least 3 reasons for the low prioritization of emotional stress as it relates to heart disease.  First, we are given limited instruction in medical school and therefore, unless a health professional is interested (and self-taught) in this area, emotional health is unlikely to be sufficiently incorporated in clinical practice.  Amazingly, even well-educated men and women don’t appreciate the relationship between chronic stress and heart disease.  Having given the lecture “Heal Your Heart” to many groups, including newly appointed Judges, the one consistent response has been a lack of awareness of this relationship.  In other words, if health professionals are insufficiently trained and unable to proactively address this issue, how can strategies be initiated to improve emotional health for our patients at increased cardiovascular risk?

Second, we have no point-of-care measure to effectively evaluate emotional stress, unlike measures available for cholesterol, glucose and other heart-risk biomarkers.  Identifying high blood pressure solely in the physician’s office (i.e, white coat hypertension) is not in itself a sensitive measure to gauge emotional health.  In fact, many of my patients with transient elevation in blood pressure readings at the office do not describe feeling overly stressed out on a regular basis.

Finally, major medical organizations have expended minimal effort in this arena…until now.  A long-awaited and newly published American Heart Association scientific statement that deals exclusively with mind-heart-body connections can be found here.   Please also check out our accompanying commentary entitled, “Stressing the Cardiovascular Implications of Mind-Body Heart Connections”.

The importance of this AHA scientific statement cannot be overstated.  First, they point out that anxiety, depression and work-related stress raises the risk of a cardiovascular event (or death) by 30-40%. By contrast, a growing body of evidence demonstrates that factors promoting emotional factors, such as optimism, sense of purpose, mindfulness and well-being may reduce risk by a near similar percent!  Taken together, emotional health should be incorporated in medical education and residency training as part of a comprehensive program aimed at optimizing heart disease prevention.

Wishing you positive emotional health and a Happy VD weekend!