We’ve all heard the expression, “It almost gave me a heart attack!” in response to shocking or frightening news. It turns out that this idiom has some scientific backing: Research has definitively shown that extreme negative emotions can be linked to a higher risk of heart disease.

Consider broken-heart syndrome (also called stress or Takotsubo cardiomyopathy), in which a person experiences symptoms that are indistinguishable from those of a heart attack in direct response to stress, grief, anger, or even surprise.

It doesn’t even take a dramatic event to influence heart health. Chronic low-level stress, personality traits like pessimism, and even depression are all linked to poorer heart health.

Fortunately, the opposite is true as well: Positive psychological states appear to be heart protective. The link is so strong that the American Heart Association (AHA) released a statement, “Psychological Health, Well-Being, and the Mind-Heart-Body Connection,” that summarizes the current body of scientific knowledge.

Negative emotions and CVD

According to the AHA’s statement, studies have shown that the risk of cardiovascular disease (CVD) rises from post-traumatic stress disorder (60 percent), social isolation and loneliness (50 percent), work-related stress (40 percent, and high perceived stress (27 percent). That’s not all.

Anger and hostility are associated with higher blood pressure, elevated heart rate, and higher rates of heart attack, stroke, and ventricular arrhythmia, according to studies in the European Heart Journal and the Journal of the American College of Cardiology.

Anxiety appears to be a risk factor for high blood pressure, obesity, and the tendency to smoke, all of which contribute to arterial disease. A study with more than 2 million people that was published in the American Journal of Cardiology found that anxiety was associated with a higher risk of stroke, heart failure, and CVD-­related death. Depression increases the risk of developing and dying of CVD. It’s also associated with a higher risk of heart attack, stroke, and mortality in patients with existing CVD.

Even your personality can affect your heart. Pessimism is a personality trait in which people expect negative outcomes. In an 11-year prospective cohort study, it was found to be a significant predictor of coronary heart disease (CHD) mortality, researchers report in BMC Public Health. (CHD, or clogged arteries, is a type of CVD.) The most pessimistic people had double the risk of the least pessimistic.

Positive psychology

As alarming as these relationships are, research also shows that positive psychological states are heart healthy.

Optimistic people, defined as those who anticipate the best possible outcomes, have lower rates of stroke, CVD, and heart failure. Even people with existing disease benefit from a positive outlook. A study published in Psychosomatic Medicine found that women who were more optimistic had slower progression of the buildup of fatty plaques (atherosclerosis) in their carotid arteries. Another study found that higher optimism was associated with decreased risk of hospital cardiac readmission among people with established CVD.

Having a sense of purpose is associated with better cardiovascular health and a 17 percent lower risk of CVD events, such as heart attack and stroke, according to a study published in 2016. It’s linked to a longer life, too. Happiness, also called positive affect, was associated with a 22 percent lower risk of incident CHD (such as heart attack, a cardiac revascularization procedure, or death), in a study published in Australasian Psychiatry.

Gratitude has been associated with better medication adherence, blood pressure, sleep, inflammatory biomarkers, and heart-rate variability (the variation in time between each heartbeat), according to small clinical trials. And people who practice mindfulness—a nonjudgmental awareness of one’s thoughts, emotions, and actions—tend to have less stress, higher levels of well-being, and a heart-healthier lifestyle that includes being a nonsmoker, being free of diabetes, and having healthy blood pressure, cholesterol, and body mass index.

Intervention effects

While we can’t always control the stress we may experience—or the personality traits we’re born with—research suggests that we may be able to improve our emotional and cardiovascular responses.

Antidepressants. Some, but not all, studies have found that antidepressant medications are associated with lower rates of heart attack and cardiovascular mortality. The Escitalopram for Depression in Acute Coronary Syndrome trial found that people who took escitalopram (Lexapro) had lower rates of major adverse cardiac events. Other trials have shown that the most common type of antidepressants, selective serotonin reuptake inhibitors (SSRIs), improve heart rate variability and mental stress-induced myocardial ischemia (reduced blood flow to the heart as a result of a partial or complete blockage of the coronary arteries). SSRIs have been linked to improvements in inflammatory markers that are associated with improved cardiovascular prognosis.

Psychotherapy. Some programs using psychotherapy or stress management training have improved cardiovascular outcomes in high-risk patients. One trial published in Circulation found that adding stress management training to cardiac rehabilitation led to lower rates of major adverse cardiac events, while another found that group-based relaxation and coping skills training improved mortality rates. Yet another study, in Archives of Internal Medicine, showed that people who received group-based cognitive behavioral therapy for one year had a 41 percent lower rate of fatal and nonfatal first heart attacks and strokes. But other studies found no benefits.

Positive psychology–based programs that use activities to improve psychological attributes and experiences have been linked to better cardiac outcomes. These programs appear to improve physical activity in patients with or at high risk for heart disease—which lowers risk. However, beneficial effects on cardiac biomarkers have been more limited. Some small studies have found reductions in markers of inflammation in patients with heart failure or coronary artery disease, but minimal effects on other markers.

Meditation. Some studies have found that meditation can decrease perceived stress, anxiety, and depression; increase smoking cessation rates; lower systolic and diastolic blood pressures, and decrease nonfatal heart attacks, cardiovascular mortality, and all-cause mortality. While more studies are needed, meditation is a low-cost, low-risk intervention that is worth trying.

Stress reduction. Lowering your stress is good for both body and mind. For some people, that could mean exercising and socializing more, sleeping well, and finding hobbies that distract you from negative thoughts. For others, it could mean retiring from a high-stress job or walking away from avoidable stresses. Something as simple as going for a walk to get a little exercise and clear your mind can help boost your mood, lower your stress, and give your heart a little protection.

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