Chapter 17.Heart Disease

Cardiovascular disease is the cause of death for one-third of American adults and the leading cause of death and disease burden in the developed world (Mozaffarian et al. 2016). Some patients experience sudden fatal illness; others have a chronic course with a marked impact on their life experience. The interface between psychiatry and cardiovascular disease includes both the effects of psychosocial factors on the cardiovascular system and the effects of cardiovascular disease on the brain, psychological function, and psychopathology. Many psychological states and traits have been identified as contributing to risk for the development or exacerbation of heart disease. Treatments for psychiatric disorders may also increase cardiovascular disease risk. Unhealthy behaviors (which can be associated with psychiatric illness), such as sedentary lifestyle, overeating, smoking, and heavy alcohol use, also add to the risk of heart disease, especially coronary disease. Conversely, heart disease seems to contribute to risk for numerous psychiatric problems, especially depression, anxiety, and cognitive disorders. Medications and other treatments for heart diseases often have psychiatric effects. Because heart disease is so common, psychiatrists must deal with the effects of cardiovascular comorbidity in the care of their patients, evaluating the role of medical factors in their mental health and recognizing the potential impact of psychiatric interventions on the cardiovascular system. Unfortunately, patients with serious mental disorders tend to receive insufficient screening and treatment for heart disease (Laursen et al. 2009).