summer 2013

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Summer 2013
 

The Mind-Heart Connection: Stress and Heart Health

Duke Psychiatry-Internal Medicine Investigator: Wei Jiang, MD

Dr. Wei Jiang is a renowned expert here at Duke, in the Departments of Psychiatry and Behavioral Sciences and Medicine, on psychosocial risks for cardiovascular diseases. She directs the Neuropsychocardiology Laboratory research program, which explores the relationships between mental health and cardiovascular diseases.

Her research on the relationship between mental stress and heart health has resulted in several groundbreaking findings, demonstrating that 1) mental stress induced myocardial ischemia (MSIMI) is more common than once thought; 2) women and individuals who live alone are at increased risk of developing this condition; 3) MSIMI is a risk factor for increased adverse cardiovascular outcomes in patients with coronary artery disease; and 4) the use of a common antidepressant resulted in a lower rate of MSIMI among patients with coronary artery disease.

The most recent of these findings came from a study evaluating the effect of escitalopram on mental stress, published in the Journal of the American Medical Association (JAMA) on May 22, 2013. The study randomly assigned 127 patients to receive either placebo or the selective serotonin reuptake inhibitor escitalopram (Lexapro), an antidepressant that is also used to treat anxiety. At the end of 6 weeks, 34.2% of patients taking escitalopram had an absence of mental stress–induced myocardial ischemia during 3 mental stressor tasks (such as performing mental arithmetic) compared with 17.5% of patients taking placebo.

While this study demonstrates that medication reduces mental stress induced myocardial ischemia, Dr. Jiang does not recommend cardiologist medicate all of their patients without first considering behavioral modification. “The adverse interaction between the mind and the heart is complex and involves multiple system of the human body. I would suggest that patients with coronary heart disease get tested for mental stress–induced myocardial ischemia and, if they have it, engage in aerobic exercise and stress-reduction therapy and then be tested several months later. If they still have it, then the physician may consider medication. On the other hand, for patients who experience mental stress–induced myocardial ischemia and are unable to engage in behavioral intervention, medication may be considered as the first choice. ”

Translational research such as Dr. Jiang’s helps physicians understand the interaction between patient’s mental and physical health, ultimately improving patient care. “I am pleased that more and more non-psychiatric colleagues are beginning to recognize the significance of mental health on a patient’s overall physical wellbeing,” Dr. Jiang shares. “It is also rewarding to see an increasing number of patients benefit from mind-heart/body integrated care.”

Dr. Jiang’s research study on mental stress was covered by the JAMA Network in a press release and video, and was featured on WRAL TV, HealthDay, Live Science, Daily Rx, Cardiology Today, ABC News Radio, Medical Daily and Reuters Health.