Ischemic Heart Disease, a condition where the heart muscle is deprived of oxygen, commonly as a result of coronary artery disease, remains the number one cause of death in the Philippines. Coronary artery disease is characterized by the buildup of plaques, also known as atherosclerosis, in the blood vessels or arteries. Thus, it restricts blood flow and proper oxygenation of the heart muscle. The reduction in oxygen supply to the heart leads to chest pain or angina, or worse, a heart attack.

Cardiovascular disease, or the disease affecting the heart and blood vessels, includes high blood pressure or hypertension, coronary artery disease or blocked arteries, cerebrovascular disease or stroke, peripheral arterial disease affecting the limbs, arrhythmia or abnormal heart rhythm, cardiomyopathy or thickened heart muscle, congenital heart disease, rheumatic heart disease, and heart failure.

While diet and exercise both play a huge role in promoting heart health and managing cardiovascular conditions, let us explore the other factors that can significantly make the heart healthier, combined with a wholesome, minimally processed, and plant-predominant diet, regular physical activity, quality sleep, and avoidance of smoking and other harmful substances.

“As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not in a negative way to cardiovascular disease but also in a positive way to better cardiovascular health and reduced cardiovascular risk,” said Glenn N. Levin, MD, FAHA and colleagues in a scientific statement from the American Heart Association on the “Psychological Health, Well-Being, and the Mind-Heart-Body Connection” published on Jan. 25, 2021.

In the scientific statement of the American Heart Association, they have emphasized that there are clear associations between cardiovascular disease, including its risk, and psychological health. This may be due to the increasing evidence of psychological health being linked to biological processes in the body and behaviors that possibly contribute to the development and cause of cardiovascular diseases. Therefore, interventions to improve psychological health can have significant benefits on cardiovascular health.

Studies have shown that negative psychological factors, personality traits, and mental health disorders could affect cardiovascular health. Some of these negative emotions and states include chronic stress and social stressors, anger and hostility, anxiety, depression, and pessimism. On the other hand, positive psychological health factors related to reduced risk of cardiovascular disease include optimism, sense of purpose, happiness and positive affect, mindfulness, gratitude, resilience, overall psychological wellbeing, and emotional vitality or having a sense of positive energy and the capacity to effectively regulate emotions.

What happens inside the body when we have negative psychological health? How does psychological health affect the heart and blood vessels?

Research has shown that anger and hostility can increase platelet aggregation and inflammation. When blood platelets or thrombocytes clump together, it can potentially cause blood clots. Other forms of psychological distress can cause dysregulation or imbalance in the autonomic nervous system that may increase the risk of the development of cardiovascular disease. Other factors can be affected by chronic psychological stress, too. These are increased blood glucose, increased cholesterol, increased triglycerides, increased inflammatory processes, and a compromised immune system.

Positive psychological factors that include the ability to effectively regulate emotions are linked to healthier biological responses to stress, better heart rate and heart rate variability, and greater vagal tone.

On Sept. 21, 2023, Xiaoxiao Wang and Chunli Song published a systematic review on the impact of gratitude interventions on patients with cardiovascular disease. Their research concluded that gratitude therapy aids in preventing the occurrence and development of cardiovascular diseases by reducing levels of inflammatory markers such as C-reactive protein, decreasing heart rate and diastolic blood pressure, as well as decreasing the production of the stress hormone cortisol.

A study was conducted by Paul J Mills, PhD, and colleagues on the role of gratitude in spiritual well-being in asymptomatic heart failure patients in 2015. Over 186 men and women diagnosed with asymptomatic heart failure were involved in the study.

“We found that more gratitude in these patients was associated with better mood, better sleep, less fatigue, and lower levels of inflammatory biomarkers related to cardiac health,” said Mills.

Furthermore, their research showed that those patients who wrote gratitude journals for eight weeks showed reduced levels of inflammatory markers related to cardiovascular health and improved heart rate variability, which is a measure of risk for cardiovascular disease.

“We found that spiritual well-being was associated with better mood and sleep, but it was the gratitude aspect of spirituality that accounted for those effects, not spirituality per se,” said Mills. He also mentioned that gratitude journaling is an easy way to support heart health.

If you wish to have a healthier heart, consider psychological and spiritual factors in addition to a healthy way of eating and being physically active.