Emotions & Heart Disease

Heartache, emotional or physical, is usually something to be avoided. Which one’s worse? They’re both really unpleasant and unsettling. It may seem like a grim overestimation, but we likely know someone who’s died from cardiovascular disease. The unfortunate truth is that it’s responsible for nearly 24% of all deaths each year in the United States. (Straub, 2017).

Whether someone loses a loved one or is traumatized from a horrible life event, both leave their mark by changing our brain chemistry. According to the Institute of HeartMath, their research explains how “the heart responds to emotional and mental reactions and why certain emotions stress the body and drain our energy. As we experience feelings like anger, frustration, anxiety and insecurity, our heart rhythm patterns become more erratic.” What’s interesting is how individuals react to emotional heartache and physical heartache. Further, HeartMath’s studies delineate a crucial link between the heart and brain. “The heart is in a constant two-way dialogue with the brain — our emotions change the signals the brain sends to the heart and the heart responds in complex ways. However, we now know that the heart sends more information to the brain than the brain sends to the heart.”

Our moment-to-moment bio-psychosocial response may play a more central role than just our genetics, in other words, our responses create a chain reaction that physiologically upregulates or deregulates us invariably. (2006)

Many of us have been lead to believe that our genetics are solely to blame. Certainly genetics play a role, however, psychosocial factors, such as low socioeconomic status, racial discrimination, and personality traits, also affect one’s vulnerability for hypertension, high cholesterol, obesity and other co-morbidities of cardiovascular diseases. (Straub, 2017). 

As our societies are modernizing, or westernizing, they’re also becoming increasingly prone to “Diabesity”; a callous umbrella term, including: obesity, insulin resistance, metabolic syndrome, and diabetes. This escalating health crisis is not only an issue in the United States, but it is an American export that is increasingly becoming a problem worldwide. As more and more people are being treated for diabesity, outcomes are not improving, they’re actually failing miserably. So perhaps, it’s time to take a different approach. Over the last twenty years, research through health psychology, behavioral medicine, social scientists and biological influences have found compelling information that links our emotions, our mindset and our sense of self-efficacy to lower adverse cardiac outcomes. With twenty years of findings, how is it that diabesity is still the leading cause of chronic disease and death, aside from the recent coronavirus? Perhaps, we have underestimated how difficult it is to change one’s mind, feelings, beliefs, behaviors and the decrepit systems of privilege, power and profit ingrained in our industry and society, which perpetuate this problem. (Chauhan, 2012)

Research by Tuck et al (2016) shows that “expressing positive emotions may predict cardiac risk via several pathways. Positive expressions are thought to have evolved to signal a willingness to interact and co-operate, potentially increasing social resources and/or reducing the risk of loneliness and isolation, both established CVD risk factors.” It appears that an optimistic mindset and ability to express emotions may be a crucial protective factor in heart disease, which is great. I’m all for some positive psychology, but on heavy days like today where the news is spinning from yet another shooting massacre that took the lives of women from the asian community, it’s difficult to accept and act with an optimistic mindset. That is the crux, the achilles heel, the kryptonite that is killing our souls and our bodies. It is incongruous to respond optimistically to deeply distressing events, layered on top of many other chronic stressful events. This is where the bad comes in: anger, fear, hostility, high blood pressure, sedentary lifestyles, over-eating, mindless eating, smoking, toxic drug use – toxic everything. People’s actions are a reflection of what is happening around us.

From a self-evaluation standpoint, my heart rate has exceeded over 100 bpm several times as I’m writing this. As a multi-racial Filipina woman, who recently had to move my family, sell our house, and go to court, all in response to ethnic harassment and terroristic threats, the recent shooting is extremely emotionally triggering. I may be going off on a tangent here, but it will be very interesting to see how heart health for Asian Americans is looking in a few years with the 150% increase in hate crimes against this population. Actually, any group that has been socially constructed as a “minority” group, especially African Americans in the wake of the Breonna Taylor, George Floyd, Ahmaud Arbery modern day lynchings, and countless other lives lost; should really receive all the interventions and help if we want to enact positive change. 

Observing the psychophysiological reactivity model (Straub, 2017), it is evident that stress, hostility, depression, and anger act slowly over a period of years to damage the arteries and heart. Researchers have studied hostile people, of different genders and backgrounds, who were harassed while trying to perform a difficult mental task. What was found was an unusually strong activation of the fight-or-flight response in the form of larger increases of blood pressure, greater outpourings of epinephrine, cortisol and impaired functioning in the endothelial cells, which leads to atherosclerotic lesions, and eventually heart disease. Also damaging are individual’s tendencies to ruminate and dwell on anger-provoking events. According to Jokela et al (2014) “Over time, recurring activation of these systems may enhance development of cardiovascular risk factors such as the progression of atherosclerosis, metabolic syndrome, decreased heart rate variability, and inflammatory markers, all of which are known to contribute to cardiovascular disease mortality.”

Not only are people reliving these moments over and over, our brains and bodies don’t know the difference and they’re eliciting the same unhealthful chemicals every time anger-inducing events come to mind. This reoccurrence puts people’s mental health and physical health at risk for developing anxiety, depression, complicated grief, trauma, many other mental disorders and maladaptive habits, which are also usually drivers for heart disease. (Straub, 2017)

Research from Galea et al (2018), advocates for more of an intersection of disciplines to tackle the drivers of heart disease, which would “focus on the contributions of low education, poverty, and spatial racial residential segregation as the causes of health and disease.” The co-morbidities of racism; the system failures of income inequality, education inequality, red-lining in the housing industry, and the criminal justice system, are the architecture which produces emotional heartache, drives depression, and many other maladaptive coping patterns. Galea et al, (2018) further states, “Efforts to improve [population health] are as much “medicine” as are the drugs that act on the molecular mechanisms of disease. That we as a society invest so much more in medical approaches and cures than in the causes of poor health suggests that we are not doing as well as we should be at making all the causes of health visible.” In other words, reducing or eradicating the environments that breed inequality, poverty, and racism, would likely be the best medicine, instead of the stop-gap, money-making, pill-pushing by pharmaceutical marketing campaigns. Unfortunately, that is going to take lifetime of progression to achieve. Obviously, these issues need to be addressed, but until they progress people will have to manage in other ways.

Assessing one’s genetic risk is the first step in preventing heart disease. Additionally, individuals are able to explore other preventative pathways that can help reduce, delay or reverse a dim diagnosis. The reality is, it’s not easy and you have to do most of the work. Conversely, developing a heart condition, and then having to manage symptoms and care for yourself with less ability, less motivation, and less time to enact positive change, is probably worse. Enacting small, daily, and achievable changes over time to develop healthy habits is key.

Some medications like Lipitor or ‘cholesteroff’ may be helpful as a stop-gap, but should ultimately not be touted as a silver bullet. As noted by Galea above, an interdisciplinary approach, instead of a siloed biological approach, is critical in order to fully address the causes of cardiovascular disease. When we ask, how can we prevent heart disease? Perhaps, we should be asking, how can we tolerate frustration?

Depending on one’s personality and situation, different steps can be taken to help tolerate frustration: cognitive behavior therapy, dialectical behavior therapy, art therapy, music therapy, and gratitude/appreciation journaling. Working with a mental health provider to find an appropriate and engaging therapeutic process can help people train to better emotionally regulate, adapt to change and provide ways of externalizing our frustration in a safe way. Taking these a step further and participating in a group setting, may also help individuals feel acknowledged, less alone and also help in establishing healthy habits. (Malchioldi, 2013).

I’m personally interested in using Costa and McCrae’s big 5 model within different therapeutic modals. For example, in the big 5 model, or O.C.E.A.N; Openness to Experience, Conscientiousness, Extraversion, Agreeableness and Neuroticism, individuals could be prompted to draw or write about a time they were ‘open to an experience’ that had a positive effect in their lives. By activating the brain in this way, I believe repetitive exercises may help individuals to visualize, remember, and realize that things are not always bad. This type of mindfulness practice may help individuals recall certain cognitive distortions, like all or nothing language, and have a realization of ‘catching themselves.’  With practice and guidance, individuals can strengthen their ability to self-regulate and take back some control in their lives.

Knowing one’s controllable risk factors and learning to optimize our self-management skills, coping mechanisms, and social supports are the areas we can control and enhance. Even when it’s hard, finding sincere appreciation and gratitude can go a long way in keeping our hearts healthy. 


Archacki, S., & Wang, Q. (2004). Expression profiling of cardiovascular disease. Human genomics1(5), 355–370. https://doi.org/10.1186/1479-7364-1-5-355

Chauhan, H. (2012, August). Diabesity – the ‘Achilles Heel’ of our modernized society. SciELO. http://dx.doi.org/10.1590/S0104-42302012000400002. 

Galea, S., & Vaughan, R. D. (2018). Making the Invisible Causes of Population Health Visible: A Public Health of Consequence, August 2018. American Journal of Public Health108(8), 985–986. https://doi-org.ezproxy.ccac.edu/10.2105/AJPH.2018.304543

Lee HB, Offidani E, Ziegelstein RC, Bienvenu OJ, Samuels J, Eaton WW, Nestadt G. Five-factor model personality traits as predictors of incident coronary heart disease in the community: a 10.5-year cohort study based on the Baltimore epidemiologic catchment area follow-up study. Psychosomatics. 2014 Jul-Aug;55(4):352-361. doi: 10.1016/j.psym.2013.11.004. Epub 2013 Dec 10. PMID: 24751113.

Malchiodi, Cathy.Trauma and Expressive Arts Therapy: Brain, Body, and Imagination in the Healing Process Feb 20, 2020

Straub, R. O. (2019). Health psychology: a biopsychosocial approach. Macmillan International Higher Education. 

Tuck, N., Adams, K., Pressman, S., & Consedine, N. (2017). Greater ability to express positive emotion is associated with lower projected cardiovascular disease risk. Journal of Behavioral Medicine40(6), 855–863. https://doi-org.ezproxy.ccac.edu/10.1007/s10865-017-9852-0

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