Happy Heart, Healthy Heart: The link between emotions and cardiovascular disease

relax2Anyone who has ever felt the ache of a broken heart, or the anxious fluttering of butterflies before a promising job interview, knows that the physical heart and the emotions are intimately linked.  In the late 1950s, cardiologists Meyer Friedman and Ray Rosenman began studying this connection after noticing that the armrests of the chairs in their waiting room were wearing down much quicker than the backs of the chairs, as one would expect.  Soon they realized that many of their heart disease patients were often perched at the edge of their seat, impatiently picking at the upholstery as they waited for their appointments.  This odd discovery lead them to coin the term “Type A Personality” to refer to these anxious and hurried patients and prompted decades of research exploring the mental-emotional component of heart disease.  Hundreds of studies later, we now know that emotions such as anxiety, depression, anger, and hostility are all associated with diseases including atherosclerosis and heart attacks.  In fact, depression poses as big a risk factor as smoking and high cholesterol when it comes to our heart health.1

The good news is that these emotions are not entirely out of our control, and other emotions and mental states such as gratitude, optimism, altruism, and forgiveness mitigate this cardiovascular risk.  Rather than send you off with the vague and obnoxious instruction “Don’t worry, be happy,” here are some concrete, researched tips shown to decrease depression, anger, and hostility while increasing positive emotions, which may just be the prescription your heart needs.

1.      Count your blessings.

Gratitude is a powerful thing.  Research shows that simply spending 20 minutes to write down three good things that happened to you in the last week decreases depression and increases well-being and optimism.  This, in turn, lowers your risk for developing or worsening  heart disease.2  Surprisingly, simply thinking about things you are thankful for is not enough.  It is the actual act of writing these things down that provides the most benefit.  Purchasing a gratitude journal from cartoonist Mollycules can aid you in this exercise.

2.      Say thanks.

Along similar lines, writing a letter to someone who has made a difference in your life or done something kind for you increases sense of happiness and well-being that can last for up to 6 months.2  Better yet, read the letter aloud to the person after you write it for extra heart-warming benefits.  Just watch this video of people doing a similar exercise and try not to feel your heart opening and expanding.

3.      Phone a friend.

Science confirms what we’ve known all along, friendship is good for the heart!  Social support is protective against cardiovascular events, while isolation and lack of a close confidant are associated with both depression and heart disease.1  It is not always the presence of friends and family in your life that matters most, but whether or not you reach out to these people for support, so don’t hesitate to identify people whom you can talk with openly and on a regular basis.

4.      Learn to forgive.

Whoever said “Holding onto anger is like drinking poison and expecting the other person to die,” was right.  It is not that anger itself is inherently bad, but when it is either suppressed or overly expressed it is associated with health problems such as heart attacks, hypertension, and sudden heart death.3  In the famous Framingham Heart Study, “not showing anger outwardly” was an independent risk factor for coronary artery disease.4  Another study actually showed that when people with heart disease thought about someone who had deeply hurt them the blood flow to their heart muscle decreased.  These same people then underwent forgiveness training, in which they learned to reduce resentment and develop increased empathy for the person who caused them pain.  After ten weeks of this training, the blood flow to their heart muscle was increased from previous levels when these patients thought about the person who wronged them, greatly lowering their risk for future heart disease.3

5.      Practice random acts of kindness.

Doing something nice for someone else is the epitome of a win-win situation.  Heart disease patients who were instructed to perform three kind acts in one day and write them down afterwards reported increased happiness, decreased anxiety and depression, and increased overall quality of life, which lasted long after the exercise was complete.  These kind acts include anything from bringing someone flowers, to giving a genuine compliment, to volunteering for a good cause.  Even if the acts are small, the key is to practice them regularly in order to benefit from the “clustering effect” that occurs when multiple kind acts are performed in a short time period.2

6.      Stash the smart phone. 

In our hyper-connected, digital world we are busier and more scattered than ever before.  It is almost as if society is pushing us all to become the “Type A Personalities” Friedman and Rosenman warned us about.  It’s easy to avoid feeling and dealing with difficult emotions when you have Facebook, Instagram, and a million things on your to-do list to distract you.  Mindfulness, a term that refers to various practices of slowing down, stilling the mind, and turning the awareness inward, has been shown to have a seemingly infinite number of health benefits.  One form of mindfulness practice, Transcendental Meditation (TM), has been shown in over 600 studies to have health benefits, including lowering blood pressure and cholesterol, reversing atherosclerosis, and decreasing risk for heart attacks.5  There are many ways to practice mindfulness, from TM to Mindfulness-Based Stress Reduction (MSBR) to exercises like yoga, tai chi, or qi gong.  You can take a class in any of these practices, or simply turn off your phone, sit in a quiet room, close your eyes, and focus on your breath for 10 minutes each day.

7.      Treat chronic depression.

Depression can be debilitating and is not something to take lightly.  There are many options for treating depression, including counseling, medication, herbal and nutritional therapy, and lifestyle changes.  Depression induces many physical changes in the body, including negative effects on our nervous and immune systems, our blood clotting abilities, and our heart.1  Don’t hesitate to contact a doctor if you are struggling with depression.  Your heart will thank you!

This February is American Heart Month, which is the perfect time to think about all the ways you can keep your heart healthy as you age.  Along with the usual diet, exercise, and smoking cessation, please do not forget about the powerful effects emotions can have on your physical heart.  If anxiety, anger, and depression have the capability to literally break your heart, then gratitude, optimism, mindfulness, and forgiveness are the glue that put it back together.

Niki Rarig, NCNM Naturopathic Medicine Program and School of Classical Chinese Medicine. Edited by Dr. Elise Schroeder


  1. Goldston K and Baillie AJ.  Depression and coronary heart disease: A review of the epidemiological evidence, explanatory mechanisms and management approaches.  Clinical Psychology Review.  February 2008; 28 (2): 288-306.
  2. Huffman JC, Mastromauro CA, Boehm JK, Seabrook R, Fricchione GL, Denniger JW and Lyubomirsky SL.  Development of a positive psychology intervention for patients with acute cardiovascular disease.  Heart International.  2011; 6 (e14): 47-54.
  3. Waltman MA, Douglas CR, Coyle CT, Enright RD, Holter AC, and Swoboda CM.  The effects of a forgiveness intervention on patients with coronary artery disease.  Psychology and Health.  January 2009; 24(1): 11-27.
  4. Rose MI.  Type A behaviour pattern: A concept revisited.  CMAJ.  February 15, 1987; 136(4): 345-350.
  5. Walton KG, Schneider RH, and Nidich S.  Review of controlled research on the Transcendental Meditation program and cardiovascular disease.  Cardiology Review.  2004; 12(5): 262-266.