A meta-analysis indicates that individuals are at greater risk of developing acute coronary syndromes (ACSs) if they have depression, anxiety, traumatic disorders or sleep disorders. People with post-traumatic stress disorder (PTSD) and sleep disorders had the highest risk of ACS, demonstrating the importance of getting quality sleep and addressing mental health concerns. "Reducing ACS risk in this population begins with recognizing that mental disorders and cardiovascular risk are not mutually exclusive. Practically, this means ensuring aggressive management of traditional cardiovascular risk factors (e.g., high blood pressure, diabetes and smoking), while prioritizing evidence-based management of underlying mental disorders and recognizing medications," said Arnav Gupta, MD, MSc, from the University of Calgary Department of Medicine, Canada, in an interview with CRTonline. These results were reported by Dr. Gupta and colleagues from Canada and Germany, in a manuscript published Wednesday online in JAMA Psychiatry. Mental health disorders are well-known risk factors for cardiovascular — and other — diseases. Depression, anxiety, bipolar, schizophrenia, substance use and other disorders put individuals at risk for earlier-onset heart problems. "Mental disorders are increasingly being investigated as a risk factor for cardiovascular disease, with the 2025 European Society of Cardiology Clinical Consensus formally recognizing it within their comprehensive guideline," Dr. Gupta told CRTonline. Study details Investigators in this review looked at the association between ACS and mental disorders compared with patients who did not have mental disorders across studies from three databases: MEDLINE, Embase and PubMed. The researchers set requirements for a study to be included in this analysis: the study had to be randomized or observational, contain measured associations with ACS and investigated any clinically diagnosed mental disorders before ACS. Mental health disorders were based on the DSM and International Classification of Diseases definitions. To assess the quality of the studies, the investigators used the National Institutes of Health Study Quality Assessment Tools. Study analyses extended from January 1966 through October 2021. The primary outcome assessed in this analysis was the association with or risk of ACS. A total of 3,616 studies were identified, and 25 full-text articles met the final inclusion criteria. These 25 articles brought 22,048,504 patients (median age=48.0 years, 40.9% female) to the analysis. Association between mental and cardiovascular health A higher risk of ACS was seen in patients with depressive disorder (hazard ratio [HR]=1.40, 95% confidence interval [CI]=1.11-1.78, p=0.01), anxiety (HR=1.63, 95% CI=1.40-1.89, p<0.001), sleep disorders (HR=1.60, 95% CI=1.22-2.10, p<0.001) and PTSD (HR=2.73, 95% CI=1.94-3.84, p<0.001), demonstrating a strong association between these mental disorders and ACS. Patients with bipolar (HR=1.48, 95% CI=0.47-4.61, p=0.28) or psychotic disorders (HR=0.97, 95% CI=0.01-178.30, p=0.06) were not significantly at greater risk of acute myocardial infarction, but point estimates were similar to a few other disorders. Dr. Gupta told CRTonline that these results also extend to patients who are already diagnosed with ACS plus a mental disorder. In this population, mental health conditions can impact recovery, medication adherence, participation in recommended cardiac rehab programs and long-term outcomes. "Identifying and treating mental disorders alongside standard cardiology care may improve both quality of life and cardiovascular prognosis," said Dr. Gupta. Some limitations of this analysis included lack of baseline characteristics such as psychiatric medications or types of ACS, statistical heterogeneity, not all mental health cases could be captured and lack of investigation into other variables (coping mechanisms, medications, other vascular risk factors). Overall, this review of 25 studies demonstrated the association between depressive, anxiety, traumatic and sleep disorders and ACS. "The findings of this comprehensive meta-analysis underscore a critical intersection between mental health and cardiovascular medicine, framing certain mental disorders not just as co-morbidities, but as potent risk factors for ACS,” Brian C. Case, MD, of MedStar Southern Maryland Hospital Center in Clinton, Maryland, told CRTonline. “PTSD and sleep disorders emerge as particularly significant drivers — potentially due to the physiological toll of poor sleep quality and heightened stress responses — the study challenges the traditional boundaries of heart disease prevention.” Source: Gupta A, Tejpal T, Seo C, et al. Mental disorders as a risk factor of acute coronary syndrome: A systematic review and meta-analysis. JAMA Psychiatry. 2026 January 14 (Article in Press). Image Credit: Andrii Zastrozhnov – stock.adobe.com