Addressing Psychological Factors in Coronary Calcification

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What Is Coronary Calcification And Why Does It Matter?

Coronary calcification (CC) refers to calcium deposits in the walls of the arteries of the heart. While people often have no symptoms at first, CC is a major risk factor associated with heart disease.¹

How Do You Measure Coronary Calcification?

To determine how extensive CC is, doctors will often use a scanner that can see into the heart and its vessels. Called cardiac computed tomography, this allows doctors to determine a coronary artery calcium (CAC) score. The higher the score, the greater the risk of heart disease.

Who Has High CAC Scores?

A CAC score that is greater than 400 is generally associated with worse clinical outcomes.³ The CAC score increases as people get older. While it is higher in men up to the seventh decade of life, after this, there are no sex differences in CAC score. It is highest in Whites and South Asian men,² followed in descending order by Chinese, Hispanics, and African Americans.

What Psychological Factors Are Related to Coronary Calcification?

While earlier studies showed that there were no statistically significant associations between depression, anxiety, hostility, stress, and CAC scores,⁴ more recent studies show the opposite.

For example, one study showed that the more angry people are, the greater their CC.⁵ Another study found that long-term but not current psychological distress is associated with severe CAC in healthy older subjects. And people who had an exaggerated cortisol response to stress were also at greater risk for CC.⁶

More recently, mental stress–induced oxygen deprivation in the heart has been identified as a significant phenomenon.⁷ And chronic stress is associated with heart disease.⁸ Cynicism, a core feature of burnout, is also associated with the progression of CC⁹, and anxiety, depression, and stress play a role in cardiovascular disease as well.¹⁰ Also, women with recurrent depression have a greater chance of CC getting worse over time.¹¹

Why Are the Associations Between These Psychiatric Syndromes and CC Not Entirely Clear?

There is very little debate about whether stress, anxiety, and depression contribute to cardiovascular disease.¹² However, the findings may be less clear since other less studied factors may influence outcomes. For example, one study of 312 women assessed an overall well-being score, including optimism, vitality, life engagement, life satisfaction, rewarding multiple roles, and positive affect. This study found that higher well-being is associated with less CAC progression. Hence, even if stressed, people with more optimistic, vital, and satisfied lives will be more protected.¹³ Another study of 783 men and women found that being single or widowed, factors regarded as “social network indices,” were associated with a higher CAC score.¹⁴ Also, when people are lonely, they may have slow recovery from exaggerated blood pressure and pulse rate responses to perceived stress, in addition to significant left ventricular hypertrophy, autonomic imbalance, and increased systemic inflammation.¹⁵

An Approach to Psychological Factors Can Reverse or Prevent Progression of CC

The possibility of reversing CC has been debated over the years. Some studies indicate that it is not reversible,¹⁶ while others indicate that it is.^17,18

Regardless, there is considerable agreement on preventing the progression of CC with diet, exercise, and lifestyle factors. For the reasons considered above, it is likely to be helpful to start with lifestyle factors. Answer the following questions:

• Social network: Is my social network substantial enough, and do I feel connected? If not, consider joining local groups, approaching friends, or developing friendships at work. Social health determines physical health.
• Vitality: Do you feel vital and alive? Are you satisfied with your choices in life? Do you have reason to be optimistic? If the answer is no to any of these, start small by including one activity or change that will help you feel more optimistic and alive. You could consume less negative news, look for positive news outlets (like the Good News Network),¹⁹ or make changes to your work life that feel positive, now.
• Cynicism: Do you feel more cynical than others? If your current life situation at home or work is getting you down, and you increasingly feel down, target those situations.
• Seek help now: Address depression, anxiety, and stress actively. If there’s a wait for a psychiatrist, try a digital therapeutic platform so that you don’t have to wait endlessly.

Conclusion

While CC may compromise your heart, there any many modifiable lifestyle and psychological factors that can be addressed now to change the course of your physical life.