Yes, long-term stress and depression are both linked to a higher risk of heart attack. The link shows up in large studies from many countries, and researchers have plausible explanations for it.
The evidence has limits, though. Most of it shows association, not proof of cause, and trials have not yet shown that treating stress or depression prevents heart attacks. Managing stress is worth doing, but it does not replace control of blood pressure, cholesterol, blood sugar and smoking.
Key takeaways
- People under constant stress at work or at home have heart attacks more often than people who are not.
- Depression is common after a heart attack and is tied to worse outcomes.
- Job strain raises risk by a modest amount, far less than smoking or high blood pressure do.
- Treating depression improves mood and quality of life, but a large trial did not find fewer repeat heart events.
- Stress care belongs next to standard risk-factor control, never in place of it.
What the largest study found
The best-known evidence comes from INTERHEART, a study carried out in 52 countries. It compared 11,119 people who had just had a first heart attack with 13,648 people of similar age and sex who had not. Everyone answered the same short questions about stress at work, stress at home, money worries, major life events and depression.
The heart attack group reported more of every kind of stress.
| Reported in the past year | Heart attack group | Comparison group |
|---|---|---|
| Permanent stress at work | 10.0% | 5.0% |
| Permanent stress at home | 3.5% | 1.9% |
| Severe financial stress | 14.6% | 12.2% |
| A stressful life event | 16.1% | 13.0% |
| Depression | 24.0% | 17.6% |
After adjusting for age, sex, region and smoking, permanent stress at work or at home was associated with roughly twice the odds of a heart attack.1 The pattern was consistent across regions, across ethnic groups, and in men and women.
One caution matters here. INTERHEART asked people about stress after their heart attack. Someone who has just been through a frightening event may look back and remember the past year as more stressful than it felt at the time.
What studies that followed people forward show
Studies that measure stress first and then follow people for years avoid that problem. A pooled analysis of 13 European cohorts included 197,473 working adults who were free of heart disease at the start. People who reported job strain, meaning high demands combined with little control, had a 23% higher risk of coronary heart disease over about seven and a half years.2
That is a real effect, but a modest one. The authors noted that preventing workplace stress would have a much smaller effect on heart disease than dealing with standard risk factors such as smoking.2
Depression and the heart
Depression is a medical condition, not a rough few weeks, and it is common in people with heart disease.
In 2014 an American Heart Association panel reviewed 53 studies and concluded that depression should be recognized as a risk factor for worse outcomes in people who have had an acute coronary syndrome, the term that covers heart attack and unstable angina.3
Does treating depression protect the heart? A large trial called ENRICHD tested this in 2,481 people who had recently had a heart attack and who had depression, low social support, or both. Half received cognitive behavioral therapy, with antidepressant medication when needed. Depression improved more in the treated group. After an average of 29 months, though, the share of people who were alive and free of another heart attack was almost the same: 75.8% with treatment and 75.9% with usual care.4
Feeling better is a worthwhile outcome in its own right. Still, treating depression should not be sold as a proven way to prevent a second heart attack.
How stress might affect your arteries
Researchers describe two broad routes. The first is direct. Stress hormones raise heart rate and blood pressure, and researchers are studying whether long-term stress also feeds inflammation, which plays a part in plaque buildup.
The second route is through behavior. People under strain tend to sleep less, move less, eat worse, drink more and find it harder to quit smoking or take medication regularly.
A 2021 American Heart Association scientific statement summed up the field this way: there are clear associations between psychological health and cardiovascular disease, and growing evidence that the link may be causal through both biology and behavior. The same statement advised clinicians to consider psychological health when they evaluate people with or at risk for heart disease.5
What helps
No approach has been proven to prevent heart attacks by lowering stress. Several are still worth your time because they help with stress and carry heart benefits of their own:
- Regular physical activity. See our guide to how much exercise your heart needs.
- Enough regular sleep. Our article on sleep and heart disease covers the evidence.
- Limiting alcohol. Drinking to unwind tends to raise blood pressure. See alcohol and heart health.
- Professional care for depression or anxiety. Talking therapy and medication are effective treatments for these conditions. Speak with your clinician if low mood, loss of interest or constant worry does not lift.
If you ever have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline, right away.
Stress is not a substitute for checking your risk factors
It is easy to blame stress for heart risk and overlook the things that can be measured. A stressful job does not explain a high cholesterol particle count or rising blood sugar, and a calm life does not cancel them.
The reverse is also true. Chest pain or pressure, shortness of breath or pain spreading to the arm or jaw should never be written off as "just stress". Call 911.
Where to go from here
If stress is part of your life, the practical step is to find out where your measurable risk stands. Our guide to a heart disease risk assessment explains what a preventive evaluation covers, and the hs-CRP test guide explains the blood test used to look at inflammation.
Cardio Res-Q, the heart-disease prevention program at YoungerMeMD, includes stress and sleep in its lifestyle and risk evaluation. You can answer the three quick questions in the screener on the program page to see whether a closer look makes sense for you.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Can stress alone cause a heart attack?
Long-term stress is linked to a higher risk, but most heart attacks happen in people who also have plaque in their arteries from other causes such as high cholesterol, high blood pressure, diabetes or smoking. Stress is best seen as one contributor among several, not a stand-alone cause.
How much does stress raise heart risk compared with other factors?
In studies that followed working adults over time, job strain was tied to a 23% higher risk of coronary heart disease. The researchers themselves noted that this is much smaller than the effect of standard risk factors such as smoking.
Will treating my depression lower my heart risk?
That has not been shown. In the ENRICHD trial, therapy improved depression but did not reduce deaths or repeat heart attacks. Treatment is still worthwhile because depression itself is a serious condition and makes it harder to look after your health.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
