People with mental disorders often show increased rates of co-occurring physical conditions such as heart disease. An increased risk of heart disease in people with PTSD may be a consequence of the disorder itself, as it is associated with dysfunction of the immunological system and excess inflammation. This in turn is associated with significant cardiovascular health problems. Unhealthy lifestyle factors such as smoking and poor diet may also contribute to any increased risk of heart disease.

What is the evidence for heart disease?

High quality evidence finds a small increased risk of coronary heart disease in people with PTSD than in people without the disorder.

Moderate quality evidence finds large effects of lower high-frequency and RMSSD (root mean square of the successive differences) heart rate variability in people with PTSD. These effects were largest in clinical populations. There was also a small increased risk of lower resting respiratory sinus arrhythmia. There was no change in low-frequency heart rate variability. The results remained regardless of medication status, year of publication, study quality score, study methodology, or participant age or sex.

Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased cardio-respiratory symptoms in general.

August 2021

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People with bipolar disorder show increased rates of co-occurring conditions. Heart disease is a common co-occurring disorder. It is unclear if the increased risk of heart disease is a consequence of the metabolic impact of medications or unhealthy lifestyle choices, or most likely, a combination of both.

What is the evidence for heart disease in people with bipolar disorder?

Moderate quality evidence suggests small increased risks of cardiovascular disease, congestive heart failure, and death due to cardiovascular disease in people with the disorder compared to people without the disorder. These findings were adjusted for other variables that may have explained the increased risks. Moderate to low quality evidence also suggests a large effect of reduced heart rate variability in people with bipolar disorder. High quality evidence finds no increases in rates of myocardial infarction.

October 2021

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