Mental health forms a crucial part of one's overall health, comprising emotional, psychological, and social well-being of a person. Broadly, it involves how we think, feel and act. Any negative alteration in such aspects can interfere with one's ability of thinking, behaviour, mood, emotions and feelings, thereby amounting to mental health disorders.
Mental health disorders pose a strong risk to development of heart disease, the effects can arise both, directly through biological pathways, and indirectly through risky health behaviours including substance abuse.
Scientific research has revealed that people experiencing mental health issues like depression, anxiety, stress and even PTSD over a long period of time may experience certain physiologic effects on their body, such as increased cardiac reactivity (e.g., increased heart rate and blood pressure), reduced blood flow to the heart, and heightened levels of cortisol. Over the course of time, these physiologic effects can lead to calcium build-up in the arteries, metabolic disease and heart disease.
Conversely, it has been evidenced that mental health disorders like depression, anxiety, and PTSD can develop after major cardiac events like heart failure, stroke, and heart attack – more so after an acute heart disease event from factors like pain, fear of death or disability including financial problems associated with the event.
Furthermore, it has been revealed that the impact of medicines used to treat mental health disorders pose a strong risk towards development of cardio-metabolic disease risk – use of some antipsychotic medications has been associated with obesity, insulin resistance, diabetes, heart attacks, atrial fibrillation, stroke including death.
Moreover, mental health disorders such as anxiety and depression may increase the chance of adopting unhealthy behaviours such as smoking, alcoholism, sedentary lifestyle or development of resistance to taking prescribed medications. This is because people experiencing a mental health disorder may have fewer healthy coping strategies for stressful situations – thus making it difficult for them to make healthy lifestyle choices to reduce their risk of heart disease.
Defining the preventive interventions
The first framework focuses on when in the course of a disease the preventive intervention is required. Primary prevention occurs before any evidence of disease and aims to reduce or eliminate causal risk factors, prevent onset and thus reduce incidence of the disease. Examples include vaccinations to prevent infectious diseases and encouraging healthy eating habits and physical activity to prevent obesity, diabetes, hypertension, and other chronic diseases and conditions.
Secondary prevention occurs at a latent stage of disease: after a disease has begun but before the person has become symptomatic. The goals that ultimately reduce the prevalence of the disease are early identification through screening as well as providing interventions to prevent the disease from becoming manifest. Screening tools and tests are examples of secondary prevention.
Finally, tertiary prevention is an intervention implemented after a disease is established, with the goal of preventing disability, further morbidity, and mortality. Medical treatments delivered during the course of diseases can be considered tertiary prevention. Relapse prevention is another form of tertiary prevention. For example, while talking about mental health disorders, primary, secondary, and tertiary prevention are exemplified respectively by eliminating certain forms of dementia that stem from vitamin deficiencies, screening for problematic drinking that precedes alcohol use disorder, and providing psychosocial treatments to reduce disability among individuals with serious mental illnesses.
The second approach of prevention, largely focuses on who receives an intervention, also has three levels of prevention: universal, selective, and indicated. Universal preventive interventions are given to the entire group (e.g., a school, an entire community, or the whole population), regardless of individuals' level of risk for the disease. Examples include fortification or enrichment of foods, school-based curricula about substance abuse, and informational campaigns, such as public announcements about wearing seat belts or not texting while driving.
Selective preventive interventions are those delivered to a subgroup at increased risk for a disease outcome. Examples include use of hypolipidaemic drugs among those with hyperlipidaemia (to prevent later cardiovascular disease) and pneumococcal vaccination in older adults.
Indicated preventive interventions are those given to an even more select group that is at particularly high risk or is already exhibiting subclinical symptoms. Examples include lifestyle modifications for pre-diabetes or pre-hypertension. While talking about mental health disorders – universal, selective, and indicated preventive interventions are exemplified respectively by social and emotional development curricula provided in elementary schools, group-based psychotherapy for children of parents with depressive disorders, and efforts to identify and treat adolescents and young adults who appear to be at clinical high risk.
Prevention of heart diseases
· Controlling high blood pressure: This is one of the most important things one can do to reduce their heart disease risk. Exercising, managing stress, maintaining a healthy weight and limiting the amount of sodium in your diet and avoiding alcohol can all help to keep high blood pressure in check. In addition to recommending lifestyle changes, one may need to take medications to treat high blood pressure.
· Controlling diabetes: One can manage diabetes with diet, exercise, weight control and medications.
· Lowering the amount of cholesterol and saturated fat in one's diet: Eating less cholesterol and fat, especially saturated fat and trans fats may reduce plaque formation in arteries. Besides dietary changes, one may need to take cholesterol-lowering medications.
· Exercising regularly: Exercise reduces risk of heart disease in many ways. It can lower blood pressure, increase the level of high-density lipoprotein cholesterol, and improve the overall health of blood vessels and heart. It also helps in losing weight, controlling diabetes and reducing stress.
· Eating a diet rich in fruits and vegetables: A diet containing five or more daily servings of fruits or vegetables may reduce risk of heart disease. Following a diet which emphasizes olive oil, fruit, nuts, vegetables and whole grains may be helpful.
· Quitting tobacco use: Smoking raises the risk of heart disease for smokers and non-smokers exposed to second-hand smoke. So, quitting tobacco use reduces risk of heart disease.
· Avoiding alcohol: It can be a risk factor for heart disease. Heavy alcohol consumption increases risk of high blood pressure, ischemic heart disease and heart attack.
· Avoiding drug abuse: Certain drugs, such as cocaine and methamphetamines, are established risk factors for ischemic heart disease.
· Anti-platelet drugs are commonly used as preventive medications. Platelets are cells in one's blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin.
· Anticoagulants: The drugs, which include heparin and warfarin reduce blood clotting. Heparin is fast acting and may be used over a short period of time in the hospital. Slower acting warfarin may be used over a longer term.