Several common mental disorders are associated with a higher incidence of acute coronary syndrome (ACS), with post-traumatic stress disorder (PTSD) and sleep disorders showing the strongest associations, according to the results of a recent study.
The large systematic review and meta-analysis aimed to estimate the association between clinically diagnosed mental disorders and the risk of ACS, compared with individuals without mental disorders.
Conducted in line with PRISMA 2020 guidance, the review included 25 observational studies (24 cohort studies and one case–control study), encompassing a total of 22,048,504 participants.
The median age of the pooled population was 48.0 years, and 59.1% were male. At baseline, 2,853,773 participants (12.9%) had a diagnosed mental disorder, defined using Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases criteria.
During follow-up, 317,780 individuals (1.4%) experienced an incident ACS event, most commonly acute myocardial infarction.
Mental disorders and increased risk of ACS
Published in JAMA Psychiatry, the random-effects meta-analyses showed that several mental disorders were associated with a significantly increased risk of ACS or acute myocardial infarction.
Depressive disorders were associated with a higher risk of ACS (hazard ratio [HR] 1.40; 95% confidence interval [CI] 1.11–1.78), while anxiety disorders were linked to increased myocardial infarction risk (HR 1.63; 95% CI 1.40–1.89). Sleep disorders were associated with a higher incidence of ACS (HR 1.60; 95% CI 1.22–2.10).
The strongest association was observed for PTSD, which was linked to a markedly increased risk of myocardial infarction (HR 2.73; 95% CI 1.94–3.84). Bipolar and psychotic disorders were not significantly associated with ACS, although point estimates were similar to other disorders and certainty of evidence was very low.
More nuanced insights needed
The authors concluded that depressive disorders, anxiety disorders, PTSD and sleep disorders were associated with an increased risk of ACS. Clinically, the findings underscored the importance of recognising mental disorders – particularly PTSD and sleep disorders – as relevant risk factors when assessing cardiovascular risk.
They also highlighted several limitations, including substantial statistical heterogeneity, reliance on administrative diagnostic codes, under-reporting of baseline characteristics, and inconsistent adjustment for confounders such as medications and health behaviours. Many analyses were based on a small number of studies, limiting precision, they added.
Well-designed prospective studies with more consistent adjustment for vascular risk factors, behaviours and psychotropic medications are therefore needed in future to provide more nuanced insights into the association between mental disorders and ACS.
The growing awareness of the close relationship between mental health and cardiovascular disease has led to the publication of the first European Society of Cardiology (ESC) Consensus Statement on this topic, which was presented at the ESC Congress 2025.
Reference
Gupta A, Tejpal T, Seo C. Mental Disorders as a Risk Factor of Acute Coronary Syndrome. A Systematic Review and Meta-Analysis. JAMA Psychiatry 2026;Jan 14:doi:10.1001/jamapsychiatry.2025.4253 [online ahead of print].