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Mental disorders and cardiovascular disease: what should we be looking out for?
  1. Matthias Michal1,2,
  2. Manfred Beutel1
  1. 1 Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
  2. 2 German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
  1. Correspondence to Dr Matthias Michal, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz 55131, Germany; matthias.michal{at}

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Learning objectives

  • To understand the importance of detecting and managing common non-organic mental disorders for the outcome of patients with cardiovascular disease.

  • To be able to identify common mental disorders and to inform the patient about it.

  • To be able to manage the mental healthcare needs of patients in cardiological settings (referral, interdisciplinary patient care).

  • To be able to explain basic mechanisms of common mental disorders to the patient.

  • To be familiar with common treatment options for patients with mental disorders.


Mental disorders are prevalent. They impair patients’ quality of life severely and are associated with an increased risk of developing cardiovascular disease (CVD) and worse prognosis.1–4 Although these facts have been well established, there is still a gap in diagnostic awareness and treatment of mental disorders in patients with CVD.5–8 Therefore, we aim to educate cardiologists about the importance of mental disorders and how to address the widely unmet healthcare needs of patients with a mental disorder in their clinical practice.

Mental disorders increase the risk for subsequent CVD

All mental disorders are associated with an increased risk of developing CVD.9–11 As an example, we show the risk estimates from a recent extensive population-based cohort study from the Danish national registries, observing 5.9 million persons for 15 years (table 1).10 In general, the risk of developing CVD increases with the number of comorbid mental disorders, for example, from 1.5-fold to 3.0-fold for one as compared with five diagnoses.11

View this table:
Table 1

Association between mental disorders and subsequent CVD10

The onset of CVD triggers mental disorders

The onset of CVD escalates the risk of developing mental disorders by 2.2-fold. The 12-month prevalence of mental disorders in patients with CVD is reaching prevalence rates of 43.7% for inpatients and 42.2% for outpatients.12 These mental disorders are worsening cardiac prognosis significantly.5 13–15 For example, the most common symptoms of mental disorders, anxiety and …

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  • Contributors MM wrote the first draft. MM and MB contributed original material to the manuscript and provided revisions. MM finalised the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.