Clinical Scorecard: The Overlooked Connection Between Cardiology and Mental Health

At a Glance

Key Highlights

• Individuals with ASCVD have a 43% increased risk of suicide compared to matched controls.
• Concurrent MI and stroke synergistically increase suicide risk by 85%, representing the highest risk subgroup.
• Elevated suicide risk persists regardless of sex, age, or documented history of depressive disorders, suggesting broader psychological vulnerability beyond formal diagnoses.

Guideline-Based Recommendations

Diagnosis

• Integrate systematic mental health screening into cardiovascular care, especially after MI or stroke.
• Identify high-risk vulnerability phenotypes beyond formal psychiatric diagnoses to capture broader psychological distress.

Management

• Utilize hospitalization, early post-discharge follow-up, and cardiac rehabilitation as structured opportunities for psychological distress assessment and intervention.
• Implement psychosocial support and targeted interventions paralleling biological risk stratification in cardiology.

Monitoring & Follow-up

• Regularly assess mental health status during high-frequency clinical encounters in ASCVD care.
• Monitor for signs of anxiety, trauma, hopelessness, and other psychological distress indicators beyond depression.

Risks

• Recognize that ASCVD-related psychological distress, socioeconomic hardship, and behavioral changes increase suicide risk.
• Acknowledge that dyslipidemia presence does not mitigate elevated suicide risk in ASCVD patients.

Patient & Prescribing Data

Nationwide cohort of individuals with prior MI or stroke in the Republic of Korea

Despite high prevalence of dyslipidemia, suicide risk remains elevated; mental health screening and referral are inconsistently implemented despite known benefits of cardiac rehabilitation on mood and depression.

Clinical Best Practices

• Incorporate routine mental health screening into cardiology practice, especially during hospitalization and rehabilitation phases.
• Address psychological distress proactively to improve medication adherence, lifestyle modification, and overall cardiovascular outcomes.
• Recognize and manage socioeconomic and behavioral factors contributing to suicide risk in ASCVD patients.

References

• Risk of suicide in individuals with atherosclerotic cardiovascular disease: a nationwide population-based study
• 2025 ESC Clinical Consensus Statement on mental health and CVD
• 2023 ACC/AHA Guideline for Chronic Coronary Disease