Sleep and mental health disorders may mediate increased ACS risk: JAMA

A new study published in the Journal of the American Medical Association found growing link between mental health and heart disease, which revealed that certain psychiatric conditions may significantly increase the risk of acute coronary syndrome (ACS).

Drawing from major medical databases like MEDLINE, Embase, and PubMed, this study evaluated research spanning decades, ultimately narrowing over 3,600 studies down to 25 high-quality investigations. These studies collectively included more than 22 million participants, with a median age of 48 years.

Individuals with certain mental health conditions face a higher risk of developing ACS when compared to those without such disorders. Also, posttraumatic stress disorder (PTSD) showed the strongest association, with affected individuals nearly 3-times more likely to experience ACS. Sleep disorders also stood out, increasing risk by approximately 60%.

Depression and anxiety were also linked to elevated risk. People with depressive disorders had a 40% higher risk of ACS, while those with anxiety disorders faced a 63% increase. These associations, while significant, were supported by varying levels of evidence certainty, which ranged from very low to moderate.

Also, bipolar and psychotic disorders did not show statistically significant associations with ACS in this analysis, although findings suggest that limited data and variability across studies may have affected those results.

The relationship between mental disorders and heart health may be driven by a combination of biological and behavioral factors. Chronic stress, inflammation, disrupted sleep patterns, and unhealthy lifestyle habits like smoking or physical inactivity are all more common among individuals with mental illness and are known contributors to cardiovascular disease.

The study adhered to duplicate data extraction and quality assessment using established tools. Despite its scale and thorough methodology, researchers caution that more work is needed to fully understand the mechanisms at play and to address limitations in existing data.

The strong association between sleep disorders and ACS highlights sleep quality as a potentially modifiable risk factor. Clinicians may need to pay closer attention to sleep health as part of cardiovascular prevention strategies. Overall, the findings reinforce the importance of integrating mental health care into broader medical practice. 

Reference:

Gupta, A., Tejpal, T., Seo, C., Fabiano, N., Zhao, S., Wong, S., Qiu, Y., MacNeil, J., Kim, D. R., Aleksova, N., Siddiqi, S., Solmi, M., & Fiedorowicz, J. G. (2026). Mental disorders as a risk factor of acute coronary syndrome: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Psychiatry (Chicago, Ill.), 83(3), 259–268. https://doi.org/10.1001/jamapsychiatry.2025.4253