Cardiovascular risk factors, accelerated by depression and anxiety, increase a patient’s risk for end-stage renal disease, according to a study presented at the American College of Cardiology’s 2025 annual meeting March 31 and published April 1 in JACC.
One of the study’s authors, Michael Osborne, MD, a cardiologist and the associate director of nuclear cardiology: education at Boston-based Massachusetts General Hospital, spoke with Becker’s about the study’s implications for increased awareness of mental health within cardiovascular medicine.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Could you give a brief synopsis of the study’s findings?
Dr. Michael Osborne: This study was led by Krystel Karam, MD, a research fellow at Boston-based Massachusetts General Hospital. We were interested in unraveling some of the mechanisms by which chronic stress, depression and anxiety lead to advanced renal disease.
We’ve been doing a lot of work on the relationship between stress and cardiovascular disease. In one recent paper, we showed that depression and anxiety actually accelerate the gain of cardiovascular risk factors, including hypertension, diabetes and hyperlipidemia. That gain of risk factors is an important mediator of major adverse cardiac events that people experience as a result of anxiety and depression.
Knowing that a lot of these same risk factors also lead to chronic kidney disease and end-stage renal disease, we wanted to explore that relationship in this study. We leveraged data from about 118,000 patients from our institutional biobank and were able to show that anxiety and depression are independently associated with end-stage renal disease. Even after adjusting for confounding factors like preexisting hypertension, diabetes, heart failure, adverse socioeconomic status and race, we found that the relationship remained significant.
We wanted to know whether the gain of hypertension and diabetes was an important factor in these individuals developing end-stage renal disease. Through mediation analyses, we were able to show that hypertension and diabetes were important mediators of the relationship between anxiety, depression and end-stage renal disease.
Q: The study’s results highlight the importance of integrated care. How can health systems better align often siloed service lines to proactively manage at-risk patients?
MO: That’s certainly a challenge in today’s medical environment, but we sort of take it to mean that individuals with identified chronic mental health conditions would potentially benefit from more intense screening and potentially earlier treatment for these adverse risk factors that seem to be driving these disease processes.
This means we need to spend more time really focusing on our patients’ mental health. That’s a struggle with the time constraints, appointments and everything else that needs to be covered, but we really do need to screen folks for underlying chronic mental health conditions. It’s not only their mental health that’s at risk, it’s their long-term cardiovascular and renal health as well.
Our research really emphasizes that in order to take the best care of patients, we need to think about the person as a whole, and not just think about their physical well-being but also spend ample time on their mental health.
It’s an onus that I would place on the entire system; everybody sort of has to have their radar up. While these findings are independent, it does sort of argue that there is a biological link between chronic stress and these outcomes. It really is something that every provider should be aware of, regardless of their role. The more hands that are on deck, and the more people that are thinking about different aspects of a patient’s well-being, the more likely you are to be able to capture these issues before they become a chronic condition.
Q: What are the most pressing challenges you see in translating this research into clinical care?
MO: It’s interesting, because there’s not really good evidence to support causality or to support the treatment of stress as an effective means of lowering cardiovascular disease risk.
One of the big challenges right now that needs to be overcome is having definitive, causal research that actually proves these relationships. By doing that, I think we will gain a lot of traction to where it can actually enter the guidelines.
We also know that stress drives a lot of other things that can impact outcomes — including health behaviors and compliance — [which are] hard to address.
There is growing evidence from cardiovascular literature that argues both pharmacologic and non-pharmacologic treatments for chronic stress appear to have some benefit on cardiovascular endpoints.
There is more work needed to know whether or not we can actually effectively intervene on these effects. The main thing is, it certainly isn’t going to hurt to address these issues and to be aware of them in the clinical realm.
Q: How should hospital and health system leaders interpret the link between mental health and end-stage renal disease risk?
MO: Anecdotally, I think everybody knows stress is a risk factor for disease. You know, we’ve all heard somebody say, “You’re going to stress yourself out till you have a heart attack.” But the guidelines for cardiovascular disease don’t even mention stress.
We need to make sure that our healthcare systems have built-in access to providers that can help patients who are showing signs that they would benefit from additional care targeting their anxiety, depression or their chronic stress in general.
Stress touches so many aspects of human health, but we’re just now starting to really gain insights into what it’s doing. My hope is that we’ll continue to make headway on this line of work and eventually integrate it into the mainstream of clinical care.
