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Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 207-208

Book review of heart disease: It is all in your head, and what to do about it

1 Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2 Department of Food Science, University of Arkansas, Fayetteville, AR, USA

Date of Submission09-Sep-2022
Date of Acceptance14-Sep-2022
Date of Web Publication30-Sep-2022

Correspondence Address:
Prof. Philip Palade
Department of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/hm.hm_39_22

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How to cite this article:
Palade P, Mahadevan M. Book review of heart disease: It is all in your head, and what to do about it. Heart Mind 2022;6:207-8

How to cite this URL:
Palade P, Mahadevan M. Book review of heart disease: It is all in your head, and what to do about it. Heart Mind [serial online] 2022 [cited 2023 Mar 29];6:207-8. Available from: http://www.heartmindjournal.org/text.asp?2022/6/3/207/357551

Book Title: Heart Disease: It Is All in Your Head and what to do about it

Book Author: Jay Mehta, MD, PhD

Hardcover ISBN: 9798788439297 Price: USD $24.99

Published Date: December 22, 2021

Paperback ISBN: 9798751958800 Price: USD $15.99

Published Date: December 23, 2021

Publisher: Kindle Direct Publishing

Many readers of Heart and Mind will no doubt have an interest in a 205-page book recently written by distinguished cardiologist Jay Mehta. Readers should not be put off by the part of the title “It is all in your head,” which could be misinterpreted by some to mean heart disease is not real. Mehta's intention is rather to indicate that stress, emotions, depression, and social interactions affect not just your mind, but also your heart, and that should make it of great interest to readers of this journal, their patients, family, and friends. Mehta has written profusely for a readership of cardiologists and other health professionals. Now, he turns his considerable experience and wisdom toward whole health, a holistic approach focusing on public health and prevention, which is most welcome. Mehta provides snippets of his own personal and family history throughout the book, making it all the more interesting, credible, commendable, and brave.

Mehta begins by telling us how the situation in India since 1970 has gotten far more stressful as it has become more Western in its economic prosperity, with a consequent deterioration of family structure, fewer children, and more divorces, resulting in epidemics of obesity, diabetes, and heart disease.

He goes on to describe a small town in eastern Pennsylvania with very low levels of heart disease despite a relatively poor diet. They all came from a region of Italy and supported each other, but lost that supportive environment and its health benefits as they gradually assimilated with surrounding communities. In Chapter 2, he suggests that it is not stress itself that leads to heart disease, but rather how one handles the stress emotionally. In Chapter 3, he dismisses the oft-assumed presumption that persons with the well-known type A personality are the most prone to stress and heart disease and identifies another personality type more prone to these outcomes. However, Mehta's conclusion that some stress is good for himself and his colleagues may risk generating adverse outcomes for those who are unable to manage stress as well as most of them do.

Mehta analyzes the influence on heart disease from earthquakes, hurricanes, pollution, financial disasters, wars, and COVID-19, a special case, in which the stress and anguish have inflicted severe isolation and loneliness on so many. Chapter 6 delves further into the epidemic of loneliness which affects people of all ages, particularly the elderly, leading to increased hospitalization, emergency room visits, and death. A chapter entitled “Depression and Its Cardiovascular Consequences” cites his own early experience in the US along with several statistical studies with many thousands of patients making the connection and describing how depression could lead to heart dysfunction.

Three chapters in a section termed “Causes” are rather technical in nature but provide necessary background information for patients who might be experiencing their first encounters with angina, a heart attack, or microvascular disease. Topics covered include symptoms, atherosclerosis, cholesterol levels, and a rather speculative section on the interaction between the brain, heart, and immune system. In Chapter 9, Mehta covers modifiable risk factors including smoking, hypertension, diabetes, high levels of bad cholesterol (LDL, low-density lipoprotein), low levels of good cholesterol (HDL, high-density lipoprotein), high triglycerides, obesity, sedentary lifestyle, and loneliness and depression as well as nonmodifiable ones such as age, male sex, family history of early coronary heart disease, and genetic factors. The chapter concludes with charts to calculate the patient's risk of an adverse event such as a heart attack with little more information than their age, cholesterol levels, and blood pressure, but these do not assess the influence of loneliness and depression. Mehta tackles stress as a primary culprit in the genesis of coronary heart disease in Chapter 10. He maintains stress and its consequences are more important than the risk factors cited in the previous chapter. He cites studies making the connection and describes how stress increases the release of catecholamines, cortisol, and growth factors and results in inflammation and platelet aggregation. He indicates that most physicians unfortunately do not assess the contributions of stress.

Mehta describes treatments in the final five chapters. In the first of these, he concentrates on various heart disease medications likely to be prescribed, along with common side effects for each. He also discusses surgical interventions such as coronary bypass surgery and stents and discusses the enormous costs of health-care treatments. Next, he similarly reviews drug therapy for the treatment of stress, along with vulnerability to addiction to antidepressants and anti-anxiety drugs. Chapter 13, “Non-Drug Therapies for Treatment of Stress”, is probably the most accessible to most readers and more useful. It covers the benefits of pets, talk therapy, sufficient sleep and physical activity, yoga, and meditation. The next chapter discusses dietary considerations for those with stress and heart disease. Mehta clearly believes that there have been a number of fad diets for these purposes that have either not been practical or successful in reducing stress or heart disease. He suggests that the success of certain diets in their localities may be more dependent on local customs which include strong social interaction during extended meals with small portions rather than being wolfed down as fast food. He is also more concerned with the imbalance between high caloric intake and insufficient exercise to work those calories off, generating our current epidemic of obesity and diabetes. Among the few foods, he claims there is sufficient evidence to endorse: those multicolored ones that are rich in antioxidants. Chapter 15 deals with the impact of attitude and support on coronary heart disease. Mehta believes a positive outlook accompanied by a daily routine with lots of social interaction and moderate exercise is more important than the type of diet itself. He also feels that helping others and community support can be very beneficial, particularly for the elderly without companions. He suggests that the prioritization of happiness for social welfare and mental health by the governments of Scandinavian countries could be very beneficial for us to reduce the detrimental effects of loneliness, stress, depression, and anxiety, even if costly to implement.

The material presented in the book is generally quite accurate and dense but succinct, although there are a few speculative sections. As Mehta humbly states in the introduction, some of these newer concepts may reflect personal biases and need more research. He raises as many questions as answers, and that is noteworthy. Sections of the book that are very detailed or daunting for some readers could be skipped on a first reading and reviewed later. Footnotes and websites also provide opportunities for further future reference. Many patients encountering heart disease for the first time could benefit the most, yet unfortunately, they would find much of the material overwhelming. Nevertheless, this is one-stop shopping about heart disease in a slim, readable format, a real tour de force. We recommend it to all Heart and Mind readers, to patients they would recommend it to, to all health-care professionals, to aging men and women at risk and their concerned spouses, and to overworked, overstressed individuals generally.


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