The 2025 European Society of Cardiology Clinical Consensus Statement on mental health and cardiovascular disease marks an important moment in cardiovascular medicine.1 It cements the long-observed, but often-neglected, relationship between mental and cardiovascular health. The statement acknowledges the complex and bidirectional relationship between mental health and cardiovascular disease (CVD), signalling a growing recognition that cardiovascular events and their outcomes cannot be divorced from the mental health of patients’ lives. This comprehensive document is a call to action for a fundamental shift in clinical practice towards an integrated, person-centred approach that acknowledges the multidirectional relationship between heart and mental health.
Establishing a Case for Integration
The consensus statement synthesises an extensive body of research demonstrating the reciprocal influence of mental health and CVD. Several key concepts merit highlighting:
- Subjective wellbeing protects cardiovascular health. Subjective wellbeing is associated with a lower risk of coronary heart disease and linked to a lower incidence of heart failure.2 This protective effect may be due to subjective wellbeing’s ability to buffer stress, which diminishes harmful physiological hyper-responsiveness, or by encouraging healthier lifestyle behaviours.3
- Mental health conditions increase cardiovascular risk. Depression, anxiety, post-traumatic stress disorder and chronic stress are consistently associated with a higher incidence of coronary artery disease, arrhythmias, heart failure and sudden cardiac death.4–6
- CVD worsens mental health. Acute cardiac events, such as MI or arrhythmia, often precipitate anxiety, depression and existential distress, while chronic conditions, such as heart failure, carry a high psychological burden.7
- The concurrence of CVD and mental health conditions worsens prognosis. Patients experience poorer quality of life, reduced adherence to treatment and worse clinical outcomes when both conditions co-occur.8
The Psycho-cardio Team and ACTIVE Principles
One key recommendation in the consensus is the establishment and operation of the psycho-cardio team. By advocating for multidisciplinary collaboration between cardiologists, nurses, psychologists, psychiatrists and allied professionals, the European Society of Cardiology provides a tangible framework to break down the silos that have historically fragmented patient care. The guidelines extend beyond emphasising the continuity of care for patients to encompass the care of caregivers, and the need for advocacy to improve cardiovascular and mental healthcare.
The proposed ACTIVE principles (Acknowledge, Check, Tools, Implement, Venture, Evaluate) offer a practical framework to guide clinicians in systematically integrating mental health into their routine workflow. The two-item questionnaires, such as the Whooley questions or the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2, are practical suggestions that can be implemented in busy practices. The stepped care model that is proposed takes into account people’s preferences, symptom severity and available resources, ensuring the best outcomes and sustainability of the initiative.
Mental Health and Cardiovascular Disease in Specific Populations
The consensus statement devotes significant attention to populations facing distinct challenges at the intersection of mental and cardiovascular health, which includes challenges faced by people with severe mental illness, older adults, migrants and refugees, those with cancer, and, importantly, the role of sex and gender in the interplay between mental health and CVD. This inclusive approach is both ethically and scientifically important, underscoring that equity in cardiovascular care must take into account the psychological and social realities, especially important in socially, economically and culturally diverse Asia.
Where are We in Asia-Pacific?
The relationship between mental health and CVD in Asia-Pacific is even less well understood than in the West. In part, this is due to the wide socio-economic disparity across the region. In underdeveloped or developing countries, education, access to basic necessities, earning an income and basic medical care are greater problems. In developed countries, while mental health is increasingly being recognised as a linchpin of overall health, there remains substantial stigma. Indeed, in Asia, several studies have highlighted the scope of the problem.9–12
How Do We Prioritise the Work Ahead?
We recognise that socio-economic factors significantly modify the relationship between mental health and CVD. For example, Wang et al. showed that older women with lower educational levels and lower household incomes were more affected.12 In this respect, there is ongoing research on the socio-economic determinants of health in CVD patients. Ongoing societal efforts in different countries to raise educational levels, reduce sex biases and prioritise economic growth will likely have a salutary effect.
In our opinion, of the various recommendations in the paper, the most important ones relate to the screening of mental health conditions in patients who are both healthy and those with CVD. Given the disparity of medical care across Asia-Pacific, the practical application of screening tools and subsequent follow-through will have to be individualised to individual national healthcare systems. Much work lies ahead.
Acknowledging the Research Gaps and the Way Forward
The guideline acknowledges the existing ‘dearth of research’ and ‘limited evidence’ base. The task force’s use of a modified Delphi process to generate the 34 consensus-based statements is a pragmatic solution where robust evidence is lacking.
Furthermore, there are knowledge gaps across several domains, including prevention and screening, clinical management, and healthcare systems and care delivery, perhaps even more complex in diverse Asia. There is a need for prospective longitudinal studies in the general population and in specific groups with different CVDs or mental health conditions, including severe mental illness. Randomised controlled trials that are larger and include more diverse patient samples are similarly needed. These trials should test the effectiveness and safety of a broad spectrum of medical and non-medical interventions, including psychological, educational, pharmacological and social approaches, to find what best prevents or reduces negative mental and cardiovascular outcomes.
The document also acknowledges the significant implementation challenges, including financial and cultural barriers. Integrating mental healthcare requires more than just clinical will; it needs structural and organisational changes, resource allocation, and a commitment from policymakers to fund and sustain these new models of care.
Conclusion
The 2025 European Society of Cardiology consensus statement is a landmark publication that will undoubtedly shape the future of cardiovascular care. While the path forward requires a concerted effort to build a stronger evidence base and overcome systemic barriers, it is a timely declaration that optimal cardiovascular care is impossible without addressing the patient’s psychological wellbeing.