The Bidirectional Relationship Between Mental Health and Cardiovascular Disease With Mary Branch, MD

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, speaks with Mary Branch, MD, a noninvasive cardiologist with subspecialty training in cardio-oncology, about the bidirectional relationship between cardiovascular disease and mental health. Branch, who trained at Case Western, Massachusetts General, UNC, and Wake Forest, built a cardio-oncology program at Cone Health in Greensboro, North Carolina, before relocating to practice in an underserved region of western Kentucky.

The conversation centers on how closely cardiovascular and psychiatric health are intertwined. Branch cites a study by Senoo et al in the Journal of the American College of Cardiology: Asia linking depression to subsequent cardiovascular disease, noting the association is particularly pronounced in women. She points out that fewer than 20% of patients with cardiovascular disease receive adequate treatment for co-occurring depressive symptoms, attributing the gap partly to patients misattributing anxiety-driven symptoms (such as palpitations) to cardiac causes, and partly to persistent stigma around mental illness. She also flags iatrogenic contributors, including cardiac and antipsychotic medications, and the role of social determinants of health.

On nutrition and food insecurity, Branch describes a gradual, culturally sensitive counseling approach rather than prescribing wholesale dietary overhauls: encouraging patients to halve portions, make small ingredient swaps (such as grilled or baked proteins in place of fried), and focus on a handful of meals they already enjoy, tweaked to be somewhat healthier.

Branch also discusses her path into cardio-oncology, sparked during internal medicine training when she found meaning in goals-of-care conversations with cancer patients. She describes the substantial mental health burden faced by patients managing both cancer and cardiovascular risk, particularly among breast cancer patients, and credits mentorship from women leaders in the still-emerging field.

Asked about alcohol, Branch notes that current hypertension guidelines lean toward abstention given cardiovascular risk, but frames occasional, moderate consumption as lower-risk than daily habitual drinking, which she suggests may signal an unaddressed mental health need.

Both clinicians advocate for closer collaboration between cardiology and psychiatry, including cross-referral relationships and joint educational events, to help identify patients whose symptoms may be psychiatric rather than cardiac in origin, and vice versa. Branch praises psychiatric colleagues' attentiveness to QTc-prolongation risk when prescribing psychotropic medications alongside cardiac care, and says the field's main need is greater psychiatric workforce capacity rather than any gap in current collaboration.

The episode closes with Branch reflecting on her legacy: a physician devoted to service, integrity, and building bridges across medical, racial, and societal lines, as a fourth-generation physician aiming to mentor others navigating similar paths.