When my grandfather had congestive heart failure years ago, he dealt with it the way many men still do today: He ignored his condition as much as possible. He never complained about feeling weak. He resumed running his small business of window and carpet cleaning as he always had. He went to medical appointments and took his pills as he was told but never reached out for any emotional support until his heart disease finally caused his death.

That tight-lipped, tough-guy stance is a common one among male cardiac survivors, as well as men who are caring for others following heart attacks and strokes. In my grandfather’s case, it may even have led him to force himself back to work after the first episode in which his chest cavity filled with fluid from his heart and made it hard for him to breathe. But pushing on stoically may also have prevented him and many others with heart conditions from getting help they need and could even put them in harm’s way.

Denial and depression

“When I had my first heart attack and angioplasty at the age of 32 in 1989,’” explains Jang Jaswal, a 60-year-old man from San Jose, California, “I was in a kind of denial. After a few weeks, I ignored the fact that I had any cardiac issues and went about living my life without much difference. I even started drinking heavy.”

“I changed my attitude. I realized that I have to fight until the last moment.”

Decades of research have demonstrated that behavior matters greatly with how well men fare with heart disease — not just the choices they make with food, drink and medications but in their overall approach to managing their emotional health — including how readily they reach out to others for support. Avoidance and denial don’t generally work. Depression is three times more common in patients after an acute myocardial infarction than in the general community. Those who push away sad or anxious feelings and ignore doctors’ recommendations for support groups or mental health treatment put themselves at greater risk for subsequent cardiac problems and death.

Renewed life

In the years after his first heart attack, Jaswal suffered two more, as well as strokes and kidney failure. He became so depressed that he thought about stopping kidney dialysis and allowing himself to die. It took strong encouragement from family members and a course of psychotherapy to convince him to hang in there until he received heart and kidney transplants in 2013, giving him a new lease on life and renewed hope.

“I changed my attitude,” says Jaswal. “I realized that I have to fight until the last moment. That it’s not over till it’s over.” One thing that has helped Jang is connecting with others in similar health situations. By reaching out through the American Heart Association’s online support network, he has found a community of people who truly understand him. With a strong support system in place, Jang is able to avoid the risks associated with dealing with heart disease in isolation.