What your heart’s worst enemy stress

You’re probably familiar with these major risk factors for heart disease: high blood pressure, high cholesterol, smoking, diabetes, obesity, and physical inactivity. And chances are your doctor has checked you more than once for these risks and, I would hope, offered advice or treatment to help ward off a heart attack or stroke.

 But has your doctor also asked about the level of stress in your life? Chronic psychological stress, recent studies indicate, may be as important — and possibly more important — to the health of your heart than the traditional cardiac risk factors. In fact, in people with less-than-healthy hearts, mental stress trumps physical stress as a potential precipitant of fatal and nonfatal heart attacks and other cardiovascular events.

Among the study participants who experienced ischemia during one or both tests, this adverse reaction to mental stress took a significantly greater toll on the hearts and lives of the patients than did physical stress. They were more likely to suffer a nonfatal heart attack or die of cardiovascular disease in the years that followed.

The new findings underscore the results of an earlier study that evaluated the relationship between risk factors and heart disease in 24,767 patients from 52 countries. It found that patients who experienced a high level of psychological stress during the year before they entered the study were more than twice as likely to suffer a heart attack during an average follow-up of five years, even when traditional risk factors were taken into account.

But what about the effects of stress on people whose hearts are still healthy? Psychological stress comes in many forms. It can occur acutely, caused by incidents like the loss of a job, the death of a loved one, or the destruction of one’s home in a natural disaster. A recent study in Scandinavia found that in the week following a child’s death, the parents’ risk of a heart attack was more than three times the expected rate. Emotional stress can also be chronic, resulting, for example, from ongoing economic insecurity, living in a high-crime area, or experiencing unrelenting depression or anxiety. Bereaved parents in the Scandinavian study continued to experience an elevated cardiac risk years later.

How stress damages the heart It all starts in the brain’s fear center, the amygdala, which reacts to stress by activating the so-called fight-or-flight response, triggering the release of hormones that over time can increase levels of the body fat, blood pressure, and insulin resistance. Furthermore, as the team explained, the cascade of reactions to stress causes inflammation in the arteries, fosters blood clotting, and impairs the function of blood vessels, all of which promote atherosclerosis, the arterial disease that underlies most heart attacks and strokes.

Defusing the stress given that poor sleep increases stress and promotes arterial inflammation, developing good sleep habits can also reduce the risk of cardiovascular damage. Adopt a consistent pattern of bedtime and awakening and avoid exposure at bedtime to screens that emit blue light, like smartphones and computers, or use blue-light filters for such devices.