Stress may be your heart’s worst enemy

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, according to the latest report.

The new
study, published in November in JAMA, assessed the fates of 918 patients known
to have underlying, but stable, heart disease to see how their bodies reacted
to physical and mental stress. The participants underwent standardized physical
and mental stress tests to see if their hearts developed myocardial ischemia —
a significantly reduced blood flow to the muscles of the heart, which can be a
trigger for cardiovascular events — during either or both forms of stress. Then
the researchers followed them for four to nine years.

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.

I wish I had
known that in 1982, when my father had a heart attack that nearly killed him.
Upon leaving the hospital, he was warned about overdoing physical stresses,
such as not lifting anything heavier than 30 pounds. But he was never cautioned
about undue emotional stress or the risks of overreacting to frustrating
circumstances, such as when the driver ahead of him drove too slowly in a
no-passing zone.

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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.

The study,
known as Interheart, showed that psychological stress is an independent risk
factor for heart attacks, similar in heart-damaging effects to the more
commonly measured cardiovascular risks, explained Dr Michael Osborne, a
cardiologist at Massachusetts General Hospital.

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 such as 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 after 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.

participated with a team of experts led by Dr. Ahmed Tawakol, also at
Massachusetts General, in an analysis of how the body reacts to psychological
stress. He said the accumulated evidence of how the brain and body respond to
chronic psychological stress strongly suggested that modern medicine had been
neglecting a critically important hazard to heart health.

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It all starts
in the brain’s fear centre, 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 body fat, blood pressure and insulin

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.

team explained that advanced neuroimaging made it possible to directly measure
the impact of stress on various body tissues, including the brain.

A prior
study of 293 people initially free of cardiovascular disease who underwent
full-body scans that included brain activity had a telling result. Five years
later, individuals found to have high activity in the amygdala were shown to
have higher levels of inflammation and atherosclerosis.

Those with an elevated level of emotional stress developed biological evidence
of cardiovascular disease.

In contrast,
Osborne said, “people who are not tightly wired” are less likely to experience
the ill heart effects of stress.

researchers are now investigating the impact of a stress-reducing program
called SMART-3RP (which stands for Stress Management and Resiliency
Training-Relaxation Response Resiliency Program) on the brain as well as
biological factors that promote atherosclerosis.

The program
is designed to help people reduce stress and build resilience through mind-body
techniques such as mindfulness-based meditation, yoga and tai chi. Such
measures activate the parasympathetic nervous system, which calms the brain and

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Even without
a formal program, Osborne said people could minimise their body’s
heart-damaging reactions to stress. One of the best ways is through habitual
physical exercise, which can help to tamp down stress and the bodywide
inflammation it can cause.

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, such as smartphones and computers, or use
blue-light filters for such devices.

relaxing measures such as mindfulness meditation, calming techniques that slow
breathing, yoga and tai chi.

common medications can also help, Osborne said. Statins not only reduce
cholesterol, they also counter arterial inflammation, resulting in a greater
cardiovascular benefit than from their cholesterol-lowering effects alone.
Antidepressants, including the anesthetic ketamine, may also help to minimise
excessive amygdalar activity and ease stress in people with depression.

© 2022 The
New York Times Company

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