Updated: Sep 15
Stress is an integral part of our lives. A bit of stress is almost unavoidable. Let us see how stress shapes our health, focusing today on the heart.
Medical research on " stress" has focussed on "job stress", which is characterized by high demand, low control and low social support at work, imbalance between effort and reward. Other types of well studied stress are " caregiver stress", that comes from taking care of a loved one with chronic illness, for example, dementia. Last but not the least, stress related to social isolation and loneliness, is an exponentially growing problem in today's society, both amongst the old and the young.
Stress exposure causes part of our brain (hypothalamus) to trigger stress hormone release and activation of the " fight or flight response" , that affects many organs, including our nervous system, metabolism and heart.
1) Chronic low level stress is thought to increase blood pressure, raise sugar level by making bodily-insulin less effective, increase clotting, and destabilize the lining of our blood vessels. Chronic stress has been studied and thought to increase risk of heart disease anywhere between 40% to 60%, compared to those without stress.
2) Chronic stress makes us fall back to unhealthy habits like, smoking, drinking alcohol, or not be physically active. Long working hours, especially > 11 hours per day is associated with shortened sleep duration and increased sleep disturbance.
3) Acute stress can cause heart attacks, strokes or sudden cardiac death. This was first studied systematically after a major earthquake in Athens in 1981. An excess of cardiac death was found over the 3 days that followed. Over the years, other disasters like major industrial accidents, wars and terrorist attacks have been related to increased cardiac deaths as an aftermath.
There is good amount of literature describing stress induced heart attacks, where no blockages are found on subsequent heart catheterization and the attack is thought to be caused by spasm of the arteries driven by stress hormones. This is more common in women.
Interesting literature from Witte et al showed risk of death from heart attack or stroke was increased 51% among Dutch men >=45 years, on the day on which the Dutch soccer team lost to the French under dramatic circumstances during 1996 European Cup. No equivalent increase was seen amongst the women. Subsequent study in Munich showed peak in cardiac emergencies on days that Germany played in 2006 World cup soccer (2.66 times higher than on other days).
4) Stress and lack of social support can delay recovery and rehabilitation amongst survivors of acute heart attacks and strokes.
So what can be done about this?
First step is recognizing that along with other risk factors, stress plays an important role in shaping our health outcomes.
It may not be completely possible to eliminate stress, but there are ways to reduce stress.
Exercise, socialization, good sleep, good nutrition and having hobbies outside of work can reduce stress.
Social support and personality traits such as optimism and developing ability to cope flexibly with challenges can help .
Participating in cardiac rehabilitation after a heart attack improves survival, in many ways, and psychological support is one of them.
Relaxation training, stress management training and psychological therapy may help. The efficacy data is somewhat equivocal and the commitment required often makes it
Acknowledgment: Nature, cardiology review. Article authored by Steptoe and Kivimaki.