Stress may be the worst enemy of your heart

You are probably familiar with these major risk factors for heart disease: high blood pressure, high cholesterol, smoking, diabetes, obesity, and sedentary lifestyle. Also, your doctor may have examined you more than once for these conditions and given advice to help prevent a heart attack or stroke. But has he also asked about the level of stress in your life?

Recent studies suggest that chronic mental stress may be just as important (and possibly more) important to your heart health than conventional risk factors.

In people who do not have a completely healthy heart, psychological stress, as a trigger for fatal and non-fatal heart attacks and other cardiovascular events, outweighs physical stress, according to a new report.

A new study published in the November issue of the journal JAMA assessed the fate of 918 patients with stable heart disease to see how their bodies respond to physical and mental stress.

Participants underwent standard physical and psychological stress tests to determine if their hearts had myocardial ischemia (a significant reduction in blood flow to the heart muscle that could trigger cardiovascular events) during physical and mental stress. The researchers then followed them for 4 to 9 years.

In participants who experienced ischemia, an adverse reaction to psychological stress had a greater negative impact on patients’ hearts and lives than physical stress. They were more likely to have a non-fatal heart attack or die of cardiovascular disease in later years.

“I wish I knew that in 1982 when my father had a heart attack that was about to kill him,” says Jane E. Brody, author of The New York Times. After leaving the hospital, he was warned about excessive physical stress, such as not lifting heavy objects. But he was never warned about unnecessary emotional stress or the dangers of overreacting to boring situations, such as when the driver ahead of him was driving too slowly in a restricted area.

The new findings underscore the results of a previous study that assessed the relationship between risk factors and heart disease in 24,767 patients from 52 countries. This study showed that patients who experienced high levels of psychological stress during the year before enrollment were more likely to have a heart attack during the five-year follow-up, even when conventional risk factors were considered. It was double.

“Stress is an independent risk factor for heart attacks, which is similar to the cardiovascular risks that are commonly measured in terms of the devastating effects on the heart,” explained Dr. Michael T. Osborne, a cardiologist at Massachusetts General Hospital.

But how does stress affect people whose hearts are still healthy?

There are different types of psychological stress. Stress can occur acutely as a result of events such as job loss, the death of a loved one, or the destruction of a home during a natural disaster. A recent Scandinavian study found that in the week after a child died, the risk of heart attack in parents was more than three times the expected rate.

Emotional stress can also be chronic. For example, chronic stress can be caused by persistent economic insecurity, living in an area with a high crime rate, or experiencing depression or restless anxiety. The bereaved parents in the Scandinavian study continued to be at high risk for cardiac events for many years to come.

How stress affects the heart

Dr. Osborne and a team of experts led by Dr. Ahmed Tavakol of Massachusetts General Hospital conducted an analysis to understand how the body responds to psychological stress. “There is a lot of evidence that the brain and body react strongly to chronic psychological stress,” he said, “that modern medicine has neglected one of the most important risks to heart health.”

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It all starts at the center of fear in the brain called the amygdala. The amygdala responds to stress by activating the fight or flight response, releasing hormones that over time can increase body fat levels, blood pressure, and insulin resistance. In addition, the cascade of stress reactions causes inflammation in the arteries, increased blood clotting, and dysfunction of blood vessels, all of which contribute to arteriosclerosis. Arteriosclerosis is the disease that causes most heart attacks and strokes.

Advanced neuroimaging has made it possible to directly measure the effect of stress on various tissues in the body, including the brain. A study of 293 people who initially had no cardiovascular disease and underwent a full body scan showed enlightening results. People with high amygdala activity were shown to have higher levels of inflammation and arteriosclerosis five years later.

Interpretation: Those with high levels of emotional stress had biological evidence of cardiovascular disease. In contrast, people with less stress were less likely to experience the pathogenic effects of stress on the heart.

Researchers are studying the effects of the SMART-3RP stress reduction program on the brain, as well as biological factors that enhance arteriosclerosis. This program is designed to help people reduce stress and create resilience through mind and body techniques such as mindfulness-based meditation, yoga and tai chi. Such actions activate the parasympathetic nervous system and calm the brain and body.

Stress release and its effects

Even without a formal plan, people can reduce the heart’s destructive reactions to stress, says Dr. Osborne. One of the best ways to do this is to exercise regularly, which can help reduce stress and inflammation in the body.

Due to the fact that poor sleep increases stress and contributes to arterial inflammation, developing good sleeping habits can also reduce the risk of cardiovascular damage. Establish a consistent pattern of sleep-wake time, and avoid exposure to blue-light displays, such as smartphones and computers, or use blue-light filters for such devices. Also, practice relaxation activities such as mindfulness meditation, relaxation techniques that slow down breathing, yoga and tai chi.

Dr. Osborne says several common medications can also help. Statins not only lower cholesterol but also fight arterial inflammation and have positive cardiovascular effects. Antidepressants, including ketamine, may also help reduce amygdala overactivity and stress in people with depression.

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