Are You Stressing Your Heart?

Between the economy, winter doldrums, and the latest episode of “Lost,” there is a lot to be stressed about these days. And you don’t need to be a doctor to know that stress manifests itself in many different ways, from the more obvious anxiety or depression to more subtle signs, like gastrointestinal distress, sleep disturbance, and yep – chest pain.

Scientific research tells us that stressful situations are associated with an increased risk of heart attacks. The best data has shown how large-scale natural and human disasters like tsunamis and terrorist attacks are correlated with more heart attacks and deaths from heart disease in the time period following these tragedies. This goes for people in the general vicinity as well as for others thousands of miles away. I imagine that we will be seeing similar data emerge in the aftermath of the recent events in Haiti.

While you might not be surprised by the impact of stressors of such magnitude, it is fascinating how every-day stressors can increase our overall cardiac risk as well. The stress of a job, marriage, or golf game in disrepair can result in depression, anxiety, and even anger (especially with golf), all of which may double or even triple our risk of having a heart attack. So what’s the missing link?

A recent study from the World Journal of Biological Psychiatry identifies several chemicals in our bloodstream that are associated with depression…and inflammation – the newest buzzword in cardiovascular disease research. We now recognize that medications may prevent heart attacks not just by lowering cholesterol or reducing blood pressure, but also by reducing inflammation. Interestingly, medications commonly used for depression and anxiety like serotonin reuptake inhibitors appear to reduce these chemical markers after several months of therapy. Larger scale studies of medication and cognitive behavioral counseling also provide some evidence that stress interventions may also reduce cardiac events.

On a more mundane level, stress also impacts the things we do every day. When your boss yells at you or your kids are “asserting their independence,” the last thing you want to do is reach for a handful of almonds – it’s not a coincidence that fast food, tobacco, and alcohol all do pretty well in a recession. Our coping mechanisms get the best of us sometimes, and unfortunately contribute to our health risks as well.

These relationships have led the American Heart Association to recommend that cardiologists routinely screen our patients for depression and social stressors that may be contributing to cardiac issues. I think we could be doing a better job. One of the side effects of our fragmented health care system is that specialists focus too narrowly on their organ system du jour and sometimes end up missing the forest for the trees. It turns out that there is a lot more to heart disease than just the heart. It might be time to give your health care providers a gentle reminder. But try not to stress them out…

- James Beckerman, MD, FACC

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