Women’s heart disease and chronic stress

by Carolyn Thomas  ♥ @HeartSisters

Cardiology researchers have recently begun calling on doctors to include the diagnosis and treatment of stress in the routine care for patients with heart disease.

A study published in the Journal of the American Medical Association, led by researchers at Université Laval in Quebec City, found that first-time heart attack survivors who returned to chronically stressful jobs within 18 months of their heart attacks were twice as likely to have a second heart attack as patients whose occupations were less stressful, and also had a markedly higher risk of death than their less-stressed peers.  

Stockholm’s Dr. Kristina Orth-Gomer, who has studied stress and cardiology for over 25 years, claims that, although we know that chronic stress is a risk factor for heart disease, physicians are slow to include stress assessment into patient care.

It’s not yet standard practice for cardiologists to evaluate a heart patient’s ability to cope with a stressful job, a difficult marriage, financial or family issues, or caring for aging parents. But doctors should be asking questions about work and home life stressors as part of routine cardiac care, says Dr. Orth-Gomer.

Well, maybe not, says Dr. Daniel Brotman of Johns Hopkins Hospital and author of a review paper on emotional stress and heart health published in The Lancet. The problem, he claims, is that many doctors don’t have the time to ask.  (See also: When Are Cardiologists Going To Start Talking About Depression?)

Highly specialized physicians like cardiologists are very busy, Dr. Brotman says, and few of them have time for leisurely doctor-patient conversations. He acknowledges the strong link between stress and cardiovascular disease, but he wonders if it’s realistic to ask doctors to screen every patient for stress.

He maintains that what can be changed, however, is the way doctors listen to their patients’ health concerns.

If a woman complains of chest pain, for example, but says it only bothers her when she’s feeling “worked up” — but not on the treadmill or climbing a flight of stairs — her physician should interpret her emotional state as a real, physical risk factor, says Dr. Brotman.

“The trigger is emotional, and physicians tend to blow that off. Traditional Western medicine has really endeavored to think of the body as a machine, and disease as how the machine breaks down. Doctors can be reluctant to think of the mind and body as being part of that same machine.”

But how can they be otherwise?  People under chronic stress often:

• neglect their health in general
• eat poorly
• sleep badly
• don’t exercise
• smoke, drink or take drugs to excess

All of these factors put us at additional risk for heart disease and stroke.

Stress also triggers the body’s endocrine systems, prompting the release of hormones that can irritate lymphatic tissue that in turn alters our immune functions, or they might cause the resting heart to beat faster or raise blood pressure and LDL ‘bad’ cholesterol levels. Dr. Brotman explains:

“Anybody who has narrowly avoided a car accident knows how much emotional stress can rev up your cardiovascular system. But having very frequent or ongoing bouts of  ‘fight or flight’ is not something the human body is designed to do.”

That’s where chronic stressors can become deadly threats to our hearts. Unmanaged stress, especially stress-related anger and hostility, can affect our health. It may cause:

• high blood pressure
• irregular heart rhythms
• damage to our arteries
• higher cholesterol levels
• the development and progression of coronary artery disease (atherosclerosis)
• a weakened immune system

Dr. Brotman adds that patients themselves may be reluctant to report the actual severity of these existing stressors. For some, admitting this feels like a sign of weakness; others resign themselves to this state, as if chronic stress were an unavoidable dimension of life. They simply carry on with 15-hour+ hamster-wheel workdays or endure unhealthy relationships, as if these were perfectly normal.

In another study published in The Archives of Internal Medicine, researchers at the University College of London followed a group of 9,000 civil servants for 12 years and found that those who experienced negative close relationships marked by conflict had a 34% higher risk of suffering a coronary event than those with low levels of negative relationships. The emotions that play out in a bad marriage, for instance, can have a direct, cumulative ‘wear and tear’ effect on organs and tissues that leaves people at greater risk of serious illness.

The Cleveland Clinic, widely considered the #1 heart institute in North America, offers these strategies for managing stress to improve cardiovascular health.

See also:

• Just Not Listening – or “Narrative Incompetence”?
• Is Family Stress Hurting Your Heart?
• Poor Marriage = Poor Heart Health for Women
• 28 Ways to De-Stress – by Tonight!
• A Heart Patient’s Guide to the Three Stages of Chronic Stress
• Not Just For Soldiers Anymore: post traumatic stress disorder after a heart attack
• Even heart patients can learn to be optimists
  
• How two cardiologists discovered Type A (and the surprising reasons Big Tobacco helped fund them for decades)
  

© Carolyn Thomas  www.myheartsisters.org