Stress: As dangerous as high cholesterol and blood pressure

According to a study released in January 2017 by the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. Many of my patients know they’re at risk for heart disease, and we work together to lower their risk by controlling their risk factors, including high blood pressure and high cholesterol.

But these aren’t the only risk factors to watch out for. People with constantly high levels of stress double their risk of heart disease. That’s equal to the risk from high cholesterol and high blood pressure. And according to real estate blog Movoto, Washington, D.C., is the most stressed-out city in the nation.

How stress may affect the heart

We’ve known about the link between stress and heart health for some time. Experts at the American Heart Association note the importance of managing stress to prevent heart disease. And in 2015, an international group of researchers identified emotional shocks as the second leading cause of stress cardiomyopathy, or broken-heart syndrome. This condition is a special kind of heart attack that isn’t caused by blockages in the heart arteries. Instead, broken-heart syndrome can happen when someone sees or learns of something traumatic, such as the death of their child.

Though we’ve known that stress can affect heart health for some time, we haven’t understood the mechanics behind how this happens. But we may be close to a breakthrough in that area of research. In January 2017, researchers showed the area of the brain called the amygdala is associated with the risk of heart disease and stroke. The amygdala contributes to the brain’s processing of emotions and helps communicate with the rest of the body on whether to get away from stress or handle it head-on. This is what many people know as the “fight or flight” response.

So we know stress is dangerous, and we have an idea of why. The question then becomes: What do we do about it? I wish I could say that we should just not have any stress. The reality is that sort of advice isn’t practical. We can’t avoid all stress in our lives.

But when it comes to your heart’s long-term health, not all stress is created equal. Some types of stress are much worse than others. It’s important to recognize these different types of stress so you can get help from your doctor before your heart is at risk.

Types of stress

I think most people would agree with me that stress is bad for you. And I think most people also would agree that stress is a part of life we simply can’t avoid. Stressors like a bad commute, a rough day at work or an argument with your spouse are part of what life throws at us.

Most sources of stress are like these. They pop up, we deal with them, and we move on. These short, intermittent episodes of stress aren’t really a problem for your heart. Even stress that comes up on a regular basis, such as rushing to get the kids to soccer practice every Tuesday, isn’t that bad for you.

The main danger of stress to your heart is when you’re constantly in a stressful situation you can’t control or get away from. We call this uncontrolled, unrelieved stress. Some examples of these types of uncontrolled stress include:

  • A terrible work environment
  • An abusive relationship
  • Ongoing depression
  • Ongoing serious financial trouble

Though these are very different causes of stress, your body can’t tell the difference. In these situations, all your body knows is that you’re under severe chronic stress that you don’t feel you can escape. And that’s a major red flag for your heart health. You need to talk to your doctor if you’re in these or similar types of stressful situations.

Get help to find stress relief

Patients don’t talk to their doctors enough about stress. A lot of patients don’t like to talk about stress with their doctors—certainly not doctors who aren’t psychiatrists or psychologists. There’s not enough time in the course of a normal visit, or they don’t think it’s a medical problem. But stress absolutely is a medical problem!

And just as patients should be willing to talk to their doctors about stress, we doctors should be asking our patients about stress. That should be part of our care for people’s overall heart risk.

When a patient brings up a source of severe stress with me, I’m always grateful. I try to point them toward resources or come up with strategies for stress management. That’s part of my job as their doctor.

It might be tempting to think, “But you can’t help me get out of my debt. You can’t fix the stress. Why bother?” And no, we can’t remove sources of stress that way, but if we identify it as a problem for your heart, it might be something you can focus on to find a solution.

We also can refer patients to get professional help for their stress from mental health professionals, if necessary, or find other ways to resolve these sources of anxiety and worry. But if it’s really to that level that you feel like you can’t control this stress, you probably need to get some help.

Recognize and address stress

Some people are more aware of stress than others. Just like beauty, stress is in the eye of the beholder. What one person might think of as no big deal could be a source of extreme stress for another person.

But some people who think they’re handling their stress might just be ignoring or suppressing it. That’s a big problem, because those people aren’t recognizing the effects of their stressors on their lives or doing enough to address it.

Whether or not you think you’re stressed, use these simple assessments to measure the stress levels in your life. You might be surprised by what you find. If your stress levels are high, talk to your doctor about it, especially if you’re already being seen by a cardiologist for a heart condition.

Stress isn’t just in your head. It’s a real, physical, medical problem. And leaving severe stress untreated could lead to your heart paying the price.

 

Chief of Cardiology, MedStar Heart & Vascular Institute at MedStar Washington Hospital Center
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