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Stress & Your Risk of Heart Attack

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There is a great deal of anecdotal observation linking prolonged levels of increased stress with cardiovascular events such as angina (chest pain due to narrowed coronary arteries), heart attack, stroke, and death due to these conditions. The precise mechanisms whereby chronic psychological stress increase cardiovascular-related disease and death are not completely understood at this time. During this prolonged period of pervasive stress and distress, as our nation confronts the worst economic crisis since the Great Depression, a timely research study on the topic of psychological stress and cardiovascular disease risk has just been published in the Journal of the American College of Cardiology.

In this prospectively conducted study, 6,576 clinically healthy men and women, with an average age of 50 years, were followed for an average of 7.2 years. At the onset of this clinical research study, extensive psychological and physiological and laboratory profiles were obtained on each patient volunteer. These profiles included previously validated psychological, behavioral and physical health questionnaires, as well as laboratory testing for C-reactive protein, cholesterol levels, and other cardiovascular disease risk factors. All patient volunteers were also evaluated for evidence of obesity and high blood pressure. After completing this comprehensive assessment of potential cardiovascular disease risk factors, these 6,576 men and women were carefully observed, for an average of 7 years, for the new onset of acute cardiovascular disease events, including heart attack (myocardial infarction) or the urgent need for angioplasty or coronary artery bypass surgery; as well as for the new onset of heart failure, stroke, or death due to an acute cardiovascular event.

During the course of this study, this cohort of middle-aged men and women experienced 223 acute cardiovascular events, 63 of which were fatal. The results of this clinical study, after analyzing the large amount of data collected, were both intriguing and instructive. First of all, high levels of psychological distress were closely linked with the following behavioral and physiological factors: an increased likelihood of smoking cigarettes, reduced levels of physical activity and exercise, elevated levels of serum C-reactive protein, and high blood pressure. A closer analysis of these same stress-associated factors revealed an even more important finding. The majority of the observed stress-associated risk for acute cardiovascular events was directly related to behavioral activities, while only a minority of the overall stress-related risk was linked to non-behavioral physiological causes.

Altogether, approximately 65 percent of the stress-associated risk for cardiovascular disease events in this large group of patient volunteers was linked to behavioral choices on the part of individuals, including an increase incidence of cigarette smoking and a decreased level of physical activity and exercise. Stress-related hypertension was judged to contribute about 13 percent of the overall risk of acute cardiovascular events observed in this study, while increased levels of the inflammatory C-reactive protein appeared to contribute to approximately 6 percent of the risk (both blood pressure and C-reactive protein levels have long been known to rise in response to stress, as well as in response to smoking).

This study is important, and for several reasons. In this study, the development of cardiovascular events, including death, were carefully followed in a thoroughly evaluated cohort of initially health middle-aged men and women, and this large group of patient volunteers were followed for, on average, the better part of a decade. All patient volunteers were carefully and comprehensively evaluated for both psychological and physiological abnormalities at the onset of the study. These research methods, therefore, provided a very rich and powerful set of data upon which this study’s conclusions are based.

We have long known that prolonged levels of psychological stress directly affect circulating levels of hormones and other stress-response proteins that can accelerate the development of cardiovascular diseases. However, importantly, this study reveals that engaging in risky health-related behaviors appears to underlie the overwhelming majority of the increased risk for cardiovascular disease that is associated with psychological stress, rather than non-behavioral stress-related physiological changes.

The results of this study suggest that the majority of stress-related cardiovascular disease risks can probably still be prevented simply by maintaining a healthy lifestyle and, most importantly, by refraining from unhealthy behaviors that tempt us when times are tough, and when we are feeling stressed. Even when you are feeling stressed, as much of nation is currently experiencing during the ongoing economic crisis, please abstain from tobacco, minimize red meat and other fatty foods in your diet, and avail yourself to whatever forms of moderate and frequent exercise are available to you (at least 4 to 5 times per week). If you have high blood pressure, or elevated serum levels of C-reactive protein or cholesterol, then ask your doctor to develop a treatment plan for you, and stick with this plan! If you are one of the estimated 48 million people in this country who, shamefully, do not have health insurance (or one of the many millions more who have completely inadequate healthcare insurance), you can still improve your blood pressure, and serum cholesterol and C-reactive protein levels, by cutting the fat and excess calories from your diet, and by exercising regularly and frequently, and by avoiding tobacco and excessive alcohol. As an added benefit, engaging in these relatively modest healthy lifestyle behaviors, you will also increase your ability to psychologically and emotionally cope with the high levels of stress that many of us are feeling these days.
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