Does Stress Really Cause Heart Disease?”
R.N. Fogoros, M.D.

Emotional stress - is it all bad? How does emotional stress cause heart problems?
From a scientific standpoint, we really don’t know for sure that it does. But we do know that people who live in a chronically stressed-out condition are more likely to take up smoking and overeating, and are far less likely to exercise.
We also know that the surge in adrenaline caused by severe emotional stress causes the blood to clot more readily, increasing the risk of heart attacks. A study at Duke University showed that the stress of performing difficult arithmetic problems can constrict the coronary arteries in such a way that blood flow to the heart muscle is reduced. So while it has not been proven scientifically that emotional stress causes coronary artery disease, a) it is associated with behaviors that do produce coronary artery disease, and b) there is suggestive evidence that it may even have a direct effect in producing coronary disease.

It has been observed for years, for instance, that many executives with high-pressure jobs seem to remain quite healthy until old age – they seem to flourish in their pressure-cooker jobs. Recent studies have shed light on this phenomenon.
It turns out that the type of emotional stress one experiences is important. In comparing the outcomes of individuals with different types of job-related stress, it was found that people with relatively little control over their own workplace destiny (clerks and secretaries for instance) fared far worse than their bosses. (Bosses, of course, tend to have more control over their own lives – and the lives of others. As someone once said, it’s good to be king.) A sense of loss of control, therefore, appears to be a particularly important form of emotional stress. Furthermore, this evidence seems to confirm that if some sense of control over one’s destiny is maintained, job related stress can be exhilarating rather than debilitating.

What can be done about emotional stress?
Actually, quite a bit of evidence suggests that it may be the individual, and not the stress itself that is the problem. People with Type A personalities (time-sensitive, impatient, chronic sense of urgency, tendency toward hostility, competitive) are at higher risk for coronary artery disease than people with Type B personalities (patient, low-key, non-competitive). In other words, given the same stressful situation, some will respond with frustration and anger, the rush of adrenaline and the fight-or-flight mode, and some will react serenely.
This is why the common advice to “avoid stress” is so useless. Nobody can avoid all stress without completely dropping out of society and becoming a monk. Besides, people of the Type A persuasion will create their own stressful situations. A simple trip to the grocery store will be filled with episodes of bad drivers, poorly-timed traffic lights, crowded aisles, indifferent checkout clerks, and thin plastic grocery bags that rip too easily. “The world is filled with half-brained incompetents whose only purpose is to get in my way,” they will conclude. “It’s a wonder any of them survived to adulthood.”

With this sort of mind-set, retiring, changing jobs, or moving to Tucson are not likely to significantly reduce stress levels – the stress will be there whether it is imposed externally, or whether you have to manufacture it. Reducing stress levels in these cases, then, requires not an elimination of stressful situations (which is impossible), but a change in the way stress is handled. Type A’s have to learn to become more B-like.

Essentially, new responses need to be learned, so that the fight-or-flight adrenaline surge is not automatically engaged at the first sign of trouble. Stress management programs have begun to demonstrate some success in accomplishing this end.

Stress management programs often consist of breathing exercises, stretching exercises, Yoga, meditation, and/or massage. There are probably several useful approaches, but they all aim toward the same goal – to blunt the adrenaline response to minor stress.

A recent study from Duke University reported a significant reduction in heart attacks among patients with coronary artery disease who underwent a formal stress management program, which was used in conjunction with a smoking cessation program, a weight-loss program, and control of lipids.

Recommendations
Stress management techniques may be quite helpful in reducing the risk of coronary events, and have the added benefit of being risk-free. Thus, there seems to be little reason not to recommend some form of stress management in people with heart disease, or with risk factors for heart disease. And finally, it should be pointed out that exercise is a great way of reducing chronic stress, and in addition has the advantage of directly lessening the risk of coronary artery disease, and helping to control obesity.