Chronic Stress Raises Your Risk of Several Types of Cardiovascular Disease
- Recent research shows people with stress related disorders are 29% more likely to develop cardiovascular disease compared to a sibling without a stress disorder, and 37% more likely compared to the general population
- Within the first year of a stress diagnosis, the risk for cardiovascular disease is even greater — 64% greater than that of a sibling and 71% greater than the general population. The link is also particularly strong for those under the age of 50
- Previous research has demonstrated that stress increases your risk of heart attack and stroke by causing overactivity in your amygdala, your brain’s fear center
- As your stress level rises, so does your level of disease-promoting white blood cells, and this is yet another way by which stress can lead to atherosclerosis, plaque rupture and heart attack
- During moments of high stress your body also releases norepinephrine, which can disperse bacterial biofilms from the walls of your arteries, allowing plaque deposits to suddenly break loose, thereby triggering a heart attack
Stress has enormous implications for your health. From an evolutionary perspective, the stress response is a lifesaving biological function that enables you to instinctively square-off against an assailant, run away from a predator or take down a prey.
However, those of us living in the modern world are now activating this same biological reaction in response to activities and events that have no life-threatening implications whatsoever, from speaking in public to filling out tax forms to sitting in traffic jams.
The sheer number of stress-inducing situations facing us on a daily basis can actually make it difficult to turn the stress response off, and marinating in corrosive stress hormones around the clock can have very serious consequences for your health.
Stress Is ‘Robustly Associated’ With Cardiovascular Disease
Recent research1 again highlights the health risks of chronic stress, as data show people with stress related disorders are 29% more likely to develop cardiovascular disease compared to a sibling without a stress disorder, and 37% more likely compared to the general population.
Cardiovascular diseases included ischemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive disease, heart failure and arrhythmia/conduction disorder.
The study, published in the BMJ, compared health data on 136,637 Swedes diagnosed with a stress disorder — including acute stress reaction, post-traumatic stress disorder and adjustment disorder — with 171,314 siblings and 1.3 million people in the general population that did not have a stress-related disorder.
Interestingly, within the first year of a stress diagnosis, the risk for cardiovascular disease was even greater — 64% greater than that of a sibling and 71% greater than the general population. The link was also particularly strong for those under the age of 50. According to the authors:2
“Most people are, at some point during their life, exposed to psychological trauma or stressful life events such as the death of a loved one, a diagnosis of life threatening illness, natural disasters, or violence.
Accumulating evidence suggests that such adversities might lead to an increased risk of several major diseases (including cardiovascular morbidity, injury, infection, and certain autoimmune diseases but not cancer) and mortality, with the largest risk elevations usually noted among people who develop psychiatric disorders as a result of their trauma …
Stress related disorders are robustly associated with multiple types of cardiovascular disease, independently of familial background, history of somatic/psychiatric diseases, and psychiatric comorbidity …
In addition, patients with stress related disorders tended to have a higher burden of somatic diseases at the index date and a lower family income level, and to be more likely to be divorced or widowed, compared with their unaffected siblings or matched unexposed people …
These findings call for enhanced clinical awareness and, if verified, monitoring or early intervention among patients with recently diagnosed stress related disorders.”
How Stress Affects Your Cardiovascular Health
As noted in the featured study3 and elsewhere,4 while there are still unanswered questions, a number of mechanisms have been proposed to explain the link between stress and cardiovascular disease. Among them:
•Increased blood pressure caused by acute stress can set the stage for acute cardiovascular events; long term, elevated blood pressure can lead to endothelial dysfunction and arteriosclerosis
•Chronically elevated cortisol, released in response to stress, can also raise triglycerides and blood sugar, which like high blood pressure are risk factors for heart disease
•Biological stress reactions can also over time trigger other risk factors for cardiovascular disease, such as:
◦Hypothalamic-pituitary-adrenal axis dysregulation
◦Altered neurochemistry that contributes to negative behavior such as smoking and poor sleep habits
◦Plaque buildup in your arteries
High-Stress Lifestyle Linked to Higher Risk of Heart Attack and Stroke
There’s no shortage of evidence showing that stress impacts your heart health. Previous research5has demonstrated that stress increases your risk of heart attack and stroke by causing overactivity in your amygdala.
Known as your brain’s fear center, this brain region, located in your temporal lobe, is activated in response to both real and perceived threats. It’s also involved in the processing of other emotions, including positive ones, as well as emotional memories of all kinds. One of its most basic jobs, though, is to keep you safe by biochemically preparing you to fight or flee as needed.
In this particular study, inflammation levels and brain and bone marrow activity of 293 participants were measured. All were over the age of 30, and none had a diagnosed heart problem. By the end of the observation period, which lasted between two and five years, 22 participants had experienced a serious cardiac event such as heart attack, stroke or angina (chest pain).
Based on brain scans, the researchers were able to conclude that those with higher activity in the amygdala were at an elevated risk of a cardiac event. As it turns out, there appears to be a significant correlation between amygdala activity and arterial inflammation — triggered by immune cell production in your bone marrow — which is a risk factor for heart attack and stroke.
This was confirmed in a sub-study involving 13 patients with a history of PTSD.6 Here, levels of C-reactive protein were also measured, showing those with the highest stress levels also had the highest amygdala activity and higher levels of inflammatory markers. Lead author Dr. Ahmed Tawakol from Massachusetts General Hospital and Harvard Medical School, told Science Daily:7
“Our results provide a unique insight into how stress may lead to cardiovascular disease. This raises the possibility that reducing stress could produce benefits that extend beyond an improved sense of psychological wellbeing. Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major cardiovascular disease risk factors.”
Ilze Bot, Ph.D., a Dutch biopharmaceutical researcher who wrote an accompanying commentary to the study, added:8
“In the past decade, more and more individuals experience psychosocial stress on a daily basis. Heavy workloads, job insecurity, or living in poverty are circumstances that can result in chronically increased stress
These clinical data establish a connection between stress and cardiovascular disease, thus identifying chronic stress as a true risk factor for acute cardiovascular syndromes, which could, given the increasing number of individuals with chronic stress, be included in risk assessments of cardiovascular disease in daily clinical practice.”
Other Ways Stress Can Trigger a Heart Attack
Stress can also promote or trigger a heart attack in other ways. For example, studies9 have shown that as your stress level rises, so does your level of disease-promoting white blood cells, and this is yet another way by which stress can lead to atherosclerosis, plaque rupture and myocardial infarction.
During moments of high stress your body also releases norepinephrine, which researchers claim10can cause the dispersal of bacterial biofilms from the walls of your arteries. This dispersal can allow plaque deposits to suddenly break loose, thereby triggering a heart attack.
A sudden release of large amounts of stress hormones and rapid elevations in blood pressure may even trigger a heart attack or stroke even if you don’t have an underlying heart problem. In the case of broken heart syndrome, the symptoms of a heart attack occur even though there’s no actual damage to the heart at all.
According to the British Heart Foundation,11 broken heart syndrome — clinically known as Takotsubo cardiomyopathy — is a “temporary condition where your heart muscle becomes suddenly weakened or stunned.” The left ventricle (your heart’s largest chamber) also changes shape, which adds to the temporary dysfunction.
This sudden weakness of the heart is thought to be due to the sudden release of large quantities of adrenaline and other stress hormones. Adrenaline increases your blood pressure and heart rate, and it’s been suggested it may lead to narrowing of the arteries that supply blood to your heart, or even bind directly to heart cells allowing large amounts of calcium to enter and render the cells temporarily unable to function properly.
While most will successfully recover, in some, the change of shape of the left ventricle can trigger a fatal heart attack. Having a history of neurological problems, such as seizure disorders and/or a history of mental health problems is thought to raise your risk.12 On the upside, while the condition can be life-threatening and requires immediate medical attention, it’s usually a temporary condition that leaves no permanent damage.
Sports Fanatics Beware
Another paper13 looking at stress and sudden heart events noted the risk of heart attack and stroke was greater following emotionally intense sporting events, such as European soccer games. As noted by the authors:
“One of the first studies was from the Netherlands, in which mortality from coronary heart disease and stroke was found to be increased in men on the day of an important football match between the Netherlands and France in the 1996 European football championship tournament. There was no similar increase found in women, nor on any of the other days in which the Dutch played a football game in that tournament.
The increase occurred on the day the Dutch played their one game that ended in a penalty shoot-out, a do-or-die situation in which the winner of the game is determined in dramatic fashion. The study investigators proposed that the heightened intensity of the game and resultant outcome (the Dutch lost) may have been responsible for the 14 excess deaths caused by coronary heart disease and stroke in the Netherlands that day …
A subsequent study from England showed that admissions from acute MI were increased by 25% on the day of and two days after England lost to Argentina in the 1998 World Cup in yet another game that ended in a penalty shoot-out.”
The researchers detail several potential mechanisms by which watching sporting events could contribute to cardiac events, including:
- Sympathetic nervous system stimulation, which can increase coronary vascular tone, thereby reducing your relative oxygen supply. At the same time, your level of circulating catecholamines (“induced by the emotional involvement in the game”) increases, which raises your need for oxygen by raising heart rate and blood pressure
- Increased ventricular inotropy and changes in coronary tone may alter “the shear stress of blood against a vulnerable atherosclerotic plaque, contributing to plaque fracture”
- Increased concentrations of catecholamines can also trigger arrhythmias and increase platelet aggregation — a part of the sequence of events that lead to the formation of a blood clot
High Resting Heart Rate Linked to Early Death
In related news, researchers also warn that having a high resting heart rate may affect your longevity. Middle-aged men with a resting heart rate of 75 beats per minute (bpm) were twice as likely to develop heart disease and die early than those with a resting heart rate around 55 bpm.14
They also found that those whose resting heart rate remained stable during the decade between their 50s and 60s had a lower risk of cardiovascular disease than those whose resting heart rate rose over time. As reported by Newsweek:15
“The researchers believe this could be because a high resting heart rate may put the heart under stress and increase oxygen consumption. It has also been linked to sympathetic overactivity where the nervous system works too hard, which is tied to conditions that affect the heart such as high blood pressure and metabolic syndrome.”
Another study found that boosting your cardiorespiratory fitness may reduce your risk of heart attack, especially for women. According to lead author Rajesh Shigdel, the results suggest your cardiorespiratory fitness — which reflects the maximum amount of oxygen your body is able to use during exertion — could be used “as a risk calculator for first heart attacks.”16
Women with the highest cardiorespiratory fitness levels were 25% less likely to have a heart attack than those with low cardiorespiratory fitness. Among men, high levels were slightly less effective for lowering their risk of heart attack at 10%. According to Shigdel, “People who want to increase cardiorespiratory fitness should strive to be physically active at least 150 minutes each week and minimize time spent being sedentary.” 17
Recognizing Signs of Stress
Many have gotten so used to being wound up into a stress-knot, they don’t even realize the position they’re in. So, the first step is to recognize that you’re stressed, and then take steps to address it. Common signs and symptoms of stress include:18
|Sleeping poorly; trouble falling asleep; excessive tiredness||Binge drinking|
|Lack of appetite or overeating||Having a “short fuse” / being quick to anger or losing your temper|
|Feeling overwhelmed, sad or irritable; frequent crying or quick to tears||Headaches and/or general aches and pains|
Lower Acute Stress With Proper Breathing
As mentioned earlier, stress is associated with an overactive amygdala, which when triggered by a real or perceived threat, causes oxygen to be shunted from your internal organs, including your brain, to your extremities. Essentially, your body is prepared for fighting — not thinking.
However, critical thinking is really what’s required when facing a stressful situation in today’s world. Fist-fighting is not the most appropriate solution when faced with traffic jams or interpersonal difficulties, for example, yet because of the stress response, your brain has been largely shut off.
Step 1, then, is to bring oxygen back to your brain, which you can do through some simple breathing exercises. You may want to experiment with a few different ones to see if one works better than another. Following are three variations that can do the trick. Breathing technique No. 1:
- Simply breathe in to a count of four
- Hold your breath for another count of four
- Breathe out to the count of four
- Hold again for a count of four
Another one I like is the 4-7-8 breathing exercise taught by Dr. Andrew Weil.
- Sit up straight and place the tip of your tongue up against the back of your front teeth. Keep it there through the entire breathing process
- Breathe in silently through your nose to the count of four, hold your breath to the count of seven, and exhale through your mouth to the count of eight, making an audible “whoosh” sound. That completes one full breath
- Repeat the cycle another three times, for a total of four breaths. After the first month, you can work your way up to a total of eight breaths per session
A third method is the controlled breathing method taught by Patrick McKeown, one of the top teachers of the Buteyko Breathing Method. If you’re experiencing anxiety or panic attacks, or if you feel stressed and your mind can’t stop racing, try the following breathing sequence.
Its effectiveness stems from the fact that it helps retain and gently accumulate carbon dioxide. This not only helps calm your breathing but also reduces anxiety. In short, the urge to breathe will decline as you go into a more relaxed state:
- Take a small breath into your nose, followed by a small breath out
- Hold your nose for five seconds in order to hold your breath, and then release your nose to resume breathing
- Breathe normally for 10 seconds
- Repeat the sequence several more times
Counter Stress by Activating Your Body’s Relaxation Response
Once you’ve addressed the oxygenation of your brain, next, engage in some sort of physical relaxation technique, as the stress response causes the muscles in your body to tighten. One simple one that can be done anywhere is to tighten the muscles in an area for a few seconds, and then release; moving from section to section. Start with your feet and legs, and move upward. This may even be done in concert with your breathing exercise of choice.
Visualization techniques such as those taught by Dr. Martin Rossman, author of “The Worry Solution,” can also be helpful. Imagery is the natural language of your brain, which is in part why visualization and guided imagery exercises are so powerful for changing thoughts and behavior.
As noted by Rossman, the three keys to calmness are breathing, relaxation and visualization. Ideally, do all three. Here’s Rossman’s suggestion for pursuing calmness: Breathe and relax your body part by part, then imagine being in a beautiful, peaceful place where you feel safe. This could be either a real or imaginary place. Spend 10 or 20 minutes there, actively visualizing the serenity of your surroundings, to interrupt the stress response.
This will disengage your fight or flight response, allowing your physiology to return to equilibrium, or what is also termed “the relaxation response.” This is a compensatory repair, renew and recharge state that brings you back to balance.
Mindfulness training — which focuses on being present in the moment — is another strategy that can be very helpful. In one study, people who participated in 10 sessions over the course of one month experienced “significantly decreased” stress, anxiety and depression.19 Mindfulness meditation is a more formal practice of mindfulness, in which you consciously zone in on, or focus your attention on, specific thoughts or sensations, then observe them in a nonjudgmental manner.
The Emotional Freedom Techniques for Stress Relief
Last but not least, energy psychology techniques such as the Emotional Freedom Techniques (EFT)can be very effective for reducing stress by helping you to actually reprogram your body’s reactions to the unavoidable stressors of everyday life. This is important as, generally speaking, a stressor becomes a problem when:
- Your response to it is negative
- Your feelings and emotions are inappropriate for the circumstances
- Your response lasts an excessively long time
- You’re feeling continuously overwhelmed, overpowered or overworked
EFT is not the same thing as mindfulness; it is entirely different and used for different purposes. I regard mindfulness and meditation as tools that are useful for your entire life, like exercise for your mind. Ideally, you should strive to be mindful and use meditation daily.
EFT is different in that it works best for targeted stress relief, such as recovering from an emotional trauma or overcoming an addiction. You might only need to use EFT a few times throughout your life, while mindfulness and meditation are life-long endeavors.
When you use EFT, simple tapping with the fingertips is used to input kinetic energy onto specific meridians on your head and chest while you think about your specific problem and voice positive affirmations.
This combination of tapping the energy meridians and voicing positive affirmation works to clear the “short-circuit” — the emotional block — from your body’s bioenergy system, thus restoring your mind and body’s balance, which is essential for optimal health and the healing of chronic stress.
While the video above will easily teach you how to tap for stress, it is important to realize that self-treatment for more serious issues is not recommended. For serious or complex issues, seek out an experienced practitioner to guide you through the process.
- 1, 2, 3 BMJ 2019;365:l1255
- 4 URMC Health Encyclopedia, Stress Can Increase Your Risk for Heart Disease
- 5 The Lancet February 25, 2017; 389(10071): 834-845
- 6 Forbes January 12, 2017
- 7, 8 Science Daily January 11, 2017
- 9 Nature Medicine June 22, 2014; 20: 754-758
- 10 mBio June 10, 2014: 5(3); e01206-14
- 11 British Heart Foundation Takotsubo Cardiomyopathy
- 12 CNN December 29, 2016
- 13 Heart 2003 May; 89(5): 475–476
- 14 BMJ Open Heart 2019; 6(1)
- 15 Newsweek April 15, 2019
- 16, 17 Medicalxpress April 17, 2019
- 18 BBC January 13, 2017
- 19 BMJ Open 2013;3:e003498