The importance of diet, exercise, and medication in the prevention of first-time and repeat heart attacks is well accepted by the medical establishment. Researchers have also shown that a person’s mental stress level and emotions play a significant role in heart disease, but how and why are not well understood.
Most people would be surprised to learn that the first time psychological and social factors were linked to a heart problem was in 1910. A Russian physician made the connection when a patient developed a heart attack during a stressful card game.
The public has been saturated with the message that if you want to prevent a heart attack you must eat a healthy diet, stop smoking, and take medication if you have high blood pressure or high cholesterol. But if the roles of stress and heart disease are so well known, why aren’t they discussed more in messages to the public?
Dr. James Muller of the University of Kentucky Medical Center, a pioneer in researching the causes of heart attacks, says that the topic has been neglected due to the difficulty in finding ways to measure stress. “There are the patient’s personal feelings, observations by others, and normal nervous system functions (like blood pressure response) to consider. Another problem is that people’s response to stress varies.” Lacking a universal way to measure stress (like the ways we can measure blood pressure and cholesterol) makes it difficult to give doctors guidelines for patients.
Due to the rise of managed care, the time doctors spend with patients is less than it was a decade ago. Most managed care plans pay doctors based on the number of patients seen, not on the time spent with them. This results in less time to diagnose whether a patient’s symptoms might be due to emotional or psychological factors. Even if they did have the time, many physicians lack the expertise to recognize emotional issues or the training to help solve them. While psychiatrists and psychologists are better trained to recognize the warning signs of stress, they may not be consulted until a crisis occurs, when the damage has already been done.
Medical research suggests that anger, heavy exertion, and early morning awakening all may create mental stress that perhaps may lead in some cases to a heart attack. Anger in particular is thought to be a powerful influence.
Depression and lack of social support are also risk factors. A person’s extreme grief over the death of a loved one has been shown to increase the risk of a heart attack the day after the death 14-fold. Even six months later, a person’s risk of heart attack is still six times higher than that of someone who has not suffered a loss.
Indeed, if doctors could identify those patients who are angry, depressed, or lack a social support system, they might be able to reduce these patients’ risk of developing heart disease.
Many studies indicate that mental outlook is the most important factor in predicting a person’s outcome or recovery after a heart attack, stroke, or surgery. Patients and their families, with the help of their doctors, should use this information to take steps to develop a positive mental outlook. This can be done by creating strong support networks, which may include friends, family, or a specific support group (that is, a bereavement group).
Combining Treatment to Reduce Risk
Will mental stress and its consequences receive more attention in the treatment of heart disease? The answer is probably yes, since more doctors and research studies now focus on a multifaceted approach to reduce the risk of heart disease. For example, the Ornish program (named for its founder, Dr. Dean Ornish) prescribes daily stress management techniques in addition to a strict regimen of reduced fat intake, exercise, and smoking cessation to help decrease risk in people diagnosed with heart disease.
At Duke University, a stress management intervention program was shown to be more effective in lowering the number of deaths from heart disease among patients than either traditional care or an exercise program. And nurse intervention programs give patients a way to discuss health questions and stressful events on a monthly basis with professional nurses.
However, while these programs have had good results, the Montreal Nurses Heart Study found that not all people responded well to stress reduction programs. They found that since stress is different for each individual, a personalized approach to stress management is critical.
What Can I Do to Lower My Stress Level
Whether you are at risk for developing heart disease or have already suffered a heart attack, develop a simple, well-rounded plan to stay healthy. By balancing your physical, mental, emotional, and spiritual needs you may be able to decrease or avoid future heart problems. To actively reduce your stress, experts suggest the following:
- Be candid with your doctor about your fears and worries.
- Build a strong support system of friends and family. This may help you ward off depression if you become ill.
- Find new ways to express your feelings.
- Decrease or avoid stressful situations when possible.
- Seek medical professionals such as psychiatrists, psychologists, medical doctors, and social workers who can help you learn to cope with your feelings.
By reducing mental stress, defusing anger and hostility, and building strong social support networks to ward off depression, you may be able to prevent having a heart attack. And if you do have a heart attack, your chances of recovery are more likely to increase.
For practical advice and information on managing stress, visit the American Heart Association’s web site at www.americanheart.org. You can also call them at 1-800-AHA-USA1, or, if you have a question about women’s health, at 1-888-MY-HEART.
Article By: Floss O’Sullivan, Medical Writer