Stress and your heart: how psychological strain affects cardiovascular health
StressKey points
- INTERHEART (52 countries): permanent stress more than doubled heart attack risk.
- Work stress: about 23% higher coronary heart disease risk.
- Amygdala activity predicted cardiovascular events through arterial inflammation.
- Stress also acts through behavior: smoking, overeating, poor sleep, less activity.
Stress is a heart risk factor
The American Heart Association recognizes psychological health as part of cardiovascular health. Chronic stress affects blood pressure, inflammation and behavior.
What the research shows
INTERHEART. This case-control study of about 25,000 people in 52 countries found that people reporting permanent stress at work or home had more than twice the odds of a heart attack (Rosengren et al., 2004).
Job strain. A meta-analysis of nearly 200,000 people in Europe found that job strain was linked to a 23% higher risk of coronary heart disease (Kivimäki et al., 2012).
The brain. In a Massachusetts General Hospital study, higher resting activity in the amygdala predicted later cardiovascular events, and the link was mediated by bone marrow activity and arterial inflammation (Tawakol et al., 2017).
How stress harms the heart
- raised blood pressure and heart rate;
- inflammation;
- unhealthy coping: smoking, drinking, overeating, inactivity, poor sleep.
What helps
- regular physical activity;
- sleep;
- mindfulness, breathing and relaxation practices;
- social support;
- treatment for depression and anxiety.
Caveat
Most studies are observational, and stress is hard to measure. But the links are consistent across countries.
Frequently asked questions
Can a sudden shock cause a heart attack?
Rarely, intense emotional stress can trigger takotsubo ("broken heart") syndrome or a heart attack in people at risk.
Does stress management lower heart risk?
Stress management in cardiac rehabilitation has been linked to better outcomes, and it improves quality of life.
Sources
- Rosengren et al. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. The Lancet 364(9438):953-962. doi:10.1016/S0140-6736(04)17019-0
- Kivimäki et al. (2012). Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. The Lancet 380(9852):1491-1497. doi:10.1016/S0140-6736(12)60994-5
- Tawakol et al. (2017). Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. The Lancet 389(10071):834-845. doi:10.1016/S0140-6736(16)31714-7
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Stress tools
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9 questions about your mood over the past 2 weeks, one of the most widely used screening tools in the world.
QuizGAD-7: anxiety screening questionnaire
7 questions about anxiety over the past 2 weeks.
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5 statements about how you have been feeling over the past 2 weeks.
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Rate your mood, energy, anxiety and sleep daily on a 1–5 scale.
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Step-by-step instructions for cyclic sighing, slow breathing and box breathing.
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