Thinking Stress Hurts Heart Can Make It So
Date: Thursday, June 27 @ 00:00:00 EDT
Topic: DHF Blog

Acute Coronary Syndrome

While individuals vary widely in their reaction to stress, those who believe it is hurtful are in fact at increased risk of coronary heart disease (CHD), a study found.

An analysis of more than 7,200 men and women found that persons who believed that stress had been affecting their health "a lot or extremely" at baseline were more than twice as likely to die from CHD or suffer a nonfatal myocardial infarction (HR 2.12, 95%CI 1.52-2.98, P<0.001) when compared with those who didn't believe stress was affecting their health, Hermann Nabi, PhD, from the Centre for Research in Epidemiology and Population Health in Villejuif, France, and colleagues reported online in the European Heart Journal.

To reach that conclusion, researchers looked at data from the Whitehall II prospective cohort study, which was started in 1985 to measure the effects of various socioeconomic factors on health and disease.

Their epidemiological study looked at civil servants between ages 35 to 55 in 20 London-based government departments over an 18-year period; the workers' mean age was 49.5 years. The question about the perceived effect of stress on health was introduced during phase III of the study, from 1991-1993. Participants had to choose from five options when asked how stress affected their health: not at all, slightly, moderately, a lot, and extremely.

The researchers found 352 cases of coronary death or nonfatal myocardial infarction (MI). Those who reported that stress had a major impact on their health were more likely to be women who were not married or cohabiting. They were also more likely to be nonwhite, to smoke, and less likely to consume fruits and vegetables daily or be physically active. They also reported more diabetes, more poor health, and a lack of social support at work.

Even after the researchers adjusted their results to exclude a variety of health-related behaviors, the link between CHD and perceived stress remained (HR 1.49, 95% CI 1.01-2.22).

They suggested several possible explanations for their findings. "Psychological stress may trigger CHD events through biological mechanisms including imbalanced sympathetic- parasympathetic activity (exaggerated heart rate and blood pressure), alteration of neuroendocrine axes (increased cortisol secretion), and activation of inflammatory systems (elevated cytokine levels)," the investigators wrote.

In addition, "Psychological stress may also influence the risk of CHD more indirectly via health-damaging behaviors such as smoking, physical inactivity, or heavy alcohol consumption," they noted.

The authors explained that they phrased the question about stress in a new way. "The novel aspect of our study is in the assessment of individuals' 'perception of stress impact on their health' rather than their 'perceived stress levels,' the latter being common in the existing literature," they wrote. This unique phrasing allowed them to "account for individuals' differences in response to stress and in stress-related outcomes."

The results suggest that "Complaints of adverse stress impact on health should not be ignored as they may indicate increased risk of developing CHD," the authors concluded. "Assessing a subjective perception of adverse impact of stress on health might be considered as a part of managing patients with stress-related complaints in clinical settings."

They also pointed out that "Randomized controlled trials are needed to determine whether disease risk can be reduced by increasing clinical attention to those who complain that stress greatly affects their health."

Among the study's limitations were that it only included civil servants, making it difficult to generalize the results. In addition, covariate analysis may have missed some important confounding variables that may have influenced the results, the authors noted.

The Whitehall II study is supported by grants from the Medical Research Council, the British Heart Foundation, the National Heart, Lung and Blood Institute, the National Institutes of Health, and the National Institute on Aging.

The authors reported no relevant disclosures.

This article comes from Delta Health Foundation

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