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How Does Stress Cause Heart Disease?

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Updated June 25, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Most physicians now believe that emotional stress can contribute to the development of heart disease.

Stress appears to lead to heart disease in at least two ways. First, if you experience chronic emotional stress, you may be more likely to develop atherosclerosis, the disease process that produces coronary artery disease (CAD), stroke and peripheral artery disease. Second, periods of intense stress apparently can precipitate acute heart problems, such as heart attacks.

Keep in mind, however, that stress is a normal part of life. You can never avoid it altogether (nor should you try). Whether or not your heart may be affected by stress appears to be related to the kind of stress you're experiencing, and, especially, how you react to it.

Stress and Atherosclerosis

While it has not been proven that stress can accelerate atherosclerosis, there is a fair amount of evidence suggesting that it does. People who react to everyday emotional stresses with an exaggerated Type A, clenched-teeth, fight-or-flight surge of adrenaline (commonly manifested as frustration, anger or hostility) appear to be at the greatest risk.

Stress, and how we react to it, can directly affect our blood vessels. Even the normal stress that we experience in everyday life can cause a temporary worsening in our vascular function, through hormonal changes and increases in the adrenaline in our bloodstream. With chronic emotional stress, especially in the Type A individuals who dump adrenaline into their bloodstreams at the slightest provocation, these temporary changes can persist. Chronic stress can also cause increased inflammation (sometimes producing elevated CRP levels), which is associated with an elevated risk of atherosclerosis.

Furthermore, chronic emotional stress is often accompanied by a worsening in several other cardiovascular risk factors. Smokers under stress commonly increase their consumption of tobacco, for instance. And overeating (and thus weight gain) is quite common in people under emotional stress. Cholesterol levels also tend to increase during periods of increased stress.

So chronic stress can potentially accelerate atherosclerosis both by directly affecting your blood vessels, and by contributing to a worsening of your overall cardiac risk profile.

People with Type A personality traits tend also to have more significant symptoms -- especially angina -- once they develop CAD. Their outcomes after coronary artery bypass surgery tend to be worse than for patients who do not have an exaggerated response to stress, and their overall risk of dying from their heart disease is also higher.

Stress and Acute Heart Conditions

There is a lot of evidence that severe emotional stress can precipitate more acute cardiac conditions, especially acute coronary syndrome (ACS) and sudden cardiac death.

Extremely stressful life events -- such as the death of a loved one, divorce, loss of a job, business failure, being the victim of violence, exposure to natural (or man-made) disasters, or serious family conflicts -- are associated with a significantly increased risk of ACS or cardiac death (both sudden and non-sudden) for up to a year after the stressful event.

This acute increase in cardiac risk is thought to be due to the significant elevations in blood pressure, heart rate, vascular tone (or vein constriction), inflammation, and accelerated blood clotting that can be seen, even in typically serene individuals, with severe emotional stress. These changes in physiology can increase the likelihood of plaque rupture -- the event that produces ACS.

Summary

Certain kinds of emotional stress in a certain kind of person can accelerate the development of chronic heart disease, or can precipitate an acute cardiac crisis. Nobody can avoid all forms of emotional stress, but if you think you may be at risk for stress-related heart disease, you ought to consider taking steps to control both your response to stress, and any other cardiac risk factors you may have.

Sources:

Sesso, HD, Kawachi, I, Vokonas, PS, Sparrow, D. Depression and the risk of coronary heart disease in the Normative Aging Study. Am J Cardiol 1998; 82:851.

Chang, PP, Ford, DE, Meoni, LA, et al. Anger in young men and subsequent premature cardiovascular disease: the precursors study. Arch Intern Med 2002; 162:901.

Mittleman, MA, Maclure, M, Sherwood, JB, et al. Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators. Circulation 1995; 92:1720.

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