Mental Stress And Heart Disease: It's All In The Mind

By
Bradley A. Radwaner, M.D., F.A.C.C.

If you think you're always in the wrong line at the grocery store or the bank, the problem may not be the service. Stress fills modern life-our feet hit the floor running when the alarm goes off in the morning; we idle on the expressway knowing we'll be late for the tension-filled "team" meeting at work; the hectic stop at the store to pick up something for dinner means we're already five minutes late for Jimmy's baseball practice. No wonder we got in the wrong line. Our bodies were built to handle stress. When danger threatens, a rush of adrenaline floods the system, the heart beats faster and the breathing rate increases. We become hyper-alert, ready to do battle or flee. This sophisticated fight-or flight mechanism served our ancestors well when they were faced with short-term threats such as an attack from a sabre-toothed tiger. Chronic rather than short-term stress is the order of modern life, however. Our fight-or-flight response is on constant low as we struggle to meet the many demands of a modern lifestyle. A response that developed as a protective mechanism, when chronically activated can become lethal. If we are surrounded by stress, we also create our own. Just as we can activate our salivary glands at the mere thought of biting into a lemon, so too can we start our adrenaline pumping as we lie in bed fretting over real or imagined problems. Yet not all stress is bad. Exercise stresses our bodies causing a surge of adrenalin and an increase in heart rate and respiration. Regular, sustained exercise actually makes our bodies more capable of handling mental stress. Healthy individuals are better able to handle stress than those who already have heart disease. For patients with diagnosed coronary artery disease, mental stress is known to bring on angina and reduce the flow of oxygen-rich blood to the heart. A study published in the New England Journal of Medicine (November 28, 1991) found that when patients were subjected to mental stress, those whose arteries were free of atherosclerotic plaque either experienced no change or their arteries dilated (widened) in response. Patients diagnosed with atherosclerosis, on the other hand, had abnormal constriction in their arteries in stressful situations.

PERSONALITY AND MENTAL STRESS

In the 1950s Drs. Meyer Friedman and Ray Rosenman identified a personality type, classified as Type A, as being more likely than others to suffer heart attacks. Type A persons tended to be hostile, impatient, self-involved and always in a hurry. Recent research has zeroed in on more specific aspects of the Type A syndrome and its link to heart disease. The aspects most related to heart disease are self-involvement, hostility and cynicism. One study concluded that it was possible to predict the likelihood of a heart attack by the frequency with which a person referred to him/herself, i.e., using the words "I", "me", "my" and "mine". Those who are overly self-involved, tend to alienate themselves from others, becoming socially isolated. Another study based on interviews with 2,320 male survivors of heart attacks showed that those who were socially isolated and had a high level of life stress had more than a fourfold risk of death from heart disease and all other causes compared with men with low levels of stress and frequent social contacts.

CHANGING OUR RESPONSE TO STRESS

If your heart disease can be traced to diet, you can measure and eliminate grams of fat from your diet. If you suffer from chronic stress, your solutions are much less tangible. Mental stress is personal and idiosyncratic. Your colleague might see a new sales goal as an exciting challenge, while you see it as an unreasonable demand. The potential for stress is everywhere and may follow even if you flee to a mountaintop in the Himalayas. A more reasonable approach is to learn to handle stress. Stress management is an essential component of a program developed by Dr. Dean Ornish. Based on research conducted over 13 years, Dr. Ornish believes that heart disease can be halted or reversed without bypass surgery or angioplasty, simply by making lifestyle changes. The program combines a low-fat diet, regular exercise at a safe level, group therapy, yoga and meditation. Participants work on improving communication skills in a group setting as a way of overcoming isolation and hostility; on an individual basis, they practice yoga and meditation in an effort to slow pulse and breathing rates and allow the individual to remove him/herself physically and psychologically from surrounding stress. It is not certain that stress alone causes heart disease, but stress is known to aggravate existing heart disease and is implicated in many other diseases. Learning to deal with the stress in our lives - whether by meditation, biofeedback or relaxation methods - may allow us to transcend the daily turmoil and achieve, not just better health, but a sense of inner peace.