Mental Stress is a Major Cardiovascular Health Risk

Mental stress may significantly impact individuals’ risk of developing cardiovascular disease.

Extensive research highlights the connection between psychological strain and mental health difficulties such as anxiety and depression. In addition, more studies point to a significant nexus between mental stress and physical disease, with most of these studies focusing on cardiovascular health risks.

The term “stress” typically represents experiences in which the environmental demands of a situation exceed the individual’s perceived psychological and physiological capacity to deal effectively.

The concept of stress may refer to acute or chronic stress or exposure to daily stressors, traumatic experiences, or stressful events in studies exploring the relationship between cardiovascular health and stress. Recent evidence links mental stress and cardiovascular disease.

In 2021, studies examined associations between mental stress (based on assessments of financial anxiety, life events, and self-perceived stress) and health risk of cardiovascular disease (CVD), stroke, and death in more than one hundred and eighteen thousand individuals (almost sixty percent were women) from twenty-one countries.

Participants were fifty years old on average and had no history of cardiovascular disease at the beginning of the study.

Results revealed that elevated stress correlates with an increased risk of cardiovascular disease and stroke after adjustment for demographic variables and traditional cardiovascular disease risk factors.

Increased stress levels correlate with an increased risk of coronary heart disease and death.

In 2021, investigators performed a pooled analysis of data from 2 randomized studies to determine the association between mental stress-induced myocardial ischemia and cardiovascular events in nine hundred and eighteen individuals (mean age sixty years old; thirty-four percent were women) with stable coronary artery disease (heart disease).

The investigators used myocardial perfusion single-photon emission computed tomography to compare the effects of myocardial ischemia provoked by mental stress (using a public speaking task) and conventional pressure (using an exercise stress test or a pharmacological stress test with regadenoson)

The findings revealed an increased health risk of cardiovascular death or nonfatal myocardial infarction in individuals with mental stress-induced ischemia versus no ischemia after adjusting for confounding variables. In contrast, those with conventional stress ischemia alone showed no significant increase in cardiovascular disease risk.

Patients with conventional and mental stress ischemia also demonstrated a substantially higher cardiovascular disease risk than those without and those with traditional ischemia of stress alone.

Hospitalizations for heart failure were also higher among individuals with mental stress-induced ischemia versus those without.

This study and others showing associations between acute stress and myocardial ischemia appear to align with frequent patient reports of angina precipitated by stressful events, according to a 2022 review.

The experts also examined evidence on the relationship between acute and chronic mental stress and other types of cardiovascular dysfunction, such as myocardial infarction.

PSYCHOLOGICAL AND MENTAL STRESS IMPACT ON CARDIOVASCULAR HEALTH RISK

The most substantial evidence that psychological and mental stress may affect the heart comes from two areas. First, psychological stress is the leading cause of Takotsubo cardiomyopathy, or stress cardiomyopathy, in which the patient appears to have an infarction. There is a significant left ventricular dysfunction.

Second, many well-elaborated reports indicate that catastrophic events, such as earthquakes or other natural disasters, correlate with a short-term increase in arrhythmias, heart attacks, and cardiac death. Finally, a growing body of data suggests that psychological stress correlates with an increased long-term risk of developing cardiovascular disease.

Many studies have described an association between various forms of stress exposure and cardiovascular disease risk, despite different study designs, different populations, and differences in the definition of stress.

Although this evidence applies to many different types of people, the damaging effects appear most substantial in high-risk groups, such as individuals with cardiovascular disease.

However, investigators base this evidence primarily on perceived or self-reported stress, which could be inaccurate.

This study used an objective way of provoking stress with laboratory stressors and examined the prognostic significance of developing ischemia with mental stress.

Those who developed ischemia with mental stress had a more than a two-fold increased risk of adverse events over a five-year follow-up period. Other factors did not explain this association.

These results may provide the most substantial evidence linking mental stress to cardiovascular disease risk.

More than forty years of evidence indicate that experiencing mental stress, especially chronic and related psychological distress, correlates with an increased risk of cardiovascular disease.

The most robust evidence in this area relates to symptoms of depression and anxiety. For example, in a recent study that collapsed in different types of distress, there was a twenty-eight percent increased risk of cardiovascular disease occurrence for adults who reported high anxiety compared to those who expressed little or no strain.

SPOT WHEN STRESS IS SNEAKING IN

Stress causes all sorts of minor physical discomforts, for example, sweaty palms and upset stomachs. Nevertheless, it can also increase the risk of severe heart problems.

The most unexpected part of the link is that stress may arise in many different settings, from relationships to jobs to sporting events. And unfortunately, all the above can affect your heart health.

Going through a divorce may be stressful enough, but until recently, researchers did not know how long the health effect of that stress might last.

In recent studies that followed individuals for more than eighteen years, women who went through a divorce two or more times had an increased risk of heart attack similar to that of a smoker or an individual with diabetes.

The study found an increased risk of a heart attack in men who had also had multiple divorces. Although men saw a health benefit from remarriage, women did not. Even decades after a divorce, relationship stress may leave a powerful imprint on your health.

Work-related stress may also damage your heart. For example, research has found that individuals most worried about losing their job are nearly twenty percent more likely to have heart disease.

However, happy individuals may also be chronically stressed because of the competitiveness of their work or profession or because they are trying to balance their work and family life.

Surprisingly, even stress related to pleasant events may increase the risk of a cardiac emergency. For example, during a recent World Cup soccer competition, heart attacks increased more than double in one German city during the days when the nation’s team was playing.

A LINK BETWEEN MENTAL STRESS AND HEART DISEASE

Stress may increase inflammation in your body, which links to factors that may damage your heart, such as high blood pressure and reduced high-density lipoprotein cholesterol (good cholesterol).

Yet continuous mental stress may also affect your heart more indirectly. For example, when you are worried, you tend to sleep poorly. You are also less likely to exercise, control your weight, or choose healthy food. All of these lifestyle changes may put your heart health at risk.

PROTECT YOUR HEART FROM MENTAL STRESS

Too often, individuals consider their mental stress almost separate from their health. If you are struggling with anxiety or strain, recognize that it can have harmful consequences since it may be a major cardiovascular health risk.

The following steps may help you protect your heart during stressful events or continuous mental stress:

Get professional counseling. Discuss your stress levels with your physician, psychologist, or healthcare provider. This step is especially critical if you have other risk characteristics for cardiovascular disease, such as high blood pressure or obesity.

Talking to your psychologist or healthcare provider may help you by treating you or assisting you in changing your lifestyle habits.

If you find yourself in a position that allows it, let stress motivate you. Turn the pressure into motivation to exercise instead of using it as an excuse to avoid physical activity. When you have a stressful day, taking a break to walk with friends during lunch may take your mind off the routine.

FOCUSING ON FUTURE RESEARCH

Future research should include more prospective studies on the impact of mental health on cardiac risk and more well-designed randomized trials of mental stress reduction interventions and their effects on cardiovascular risk.

We need more studies to demonstrate the utility of recognizing and treating myocardial ischemia caused by psychological stress in the clinical setting.

Furthermore, we need to investigate alternative ways to identify those individuals most vulnerable to the harmful effects of stress on the cardiovascular system because cardiac imaging is expensive and radiation-intensive, and the protocol is time-consuming.

Identifying more practical ways in the clinical setting would be advantageous, such as vascular reactivity testing for stress or a stress biomarker blood panel.

Social and biological differences exist in the types of stressors and their impact on men and women, respectively.

Understanding the links between mental stress and cardiovascular disease risk by sex may help clarify the benefits of mental stress screening and the psychological care needed for each group.

You and your physician, psychologist, or healthcare provider may work together to identify your risks and find ways to reduce them.

We are Modern Heart and Vascular Institute, a diagnostic and preventative medicine cardiology practice. For more information, contact us.