World Heart Federation : Stress and cardiovascular disease

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Stress

May 2007

Psychological factors and CVD

  • In people with coronary artery disease (CAD), mental stress is as dangerous to the heart as physical stress.1,2
  • There is strong and consistent link between depression, social isolation and lack of quality social support and heart disease.3
  • Depression, social isolation and lack of quality social support are as risky to heart health as abnormal levels of blood fats, smoking and high blood pressure.3


The psychological factors that exacerbate CVD

  • Three psychological risk factors are associated with coronary heart disease (CHD): acute and chronic stress, hostility and depression.4
  • Stress can worsen heart disease, induce heart attack5 and even cause fatal loss of blood to the heart.6
  • Chronic stress is associated with risk factors that lead to the development of CVD.7
  • A stressful job can lead to coronary heart disease (CHD):  latest findings suggest an increase in risk of as much as 50%.8
  • A stressful job can raise blood pressure, itself a risk factor for CVD.9
  • Depression plays a role in the development and progress of CVD.7
  • People with CVD often have depression too.10

Managing stress

  • Stress reduction, when in the prevention and control of high blood pressure, can reduce death by CVD.11
  • Exercise and stress management training can reduce emotional distress and improve heart health, more than usual medical care alone.12
  • Being happy protects against CV mortality.13

1 Akinboboye O, Krantz DS, Kop WJ, Schwartz SD, Levine J, Del Negro A, Karasik P, Berman DS, O'Callahan M, Ngai K, Gottdiener JS. Comparison of mental stress-induced myocardial ischemia in coronary artery disease patients with versus without left ventricular dysfunction.
Am J Cardiol. 2005;95(3):322-6

2 Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S;  INTERHEART investigators.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953-62

3 SJ Bunker, DM Colquhoun, MD Esler, IB Hickie, D Hunt, VM Jelinek, BF Oldenburg, HG Peach, D Ruth, CC Tennant and AM Tonkin. Position Statement: "Stress" and coronary heart disease: psychosocial risk factors. Medical Journal of Australia 2003; 178 (6):272-276

4 Strike PC, Steptoe A. Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis. 2004;46(4):337-47.

5 Peix A, Trapaga A, Asen L, Ponce F, Infante O, Valiente J, Tornes F, Cabrera LO, Guerrero I, Garcia EJ, Carrillo R, Garcia-Barreto D. Mental stress-induced myocardial ischemia in women with angina and normal coronary angiograms. J Nucl Cardiol. 2006;13(4):507-13.

6 Critchley HD, Taggart P, Sutton PM, Holdright DR, Batchvarov V, Hnatkova K, Malik M, Dolan RJ. Mental stress and sudden cardiac death: asymmetric midbrain activity as a linking mechanism. Brain. 2005 Jan;128(Pt 1):75-85.

7 Ranjit N, Diez-Roux AV, Shea S, Cushman M, Seeman T, Jackson SA, Ni H. Psychosocial factors and inflammation in the multi-ethnic study of atherosclerosis. Arch Intern Med. 2007;167(2):174-81.

8 Kivimaki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J. Work stress in the etiology of coronary heart disease--a meta-analysis. Scand J Work Environ Health. 2006;32(6):431-42

9 Kjeldsen SE, Knudsen K, Ekrem G, Fure TO, Movinckel P, Erikssen JE. Is there an association between severe job strain, transient rise in blood pressure and increased mortality? Blood Press. 2006;15(2):93-100.

10 Ferketich AK, Binkley PF. Psychological distress and cardiovascular disease: results from the 2002 National Health Interview Survey. Eur Heart J. 2005;26(18):1923-9.

11 Schneider RH,  Alexander CN, Staggers F, Rainforth M, Salerno JW, Hartz A, Arndt S, Barnes VA, Nidich SI. Long-term effects of stress reduction on mortality in persons > or = 55 years of age with systemic hypertension. Am J Cardiol. 2005;95(9):1060-4.

12 Blumenthal JA, Sherwood A, Babyak MA, Watkins LL, Waugh R, Georgiades A,Bacon SL, Hayano J, Coleman RE, Hinderliter A. Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial. JAMA. 2005;293(13):1626-34.

13 Giltay EJ, Geleijnse JM, Zitman FG, Hoekstra T, Schouten EG.  Dispositional Optimism and All-Cause and Cardiovascular Mortality in a Prospective Cohort of Elderly Dutch Men and Women.
Arch Gen Psychiatry, November 1, 2004; 61(11): 1126 - 1135