Virtually everyone has experienced stress at one time or another—a feeling of emotional or physical tension that can come from any event or thought that makes you feel frustrated, angry, or nervous. But did you know that stress can affect your body—especially your heart?
Many people, over the course of their lives, have experienced acute (or short-term) stress, a physiological and psychological reaction to a specific event that goes away quickly, such as giving a speech (if you are nervous about public speaking), hitting the brakes suddenly to avoid an oncoming car, or having a fight with your partner. Chronic stress, however, is a consistent sense of feeling pressured and overwhelmed over a long period of time—it could result from a toxic work environment, for instance, or caregiving, or being unable to pay your bills.
“Stress is sometimes underrecognized as a risk factor for heart disease,” says Rachel Lampert, MD, a Yale Medicine cardiologist.
In fact, some experts go further to say that stress is a leading risk factor for heart disease—the biggest killer in the United States—up there with unhealthy diet, physical inactivity, smoking, excessive alcohol use, and obesity.
We spoke to Dr. Lampert; Yale Medicine cardiologist Erica Spatz, MD, director of the Yale Medicine Preventive Cardiovascular Health Program; and Allison Gaffey, PhD, a Yale Medicine psychologist who specializes in cardiology—all of whom have particular interests in the effects of stress on the heart, both clinically and in their research.
Below, they discuss the connection between stress and heart health, as well as strategies for keeping your heart healthy.
1. There are many ways stress can affect the heart.
There are several pathways through which stress can lead to heart disease. “Long-term—or chronic—stress can cause higher levels of inflammation in the body that contribute to increases in plaque buildup in the arteries—and that can lead to such problems as coronary artery disease,” says Dr. Lampert. Coronary artery disease can lead to heart attack, abnormal heart rhythms, and heart failure.
Also, stress drives an increase in catecholamines, hormones made in the adrenal glands. One catecholamine is adrenaline, the “fight or flight” hormone, which increases mental alertness during stressful situations. But adrenaline also causes the heart to beat faster and raises blood pressure. Too much of that, over time, can eventually damage the heart. Prolonged elevations of another stress hormone, called cortisol, also increase blood pressure, as well as blood sugar, cholesterol, and triglycerides.
For a person living with chronic stress, the result can be chest pain, irregular heartbeats, shortness of breath, and an increased risk of heart attack and stroke.
Short-term stress can have an impact as well. “For example, in people who already have a buildup of plaque in their arteries, the surge of adrenaline can sometimes contribute to a plaque rupturing, resulting in a blood clot that could grow large enough to block blood flow completely and cause a heart attack,” Dr. Lampert says.
In people with pre-existing heart problems, such as arrhythmias (abnormal heart rhythms), sudden stress can exacerbate their symptoms, Dr. Lampert adds.
But stress can also have indirect effects on the heart. “When people feel they cannot escape the circumstances of their chronic stress, they may cope by turning to unhealthy behaviors,” says Gaffey. “We know that stress is associated with behaviors such as unhealthy diet, smoking, and increased use of alcohol.” These behaviors can lead to such health issues as high cholesterol and hypertension, which are primary risk factors for heart disease, she adds.
2. Stress affects people in different ways.
When it comes to stress, everyone is different—and the same is true with heart disease, Gaffey explains. “What is considered to be a stressor or what is stressful for one person versus another is subjective—there's also a lot of variability in the effects of that challenge, depending on your past experiences and how you have learned to cope with the emotional effects,” she says.
To that end, some people who have experienced significant stress will develop heart disease, while others won’t, adds Dr. Lampert. “This is similar to cancer,” she says. “Among people who smoke, some don't get cancer, and others do. Why is that? It is a combination of their genetic vulnerability, environment, and lifestyle—and how all those factors work together in the development of disease.”
A study in The Lancet showed that people who reported high stress, a history of depression, and other psychosocial factors were 2.5 times more likely to have a heart attack than those who had low stress or no history of depression, Gaffey says. Other research has linked stress and heart disease in groups that have experienced discrimination, including women, people from particular ethnic or racial backgrounds, and those with mental health disorders.
Not all symptoms during stress are due to heart problems, Dr. Lampert adds. Stress can also cause symptoms, such as a racing heart, “that are just how your body normally feels when you're overwhelmed.” Most importantly, anyone experiencing new or recurrent symptoms should talk to their doctor to figure out to what extent a heart issue might—or might not—be causing the symptom, she says.
3. Talk to your health care provider about your level of stress.
Anyone concerned about their stress levels should talk about it when they visit their primary care provider or, if they have one, their cardiologist. “I talk a lot about stress with patients,” says Dr. Spatz. “We want to know how stress from their family, job, or community has impacted them. And how that may be contributing to their blood pressure, their weight, and, ultimately, to their risk of developing heart disease.”
“During these appointments, it’s important to raise the issue of stress because a provider may not always ask you about your current life circumstances, stressors, or stress level,” Gaffey says. “But they can share helpful recommendations, resources, and tools to help people better manage their stress.” Those might include increased physical activity, yoga, and other relaxation techniques; improvements to sleep hygiene; spending time with others; psychotherapy; social work resources or aid with health care access; and even medication to help with ongoing symptoms of depression or anxiety.
The type of stress reduction that works best is different for everyone, Dr. Lampert adds. Some people find meditation or yoga helps; others may prefer a walk in the woods or a run. “It’s whatever works to keep your stress levels in check,” she says.