How Does Stress Affect The Heart by Dr Michael MacDonald

The stress response is a normal physiological response to help you deal with threats. When your body perceives a threat, it increases the production of cortisol and adrenaline. Cortisol raises your blood sugar and adrenaline elevates your heart rate and blood pressure. They are complex hormones that combine to alter the way multiple systems in your body function i.e. digestion and immune systems. When the threat diminishes the hormone levels return to normal.

The problem is that work-related stress also activates the same biological systems and can lead to chronic activation of the stress response. Persistent activation of cortisol and adrenaline leads to negative changes in the immune system, glucose regulation, blood lipids, blood clotting, and blood pressure. Each of these processes can have a negative impact, particularly on the heart and blood vessels.

Short term stress is generally very well tolerated unless it is extreme. After major natural disasters such as earthquakes (and also major sporting events!), there is an increase in the rate of heart attacks, strokes, and death. If stressors are always present such as in work-related stress, then activation of the stress response can become chronic and is associated with an increased risk of atherosclerosis, heart attack, stroke, heart failure and death from heart disease.

Can the stress itself cause heart problems or is it only the unhealthy ways of coping with stress (overeating, smoking etc.) that contributes to heart issues?

As described above stress has multiple effects that can lead to heart attacks and strokes that are independent of the unhealthy behaviours they promote. However, there is no doubt that behavioural change also plays a major role. Stress leads to over-eating, obesity, inactivity, alcohol excess, smoking, and social isolation. All of which increase the risk of heart attacks, diabetes, strokes, and death.

What about acute vs day to day stress? What sort of damage is done by each?

See above.

Does stress affect men's hearts differently than women's?

It is not known if there is a difference between men and women. Most of the studies that looked at stress and the heart have been performed in men. This is because men are more likely to have heart problems than women.

Can heart disease risk be reduced by managing stress?

Stress management techniques can definitely play a part in the reduction of a person’s risk for heart disease; however, they cannot be used in isolation. To properly manage someone’s risk of heart disease you need to take a holistic approach and examine all of a person’s risk factors: blood lipids, blood pressure, glucose profile, lifestyle, family history, obesity, stress, co-morbid disease. The reason for this is that risk factors are often inter-related and cannot be managed in isolation. Once a person’s full risk profile has been determined, a comprehensive, risk management plan can be tailor-made for the individual.

What are your top tips for managing stress? Are there any specific lifestyle changes you would recommend?

Stress in the workplace is often driven by a perceived lack of job control, excessive job demands and lack of social support in the workplace. Start by trying to manage your workplace stress by speaking with your HR department or boss. If you are unable to effect changes in your job to manage your stress, there are simple lifestyle changes that will help you combat excess stress.

  1. Sleep. Always try to get 7-8 hours a night. We all know how seemingly minor things can annoy us when we are tired!
  2. Exercise. Too many benefits to list! Exercise impacts multiple cardiovascular risk factors in one go combat the feelings of stress and makes you feel good. It is a true panacea!
  3. Reduce alcohol. It is too easy to reach for a glass of wine (or two!) if you are stressed, but too many and it impacts sleep, increases blood pressure and weight and compounds the stress response.
  4. Socialise. People under stress often isolate themselves. Try to stay connected with friends and family
  5. Meditation – there is increasing evidence that meditation can lower your risk and help combat stress and improve general well-being. Just 10 minutes a day can help. I recommend the Headspace app as a great tool to get you started.

Anything else we should know?

Stress can be much harder to cope with if you suffer from underlying depression or anxiety. Don’t suffer in silence, if that’s you, talk to your doctor about it. We are here to help!

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