Stress and your heart

The real connection between stress and heart disease, and what to do if you're under too much pressure.

You're stuck in traffic, late to an important appointment. Your breath quickens. Your heart races. Your muscles tense. As your anxiety builds, you might even feel like you're on the verge of having a heart attack.

What you're experiencing is the phenomenon Harvard physiologist Walter Cannon once termed the "fight-or-flight" response. In a stressful situation, your body releases a flood of chemicals such as cortisol and epinephrine (adrenaline), which prepare your body for action. If the car in front of you were to burst into flames, you'd be ready to leap from your car and flee. But the reaction is counterproductive when you're just waiting in traffic.

Chronic stress—whether from a traffic-choked daily commute, unhappy marriage, or overbearing boss—has been linked to a wide range of harmful health effects. It can interfere with your mood, sleep, and appetite. But can stress cause heart disease?

Severe stress and the heart

There's no question that stress can exert real physiologic effects on the body—including the heart. This is most true in the case of severe and sudden (acute) stress. People who've received traumatic news—like the death of a child—have, in rare cases, suffered an immediate heart attack. "This isn't just an anxiety attack. When you do a cardiac catheterization procedure on them, an artery that was previously open is now closed," says Dr. Deepak Bhatt, director of the Integrated Interventional Cardiovascular Program at Brigham and Women's Hospital.

The condition is known as "broken heart syndrome," and it is much more common in women—even in those with no history of heart disease, Dr. Bhatt says.

Day-to-day stress

Broken heart syndrome is an example of the cardiovascular damage that can result from a severe, acute form of stress. But what about everyday stresses, like rush-hour traffic, marriage strains, and on-the-job aggravation? The connection between these chronic forms of stress and heart disease isn't as well defined. "I think the conventional opinion is that stress is bad for your heart, but the data are much murkier," Dr. Bhatt says.

It has been suggested that stress triggers inflammation, a known instigator of heart disease, but that hasn't been proven. Yet stress may influence heart disease in more subtle ways. "Stress does cause some people to act in ways that increase their risk for heart disease," Dr. Bhatt says.

For example, often people turn to comfort foods—like pizza, pie, and cookies—when they're stressed. These high-fat, high-cholesterol foods contribute to the artery damage that causes heart attacks and strokes. Stress can also lead us into other heart-damaging behaviors, such as smoking and drinking too much alcohol.

"I think stress does lead to heart disease, but I think it's through these established pathways," Dr. Bhatt says. Breaking the connection, then, is a matter of both relieving stress and managing the unhealthy habits it triggers.