Stress Breaks Hearts

Sept. 20, 2007 -- Here's a health fact most of us understand better than our doctors do: Emotional stress really can harm our hearts.

Intense grief, acute anger, and sudden fear can have direct -- sometimes fatal -- effects on the human heart. And long-term emotional stress shortens lives by increasing the risk of heart disease, notes Daniel J. Brotman, MD, director of the hospitalist program at Johns Hopkins Hospital, Baltimore.

"What is intuitive to people is not necessarily intuitive to physicians," Brotman tells WebMD. "Emotional stress, conceptually, is the same thing for cardiovascular risk as physical stress. But a lot of doctors blow that off, because they think emotional stress is a psychological problem, not a physical problem."

To overcome this false impression, Brotman and colleagues reviewed recent studies looking at the short- and long-term effects of emotional stress on the heart. Their resulting report, "The Cardiovascular Toll of Stress," appears in the Sept. 22 issue of The Lancet.

"In the hospital, I see people under all sorts of stress all the time -- and I see what happens to bodies under stress," Brotman says. "Our study illustrates how important the body's stress responses are in precipitating cardiovascular effects."

Heartache, Heart Harm

Psychological disorders, personality types, and other psychological stressors are linked to various heart problems:

• People who suffer from depression, hopelessness, or a pessimistic outlook are more likely than others to suffer heart attack and sudden heart death. They are more likely to develop conditions that increase heart risk, such as obesity, diabetes, high blood pressure, and impaired heart rate.
• People who suffer chronic anxiety are more likely than others to suffer heart attack, atrial fibrillation, and sudden heart death. Their propensity for high blood pressure and impaired heart rate increases their heart risk.
• Emotional trauma -- such as the death of a spouse, mental or physical abuse, or posttraumatic stress disorder -- increases risk of heart attack and heart death.
• People with type D personalities (characterized by pessimistic emotions and inability to share emotions with others) and type A personalities (characterized by anxiety directed outward as aggressive, irritable, or hostile behaviors) are more likely than others to suffer heart attacks.
• People with angry or hostile temperaments are more likely than others to suffer heart death.
• Acute fear, grief, startling, or anger can cause "stunned heart." Wallops of emotion also can cause sudden death due to life-threatening abnormal heart rhythm.

Even when intense bouts of emotion don't kill, they may cause long-lasting heart damage.

"Most people who suffer the death of a loved one are not coming to medical attention, but that does not mean their hearts are not stunned for a period of time," Brotman says. "We doctors only see those with heart failure, or those with already-damaged hearts whose defibrillators fire. But probably, in every body, what stress hormones do today have some impact on how healthy your cardiovascular system will be 20 years from now."

It would seem to be wise for all of us to learn to deal with stressful emotions. But Brotman warns that there does not seem to be any one-size-fits-all way to do this.

"We don't have concrete evidence to suggest that if you manage your stress levels you will reduce your cardiovascular risk," he says. "People are different and have different ways of reducing stress. It is disingenuous to suggest that stress reduction is going to be simple."

Meanwhile, he urges doctors to pay more attention to what their patients are telling them when they talk about stress.

"Real-time physical effects correlate with intense emotional states," Brotman says. "We should think beyond cholesterol, beyond blood pressure, when thinking about what it means to live a heart-healthy lifestyle."