Does stress cause heart disease?

For many years there has been conjecture in the medical profession around the place of stress and its relation to a number of diseases. There are still some members of the medical profession who believe that stress has no place in the precipitations or causation of cancer whereas most people in cardiology do believe there is a clear & robust relationship.

A number of years ago, the Interheart study suggested that 20% of heart disease was directly related to some form of stress. Professor Geoffrey Toffler from Royal North Shore Hospital in Sydney has performed elegant work demonstrating that within 2 hours of becoming acutely angry or anxious there is an 8 times increased risk for a heart attack.

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There is now the relatively common and well-recognised Takutsubo’s cardiomyopathy which is the development of acute heart failure whilst under stress, felt to be due to adrenaline induced constriction of the arteries in the heart.

Post traumatic stress disorder is felt to be a chronic syndrome which follows on from acute stress. The symptoms of post-traumatic stress disorder include excessive reactions to loud noises, flashbacks to the stressful event, nightmares, feelings of detachment, anger, varying degrees of depression and irritability. The acute stress disorder occurs within 3–30 days of the event and is estimated that around 20% of motor-vehicle victims, 50% of rape, assault or survivors of mass shootings will develop an acute stress disorder. Of these, 50% will go on to experience post-traumatic stress disorder. It is estimated that just under 4% of adults living in the modern world are suffering some form of post-traumatic stress disorder.

This new study from the Swedish National Patient Register examined 136,637 patients with acute stress disorder and subsequent post-traumatic stress disorder, diagnosed between 1987–2013. They compared these people with around 1.5 million people without either of these disorders.

It appears that a stress related illness increased the risk for cardiovascular disease by 64% within 12 months of exposure to the stress especially in people under the age of 50. Although this does not prove that stress causes cardiovascular disease, it still suggests that people who are predisposed to this disorder should try their best to minimise stress. Unfortunately, the underlying precipitant of acute stress disorder and post-traumatic stress disorder is typically a circumstance beyond the control of the sufferer, so the best approach here is for the health professionals involved in the care of such people should be considering cardiovascular risk factors and bring in appropriate measures to minimise any extra harm in this situation.

I say to all of my patients that what puts the muck in the walls of your arteries in the first place is totally different to what actually makes the established fatty plaques rupture to cause a heart attack or stroke. Whether stress is a factor in the generation of atherosclerosis (i.e. the major predisposing factor to acute vascular events such as heart attack or stroke) or whether it is purely a precipitant has not been clearly established. Regardless, it is vitally important to recognise that people who are under significant stress are much more vulnerable, and the other health consequences of these variety of stresses needs to be recognised and managed.