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Saturday, Oct 19, 2019

Matters of the heart: how best to deal with stress

How can we modify the damaging effects of stress on our hearts and our well-being? Limiting stressers may be one of the ways

analysis Updated: Sep 29, 2019 14:08 IST
Dr Upendra Kaul
Dr Upendra Kaul
World Heart Day,  observed today, is a day to promote health education
World Heart Day, observed today, is a day to promote health education (Getty Images/iStockphoto)
         

World Heart Day, observed today, is a day to promote health education and awareness on how to contain the epidemic of heart diseases. According to a conservative estimate, there are 30 million patients suffering from heart-related ailments. A contribution by all, and at every level, is a highly ambitious, but essential, step to fight this growing problem.

Stress is emerging as an important risk factor contributing to heart disease besides tobacco use, high blood pressure, diabetes, high cholesterol, a lack of exercise, diet rich in fats, and obesity. However, this risk factor, stress, needs emphasis since other factors are often talked about.

Emotional or psychological stress, a common phenomenon in competitive environments seen in cities, contributes to heart diseases. INTERHEART, a scientific study, has established it as an independent risk factor for the causation of myocardial infarction.

Several studies and experience suggest that emotional stress may increase blood pressure and bad cholesterol. It may also constrict arteries, lead to arterial inflammation and blood clotting, and increase the risk of a heart attack and sudden death. Stress is a normal physical response to events that threaten or upset our balance. When we sense danger — real or perceived — the body’s defences aggressively kick in, leading to a “fight-or-flight” response.

An example of this could be if one is walking in a forest and is confronted by a wild animal coming out of the bush. There is no way but to face the dangerous situation. Stress hormones are then released into our blood stream. They increase heart rate and blood pressure; our blood sugar levels increase to supply immediate energy; and our breathing becomes faster. All these changes increase the supply of oxygen to the muscles to respond to the threat. This response may be to fight or flee. Although the response is a protective one, beyond a certain point, stress stops being helpful. At that stage, it may cause damage to our health, negatively affecting our quality of life and increasing our risk of disease.

Acute and chronic stress have long been suspected as risk factors for a heart attack. Heart attacks commonly result from an acute blockage of a coronary artery, following the rupture of an atherosclerotic ulcer (plaque) in the arterial wall. These blockages occur suddenly and usually at a place where the narrowing of the artery is minimal. Thus, the transformation of a stable plaque to an unstable one seems to occur acutely. Likewise, extended work hours, multitasking, long commutes, nuclear family households are just some of the issues many of us have to deal with. The message, therefore, is that it is not easy to avoid stress, but we need to manage and control it effectively.

The causal relationship between stress and cardiovascular disease is not entirely clear like the association of high blood pressure and strokes. Cardiovascular disease is much more complicated. It involves a number of different pathologic and causative mechanisms. However, considering that emotional stress is a risk factor for heart disease, and may sometimes trigger an acute event, modifying stress might reduce risk. Besides reducing heart attacks, it would also have a beneficial effect on patients with high BP, diabetes.

How can we modify the damaging effects of stress on our hearts and our well-being? Limiting stressers may be one of the ways. Acute stressers such as a disaster, an accident, a business failure, the loss of a job, or divorce are difficult to avoid. Similarly, chronic stressers such as marital problems, a stressful job and so on cannot be avoided. The effects of stress on the cardiovascular system can, however, be modulated by the use of drugs. Beta blockers reduce the response of the sympathetic nervous system to stressful situations.

This may, to some degree, explain why beta blockers improve prognosis and reduce the risk of sudden death after a heart attack. However, treatment with antidepressant drugs has not been shown to be improve survival after a heart attack.

We must recognise the factors that contribute to heart-related problems. Managing stress is about taking charge of your thoughts, emotions, schedule and environment. This is key. Adequate sleep, regular exercise, healthy eating (avoiding refined sugars and processed foods, and choosing fresh foods, whole grains and high-quality protein), are all important in this journey.

Last, ensure timely consultations with medical professionals. This doesn’t just help relieve stress, but can potentially save your life.

Upendra Kaul is executive director and dean, Batra Heart Center, BHMRC
The views expressed are personal

First Published: Sep 29, 2019 13:15 IST

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