Reducing Stress In Order To Manage Risk Factors Linked To Adverse Cardiovascular Outcomes

Editor's Choice
Main Category: Anxiety / Stress
Also Included In: Cardiovascular / Cardiology;  Mental Health
Article Date: 21 Sep 2007 - 1:00 PDT

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A Review in The Lancet stresses the value of a healthy lifestyle to reduce stress so as to manage risk factors linked with undesirable cardiovascular outcomes.

Dr Daniel Brotman, Johns Hopkins Hospital, Baltimore, MD, USA and team examined documents published during the period 1990 - 2006. "Since antiquity, people have been intuitively aware of the connection between the heart and emotional stress," they explained.

They looked at how stress affects the sympathetic nervous system, its impact on physiology, plus the effect it has on cardiovascular outcomes. "Acute physical stressors such as surgery, trauma, and intense physical exertion are well-known triggers of cardiovascular events. Emotional stressors are increasingly recognized as precipitants of such events," they wrote.

In 1994 the number of cardiac deaths during the time of an earthquake in Los Angeles was two to five times the normal rate among patients who did not undergo direct physical trauma or raised physical exertion.

The Review also looks at subacute and chronic stressors. Major life changes linked to psychological/emotional adjustments can raise the chance of a cardiac event. For example, after the death of a spouse any type of mortality rises, especially cardiovascular ones. "Similarly, the fear in the USA subsequent to the terrorist attacks on the World Trade Centre in New York in 2001 resulted in a rate of defibrillator firings of two to three times normal during the month after the event," the authors write.

The scientists also looked into why people have varying responses to stress, and why cardiovascular events linked to stress are more common early in the morning rather than at other times during the day. They say daily fluctuations in stress hormones and endothelial dysfunction are part of the reason.

They point out that the evidence to support the efficacy of behavioral and psychological stress reduction to prevent cardiac events is just not there, techniques which are currently being studied in controlled clinical trails.

The writers conclude that stress is evidently an significant - a potentially modifiable - risk factor for acute and chronic adverse cardiovascular disorders, and that effective drugs are already being used. "Ample evidence exists for a strong and consistent association acute and chronic psychological stress with cardiovascular risk factors…physicians should remain cognisant of the cardiovascular risk associated with chronic mental illness and psychological stressors, should take seriously patient symptoms (such as chest pain) which arise in conjunction with negative emotions, and should help their patients to alleviate unnecessary psychological strain, by advising that a healthy lifestyle should include stress reduction, anger management, and treatment of mental illness," the authors write.

http://www.thelancet.com

Written by: Christian Nordqvist
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