New research due to be presented at the 18th Annual Congress of the South African Heart Association shows that financial stress may increase the risk of a heart attack by 13-fold, and work stress by almost six times.
People worry about money — a lot. According to a recent survey by the American Psychological Association (APA), 72 percent of those in the United States felt the weight of financial stress at least once in the past month.
Another sizeable 22 percent said that they experienced extreme financial stress in the past month. "Money and finances have remained the top stressor since [...] 2007," report the APA.
The same organization warn that "stress related to financial issues could have a significant impact on Americans' health and well-being." New research, which will be presented at the 18th Annual Congress of the South African Heart Association, held in Johannesburg, may help us to understand exactly how significant that impact could be.
Lead study author Dr. Denishan Govender, who is an associate lecturer at the University of the Witwatersrand in Johannesburg, explains the motivation for his research.
"The role of psychosocial factors in causing disease," he says, "is a neglected area of study in South Africa, perhaps because there are so many other pressing health challenges such as tuberculosis and HIV."
Studying stress and heart attack risk
In order to study the impact of psychosocial factors on the chances of having a heart attack, Dr. Govender and colleagues examined 106 people who had checked into a large public hospital in Johannesburg for a heart attack.
The researchers also examined a control group of 106 healthy, age-, sex-, and race-matched participants.
Participants were asked to fill in a questionnaire inquiring about their psychological well-being, with questions about depression, anxiety, stress, work-related stress, and financial stress included.
To assess and measure the experience of each of these conditions, the team used the Likert scale. The participants' answers were grouped into four categories: no financial stress; mild financial stress; moderate financial stress; and significant financial stress.
Mild financial stress meant they had an income but needed additional financial support. Those who fell under the moderate financial stress category had an income but found themselves in financial distress.
Having no income and occasionally finding it difficult to meet basic needs counted as experiencing significant financial stress.
Dr. Govender and his colleagues calculated the correlations between the two groups' scores and the incidence of a heart attack.
Asking about stress should become routine
As much as 96 percent of those who had had a heart attack reported having experienced some level of stress, and 40 percent of them said that they had experienced severe levels of stress.
People who reported significant financial stress were 13 times more likely to have a heart attack than those who had minimal or no stress.
Among those who experienced moderate work-related stress levels, the chances of having a heart attack were 5.6 times higher.
Additionally, people who had experienced mild, moderate, or severe depression in the past month were three times more likely to have a heart attack.
"We know that the depressed cardiac patient is at greater risk," says Dr. David Jankelow, chairman of the South African Heart Association 2017 Congress. "We, as clinicians, need to identify them much earlier, so that they can be referred for appropriate intervention.
"Cardiac rehabilitation together with counseling and reassurance will play an important role, as well," adds Dr. Jankelow.
Dr. Govender also comments on the significance of the findings, saying, "Our study suggests that psychosocial aspects are important risk factors for acute myocardial infarction. Often patients are counseled about stress after a heart attack, but there needs to be more emphasis prior to an event."
"Few doctors ask about stress, depression, or anxiety during a general physical and this should become routine practice, like asking about smoking. Just as we provide advice on how to quit smoking, patients need information on how to fight stress."
Dr. Denishan Govender
Last study author Pravin Manga, who is a professor of cardiology at the University of the Witwatersrand, notes, "There is growing recognition that many developing countries are experiencing an increasing prevalence of chronic diseases of lifestyle such as myocardial infarction, and South Africa is no exception."
"Our study shows that psychosocial aspects are an area of cardiovascular prevention that deserves more attention," concludes Prof. Manga.