Here’s how stress is affecting your heart

We commonly think of stress manifested with physical symptoms including headaches, muscle pain, fatigue and even an upset stomach.

Researchers have long studied the physical effects of stress on one’s body, but does stress – specifically mental stress – affect men and women differently? Researchers sought to answer that question.

The study involved over 650 people, all with coronary artery disease (CAD). People with CAD have an accumulation of plaque in their arteries, which can cause various symptoms like discomfort, chest pain, shortness of breath and in more serious situations, the disease can lead to a heart attack.

As part of the study, each participant took a mental stress test, the often-dreaded task of public speaking. While the participants took part in the public speaking test, the researchers examined images of their heart to determine the effect of the mental stressor.

They specifically were interested in whether women with CAD were more likely to suffer from a condition called myocardial ischemia, which refers to a reduction of blood flow to your heart and can lead to a higher risk of  fatal heart complications.

The results showed that almost 15 percent of study participants had mental stress-induced ischemia, with similar rates between men and women. But interestingly, the researchers found that the underlying causes of ischemia were different for the sexes.

For women, it was attributed to a constriction of the small blood vessels. That was not the case for men. Instead, it was triggered by a rise in their blood pressure and heart rate.

“Mental and emotional stress can be manifested with physical symptoms, but often, patients, especially younger women, come to me with sudden, elevated blood pressures and pulse rates,” says Dr. Carissa Buenvenida, a cardiologist with Advocate Heart Institute at Lutheran General Hospital in Park Ridge, Ill.

“Women tend to deny the presence of stressors in their lives as they multi-task and juggle several roles.”

In addition, she adds, “it is known that women have smaller hearts and smaller coronary artery diameters. This affects diagnosis, imaging and management of heart disease in women. This study gives us insight on vascular biology and how blood vessels react to stress differently in women versus men. We have a tendency to focus more on reducing and treating cardiovascular risk factors in our post-menopausal women patients. Less attention is placed on our pre and peri menopausal patients, since they still presumably have the protective effects of estrogen. This study is important because it encourages us to go beyond the prevention of the traditional risk factors (hypertension, diabetes, hypercholesterolemia) and identify mental and emotional stressors that can make smaller size arteries react even worse, causing intermittent ischemia and blood flow issues. The physical manifestations might not be evident early, but we are slowly and silently altering the vascular response to stress.”

Why does it matter?

Oftentimes, there is an unequal focus on men’s and women’s heart health.

“Couples often come to me focusing on the cardiovascular health of their husbands. In reality, a woman’s life involves several stages of significant emotional and mental stressors that can contribute to their cardiovascular risk in the future. This begins with pregnancy, followed by the multi-tasking of raising young families with career development and often in a sandwich generation, the burden of caring for older parents. Since women have longer life expectancies, they also are exposed to the loneliness and depression of living alone. These life situations, coupled with hormonal changes with the addition of medical issues like hypertension, diabetes (gestational) high cholesterol, (pre) eclampsia and obesity, can remain asymptomatic for years, but repetitive and persistent alterations in vascular biology results in ischemic changes, myocardial damage and eventually symptoms which can result in cardiovascular morbidity and mortality”.

So what should people do?

“Eliminating mental stressors is not always an option. Mental and emotional stressors from family, relationships and work are present at all stages in life,” says Dr. Buenvenida. “Finding healthy coping mechanisms to deal with stress helps keeping inflammation (a contributor to arteriosclerosis) down and helps women stay healthy.”

Dr. Buenvenida adds that it’s particularly important for women of all ages to focus on prevention and cardiovascular risk reduction. Young women should avoid obesity, hypertension and diabetes to avoid (pre)eclampsia, gestational diabetes and other pregnancy complications. Stress reduction, good eating habits and carving time out for exercise is important for young mothers who juggle kids, older parents and careers. Keeping active, working on balance and preventing depression and loneliness is important for older female patients. “Cardiovascular risk prevention starts young, regardless of hormonal status since early brief medical issues (like eclampsia and gestational diabetes) can contribute to cardiovascular disease in the future.”

Need some tips to cope with common mental stressors?

Dr. Buenvenida recommends the following:

• Get active. Exercise regularly and keep an active lifestyle.
• Cherish quiet time. Meditate. Do yoga. Mental fitness is as important as physical fitness. Even short 10-minute mental breaks reduce blood pressures and pulse rates.
• Prioritize. Have a “to do list”, but save time for physical fitness and mental breaks.
• Socialize with friends and family. Having a sounding board can often help diffuse issues and present constructive ways of fixing problems. It also combats loneliness and depression.
• Ensure healthy eating habits. A well-balanced diet includes controlling salt and sugar content, adding in multigrain, high fiber foods and lowering saturated fats and high cholesterol foods. Avoid store bought and processed goods. A clean and healthy diet often leads to us feeling good about ourselves both physically and mentally.
• Hydrate with water. Avoid sugary and caffeinated beverages. Maintaining adequate fluid balance wards off some of the physical manifestations of stress.
• Sleep. Identify and treat sleep apnea when present.