Can you have a heart attack from too much stress?

Chronic stress can have real consequences on the body. For years, we’ve focused on risk factors like high blood pressure and high cholesterol, but are only recently turning our attention to how our mental health can impact our physical health. This year has been incredibly stressful for most of us, and so you may be wondering - how does stress affect the heart?

Does chronic stress increase the risk for heart disease?

Evidence has been mounting that psychological factors can certainly impact risk for heart disease. While we’ve known for some time that discrete, traumatic stress resulting in post-traumatic stress disorder (PTSD) is a particularly potent risk factor for cardiovascular disease, cumulative exposure to daily stress can also increase risk for heart disease.

One meta-analysis focusing on patient perceived stress levels found that individuals reporting high stress levels, regardless of cause, had a 27% increased risk of heart disease. Another study that looked specifically at work related stress found a 40% increased risk of heart disease. Other sources of stress, including social isolation and financial hardship have also been linked to increased risk of heart disease.

Anxiety, depression, and excessive anger may also increase risk for heart disease. In contrast, several indicators of positive psychological health, such as optimism, resiliency, and a sense of purpose, have been associated with a reduced risk.

How does stress lead to heart disease?

Likely by several different pathways.

First, stress revs up certain biological processes that can directly increase our risk for heart disease. Psychological distress has been shown to lead to activation of our sympathetic nervous system (our “fight or flight” response) that increases heart rate and blood pressure. It also supercharges a part of our hormonal pathway that leads to increases in stress hormones like cortisol and catecholamines like epinephrine. Inflammation, increased clotting, impaired glucose control, vascular dysfunction, and worsening cholesterol levels have also been seen.

Indirectly, stress also makes it more difficult to engage in healthful behaviors that we know reduce our risk of heart disease. Individuals with significant chronic stress are also more likely to smoke, have decreased levels of exercise and a poorer diet. I don’t know about you, but when I’m feeling stressed, a decadent slice of chocolate cake sounds a whole lot better than a salad.

So what can we do? Does meditation help?

Meditation, a collection of different practices that focus on attention inward, mindfulness, and concentration, has been increasing in popularity. While there are several different forms, some are better studied than others. One well studied type is that of transcendental mediation - a form of meditation in which the practitioner focuses on a personal mantra for 20 minutes twice a day. Mindfulness meditation, a type of meditation which centers of focused attention and observation without judgement, is also fairly well studied.

So what does science say?

Meditation has been found in several trials to lower blood pressure modestly (in one meta-analysis about 4 mm Hg systolic), reduce stress and anxiety, and help people quit smoking. It has also been found in several small trials to significantly reduce the risk of heart attack and death from heart disease in both people who have established heart disease and those at risk for heart disease - however, these trials were quite small, and of modest quality, and so require replication. A recent meta-analysis on mindfulness-based interventions - which included mindfulness-based stress reduction techniques, mindfulness meditation, and mindfulness-based cognitive behavioral therapy - in patients with heart disease, found improvements in psychological health and reductions in systolic blood pressure.

So what’s the bottom line?

The mind-heart-body connection is real. Our mental health is a very important part of our overall wellness, wellbeing, and heart health. Disruption of psychological health is linked with increased risk for heart disease - both by directly activating our stress response system as well as promoting chronic, unhealthy behaviors. Your doctor should be asking you about your stress levels and offering you suggestions to help you mitigate this. Interventions, such as meditation and other mindfulness based practices, have been demonstrated to reduce stress, cardiovascular risk factors, and possibly also risk of heart attack. If you can, try to incorporate some amount of stress reduction or mindfulness based practice in your daily life - consider things like 10 minutes of meditation, a walk in nature with your family, gratitude journaling, or yoga. We must nourish our mental health as much as our physical health to optimally improve our heart health.

Interested in working directly with Dr Harkin to optimize your heart health and create a personalized plan?