Stressed Out? Address Your Lifestyle First

Stress and cardiovascular disease are linked, both in popular folklore and in medical experience. But what is the nature of the connection? How does stress, an emotional problem, affect the cardiovascular system, a physiological structure? And would knowledge of the connection improve the chances of effective treatment?

This knotty problem was tackled by Dr Mark Harmer of University College, UK. He’s published his results in the Journal of the American College of Cardiology.

Over 6,500 healthy men and women had three aspects of their lives assessed at baseline:

Psychological distress, using a well-recognized rating scale

Behavioral lifestyle – smoking, alcohol use, physical activity

Measurable cardiovascular risk factors – C-reactive protein (CRP), fibrinogen level, total and high-density lipoprotein cholesterol, obesity, high blood pressure.

The so-called ‘outcome measure’ was a cardiovascular ‘event’ – hospitalization for a myocardial infarct (MI, or heart attack), coronary artery bypass, angioplasty, stroke, heart failure, or cardiac death.

The average follow-up was more than 7 years. During follow-up, there were 223 cardiovascular events, of which 63 were fatal. Those participants who showed up as having psychological distress were found to have a 54% increased risk of having a cardiovascular event. This was an expected finding. However, analysis showed that behavioral factors (smoking, inactivity, alcohol, etc.) accounted for 65% of the relationships between stress and cardiovascular event, with only an additional 19% explained by measurable cardiovascular risk factors (CRP, high blood pressure, etc).

These results show that the relationship between psychological distress and cardiovascular disease is largely explained by behavioral processes. The investigators, therefore, suggest that treatment of distress to reduce cardiovascular risk should primarily focus on health behavior changes (quitting smoking, exercising, moderating drinking, and so on). This is a concept that we’ve been promoting for years, as it happens. And it may be easier to implement than trying to address the environmental factors that provoke stress in the first place.