Recently, a very close friend confided in me that he was experiencing intermittent chest pain. Upon further discussion, he shared with me that has been under tremendous stress over the past few months. I urged him to see his family physician and after a series of examinations and tests it was concluded that his symptoms were stress related. However, it reminded me of another friend who was not so lucky. He was experiencing similar symptoms, did not report them to his physician and suffered a heart attack. While he required coronary by-pass surgery, he is living a happy and healthy life today. For me, the disturbing part of these two stories is the fact that both middle-aged men live a very healthy lifestyle. They have healthy diets, get plenty of exercise, and maintain good weight control. Neither have any of the “risk factors” typically associated with heart disease: heredity, obesity, diabetes, high cholesterol, high blood pressure, and smoking. However, the one common factor that was evident for both men was “stress.” Stress is a significant risk factor. Unfortunately, some people, like my friends, do not handle stress very well, especially when coupled with the fact that they have classic “Type A” personalities. Medical researchers are not sure how stress increases the risk of heart disease but more and more evidence suggests a relationship between the two.
There are different types of stress. For example, physical stress such as exercise and other forms of physical exertion can place good demands on heart. In fact, the lack of physical stress (e.g. a sedentary lifestyle) is a major risk factor for heart disease. However, emotional stress, if severe and chronic enough, can also cause heart disease. Stress is unavoidable in a contemporary society. However, while we cannot control or avoid it, we can control how we react to it!
Emotional stress can be caused by many factors including minor daily hassles to major lifestyle changes: illness, death, screaming children, nagging boss or spouse, new job, unemployment, traffic, pregnancy, crowds, legal problems, and financial concerns. Our emotional responses to these and many other situations determine if we are experiencing good stress or bad stress. If we feel that we are in control of our lives and our destinies, we are in a better position to manage stress when faced with a difficult choice or when placed in a challenging situation. However, if we feel that the circumstance or situation controls us, our responses, we will feel out of control and experience bad stress. Also, our personality can be a factor in our perception of stress. If we have a “Type A” personality (e.g. time-sensitive, inpatient, chronic sense of urgency, tendency toward hostility, perfectionist, and competitive), we may be creating our own emotional stress! For example, a simple trip to the grocery store will be filled with episodes of bad drivers, poorly-timed traffic lights, crowded aisles, ignorant check-out clerks, and thin plastic bags that rip too easily.
Researchers are not sure if emotional stress is a direct or indirect cause of heart disease. As a direct cause, emotional stress has been shown to constrict coronary arteries, cause blood to clot more readily, increase heart rate, and raise blood pressure. Also, emotional stress can trigger an increase in cholesterol levels by causing the body to produce more energy in an attempt to adequately respond to increased stress. Increasing the body’s cholesterol, raises HDLs (good cholesterol) as well as LDLs (bad cholesterol). Furthermore, emotional stress increases the production of cortisol. Cortisol stimulates fat and carbohydrate metabolism for fast energy in addition to insulin release for maintenance of blood sugar levels. The end result of these actions is an increase in appetite. Emotional stress that stimulates your appetite may cause weight gain. Moreover, cortisol can affect where you put on the weight. Cortisol tends to cause fat to deposit in the abdominal area rather than at the hips. This type of fat deposition has been strongly correlated with the development of heart disease.
As an indirect cause, emotional stress can cause people to participate in bad habits that are associated with heart disease. Overeating may be an attempt to fulfill a psychological need. People that overeat because of stress often binge on “comfort” foods that are high in fat, cholesterol, and sugar. These foods are associated with significant weight gain. Also, emotional stress can trigger depression. Depression can not only cause indulgence in comfort foods but also reduce motivation for physical activity and exercise. Moreover, an individual experiencing emotional stress may attempt to reduce stress by participating in dangerous activities such as smoking and alcohol abuse.
No one can escape from emotional stress because it is a normal part of everyone’s life. We must learn to manage stress effectively so that stress can be used as a motivational tool rather than as an implement of self-destruction.
Contributor: Janet Caputo, DPT, PT, OCS, is a physical therapist specializing in the management of orthopedic and sports injuries with a special interest in vestibular rehab and falls prevention at Mackarey Physical Therapy in downtown Scranton.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part 2 “Managing Stress” in the Scranton Times-Tribune.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.orgPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.