The stress that accompanies a fender-bender or a violent argument gets your heart beating faster, quickly raises blood pressure, and may provoke the chest pain of angina in people with coronary heart disease (CHD). You would certainly think that chronic exposure to stress would be bad for your heart and could possibly create other health problems.
Several large studies have indeed shown that various types of chronic stress are linked to a greater risk of heart attacks or the development of heart disease in the first place.
How can stress cause heart disease? Chronic stress can cause problems by elevating levels of adrenalin and adrenal steroid hormones. Chronic stress can also lead to depression or disturbed sleep. Other possible consequences of stress include smoking more tobacco; self-medicating with illicit drugs or too much alcohol; overeating, which, along with decreased exercise, can lead to obesity; and failing to adhere to medical regimens.
But other studies have failed to show the association of stress with heart disease. And the relationship between stress and other health problems is even less certain.
The problem is that stress is a very personal matter. You might think, for example, that the CEO of a large corporation or a starting quarterback in the National Football League would be under enormous stress.
It turns out, however, that the mail clerk is under more strain than the CEO. And the backup quarterback, standing on the sidelines wondering if and when he will get a chance to play, may be more stressed out than the starting quarterback, out on the field being mauled by enormous defensive players.
A recent study reported in the Journal of the American Medical Association looked at 972 Canadian men and women during the six years after they returned to work after an initial heart attack. The study demonstrated that those participants who experienced chronic high stress on the job had a significantly greater likelihood of suffering another heart attack than did those in less stressful jobs. This increased risk associated with stress persisted even after adjusting for such CHD risk factors as high blood pressure, high cholesterol and cigarette smoking.
A key to understanding these findings is the researchers' definition of job strain: A combination of high psychological demands and few opportunities to make decisions. This agrees with the general belief that certain major job factors may put higher levels of stress on the mail clerk than on the CEO. Additional stressful features of the mail clerk's job are an imbalance between work demands and rewards, low job security, and few career opportunities.
Other major sources of stress—life events like divorce or the death of a family member, marital discord, and severe financial difficulties—have also been associated with an increased risk of CHD or its complications. A 12-year study, for example, of about 9,000 civil servants in London found a 34 percent increased risk of a CHD event in those who experienced conflict and fighting in their closest personal relationships.
Ways to keep stress at bay are legion - from exercise to meditation to breathing exercises to engaging in sex - but some suggestions may not be as practical or feasible as one thinks.
It's not so easy, for example, to find a less stressful job or to overcome marital or financial difficulties. Whatever relaxation techniques you choose to try, the first helpful step is merely to recognize the presence of chronic stress in your life and its causes, and to talk about them with family members, close friends, a minister, or a counselor. (I don't, however, advise the stress-relief dietary supplements promoted on the Internet.)
Quite frankly, doctors have neither the time to delve deeply into their patients' sources of stress nor the training to do anything useful about those stressors. Nonetheless, it's a good idea to at least broach the subject of stress with your doctor, because it's unlikely that he or she will bring up the topic on their own. And, if you are lucky, they may have some helpful suggestions.
