Don’t Let Your Head Hurt Your Heart

By Janis Jibrin, R.D.

Are you having a hard time coping? Feel like you’ve lost control over your finances, family duties or other important areas of your life? Depressed? If stress and emotional distress have become a way of life (instead of short-term and temporary), you may be setting yourself up for heart disease and other physical ailments. And if you already have heart disease, a difficult emotional environment can sap motivation to make those all-important lifestyle changes, like exercising and eating more nutritiously.


In the doctor’s office and in the media, high blood pressure, high cholesterol and other more tangible risk factors seem to get most of the attention. But stress and emotional distress may also be destructive to your heart. For example high LDL (“bad” cholesterol) can increase your risk of heart disease by about 74 percent.1 Pretty dramatic, right? But now look at what your mental state can do:

  • Having major depressive disorder (also called “clinical depression”) can increase risk of developing heart disease by a whopping 300 percent. And milder forms of depression (depressive symptoms) can be associated with a 50 percent increase in heart disease.2
  • Depression was associated with a 30 percent increased risk of stroke in the long-running Harvard University’s Nurses’ Health study.3
  • The Nurse’s health study also found that women who care for a sick or disabled spouse were nearly twice as likely to have a heart attack or other heart-related problem over a four-year period.4
  • Having a small social network has been linked to a two- to threefold increased risk of developing heart disease.5


How does your mental state affect your heart?


How is it that a bad marriage, being depressed or other chronic stressors may take such a devastating toll on your heart? It can do so by triggering the release of hormones that, in myriad ways, pave the way for heart disease.1 That’s because the body can interpret emotional distress as physical distress, and emit hormones that help cope. For instance, it releases adrenaline, the famous “fight or flight” hormone, which primes our muscles for action. It raises heart rate, allowing more oxygen to flow to muscles and releases stored blood sugar to fuel those muscles. Useful if we’re running away from a mugger, but destructive if we’re just sitting around because, over the long run, adrenaline and other similar hormones can raise blood pressure, blood sugar, may make arteries more likely to become clogged, and blood more likely to clot (which can cause heart attacks and stroke).


Chronic stress and emotional distress can also stimulate the release of cortisol, the so-called stress hormone.1 Cortisol favors the storage of body fat to the worst possible place—deep inside your abdomen where it can cause insulin resistance, often a precursor to type 2 diabetes. As if all this isn’t bad enough, stressors like depression can also cause chronic inflammation, yet another risk factor for heart disease, as well as type 2 diabetes.1 Plus, these hormones can make it even harder to cope with stress by making you feel more wired and jumpy so you have an even more exaggerated reaction.1


Depression and heart disease seem to be a two-way street.6 Suffering from depression may raise the chance that you’ll develop heart disease. Particularly if your symptoms are fatigue, appetite and sleep disturbances or pain—these can be more destructive to the heart than the more cognitive symptoms, such as lack of interest in things you once enjoyed, guilt or suicidal thoughts. And heart disease itself can trigger depression, both because of the uncertainty and fear, and because inflammation in blood vessels can affect sleep and mood.


So not only does your emotional state raise risk for heart disease, but if you already have the condition, stress, anxiety, depression and the like can become obstacles to getting to the gym, cooking healthy meals and complying with all the great advice from your healthcare provider.


Top Sources of Stress for Americans

Here are the top sources of stress according to a joint American Psychological Association/ Harris survey taken in 2011.7
Source of Stress Percent of Americans reporting it to be a significant cause of stress
Money 75%
Work 70%
The economy 67%
Relationships 58%
Family responsibilities 57%
Family health problems 53%
Personal health concerns 53%
Job stability 49%
Housing costs 49%
Personal safety 32%


Turning It Around


If your head is getting in the way of your heart’s health, there are many ways to help get your emotional and mental equilibrium back. Here are some suggestions:


Pinpoint the source of the problem.8 Sometimes the issue is obvious—a stressful and unrewarding job, a bad marriage, a history of depression, etc. But sometimes it’s not so easy to figure out. For instance, you may not realize that you’ve taken on way too much—even if they are things you don’t mind doing—and are left feeling overwhelmed and overstretched. To help pinpoint sources of stress and emotional pain, it might help to keep a “stress log” in which you write down daily events and situations in one column and your emotional state in a second column.


Change what you can.8 Say it’s your job that’s a huge source of stress. With the dismal job market, now may not be the time to quit your job, but you might start looking for another one or doing what you can to make the work environment better, or both. Same with other sources of pain and stress: Is there anything you can do to ease the situation?


Accept less than perfection.9 If you expect perfection from yourself and others, you’re bound to be let down. It’s fine to keep your standards high, but keep them reasonable and you won’t be constantly disappointed.


Manage stress. There are many ways to alleviate stress—we all have our favorites. Here are some techniques that have been shown to be helpful in research studies. If your tried and true stress reliever isn’t on the list, that doesn’t mean it’s not just as—or even more—effective.


  • Expand your support network. “We all need somebody to lean on” goes the refrain of the classic Bill Withers tune—so true, especially when it comes to protecting your heart.1 Friends, family, co-workers, hired help are all people you can lean on to lighten your load and alleviate stress. Support comes in many forms: Your husband or mother watching the children while you go to the gym, a fun night out with friends, a co-worker pitching in so you can make your deadline.Don’t be afraid to ask for help—you can always reciprocate when you’re up to it. Don’t have anyone to turn to? You might have more options than you think—make a list of all your current sources of support. Are there people or institutions (like your church or other community organization) that you could be tapping? Could you give up something (like an expensive cable TV package) to free up money to hire help once in awhile?
  • Try yoga, tai-chi or aerobic exercise.10-13 All three have been shown to reduce stress or depression. Think you don’t have time? You might find that time if you make it a priority. Perhaps you could cut back on TV and Web-surfing. Or (like many of us) you could be more organized and procrastinate less making more efficient use of your time.
  • Listen to music—it can lower anxiety and heart rate, and may produce a more significant drop in blood pressure in people who have heart disease according to a comprehensive analysis of the research by Temple University’s Boyer College of Music and Dance in Philadelphia, PA.14 A variety of musical genres, such as jazz and classical, have been shown to be effective, so it’s not clear if any one type is most helpful. However, some research indicates that heavy metal and techno may actually be counterproductive.15 So play music you enjoy that doesn’t annoy you or stress you out!
  • Make time for activities you enjoy. Going out dancing, doing crafts, painting and any other hobby can reduce stress and bring you joy. And may help your heart according to Japanese research.16 The study tracked men and women at the very beginning stages of atherosclerosis (narrowing of the arteries leading to the heart) for two to three years. Those with hobbies had less arterial narrowing and fewer symptoms of heart disease than those who had no hobbies.
  • Get enough sleep. If your fuse is shorter when you’re sleep-deprived, it’ll come as no surprise that lack of sleep has been linked to increase stress and depression.17 It can also be another risk factor for heart disease.18 Most of us need about eight hours nightly.

Get counseling. If your own attempts to combat stress, depression, anxiety and other chronic psychosocial downers aren’t bringing you the relief you need, psychological counseling is in order. Talk therapy or medication, or both, can make all the difference.6


1. Rozanski, A. et al. The Epidemiology, Pathophysiology, and Management of Psychosocial Risk Factors in Cardiac Practice. The Emerging Field of Behavioral Cardiology. J Am Coll Cardiol 2005;45:637–51.
2. Rugulies, R. Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 2002;23:51– 61.
3. Pan A, Okereke, O, Sun, Q, Logroscino G, Manson J, Willett W, et al. Depression and incident stroke in women. Stroke. 2011;42:2770 –2775.
4. Lee, S, Colditz, GA, Berkman, LF, Kawachi, I. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med 2003;24:113–9.
5. Rozanski, A, Blumenthal, JA, Kaplan, J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192–217.
6. von Känel, R. Psychosocial stress and cardiovascular risk–current opinion. Swiss Med Wkly 2012;142:w13502.
7. Stress in America: Our Health at Risk. American Psychological Association,. Released January 11, 2012. http://www.apa.org/news/press/releases/stress/2011/final-2011.pdf
8. Understanding Chronic Stress. American Psychological Association Psychology Help Center website. http://www.apa.org/helpcenter/understanding-chronic-stress.aspx
9. Mind/body health: Stress. American Psychological Association Psychology Help Center. website. http://www.apa.org/helpcenter/stress.aspx
10. Li, AW, et al. The effects of yoga on anxiety and stress. Altern Med Rev. 2012 Mar;17(1):21-35.
11. Wang, W.C. The effect of Tai Chi on psychosocial well-being: a systematic review of randomized controlled trials. J Acupunct Meridian Stud. 2009 Sep;2(3):171-81.
12. Mead, GE, et al. Exercise for depression. Cochrane Database Syst Rev. 2009 Jul 8;(3).
13. Herring, M.P. et al. Effect of Exercise Training on Depressive Symptoms Among Patients With a Chronic Illness Arch Intern Med. 2012;172(2):101-111.
14. Bradt, J, Dileo, C. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews 2009, Issue 2.
15. Trappe, HJ. The effects of music on the cardiovascular system and cardiovascular health. Heart. 2010 Dec;96(23):1868-71.
16. Saihara, K. et al. Enjoying hobbies is related to desirable cardiovascular effects. Heart Vessels 2010 Mar;25(2):113-20.
17. Grandner, MA, et al. Problems Associated with Short Sleep: Bridging the Gap between Laboratory and Epidemiological Studies. Sleep Med Rev. 2010 August; 14(4): 239–247.
18. Levy, P., et al. Sleep deprivation, sleep apnea and cardiovascular diseases. Front Biosci (Elite Ed). 2012 Jan 1;4:2007-21.

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