When It Comes to Heart Disease, Don’t Underestimate Chronic Stress

High cholesterol, high blood pressure, diabetes, smoking, physical inactivity and obesity. Most of us are familiar with these as major risk factors for heart disease. But what about stress? Is there a connection between stress and heart disease?

“Not all stress is bad,” says Dr. Mark Callesen, Chief Medical Officer for Jewish Family & Children’s Service. “It can simply be a response to a single short-term event. But it also can be chronic (toxic) and associated with a medical condition or feeling pressured over a long period of time.”

Hormones and Stress
To understand how stress affects the body, Dr. Callesen recommends starting with the hormones most closely related to its basic biology: adrenaline and cortisol. When we encounter a perceived threat — say, a large dog running toward us — our brain’s fear center, the amygdala, triggers the release of these hormones to prepare us for action. They’re what make our breath quicken, our heart race and our muscles tense – the so-called fight-or-flight response. Cortisol, the primary stress hormone produced in our adrenal glands (atop the kidneys), also alters functions not essential to fight-or-flight situations, such as suppressing our digestive system and immune system responses.

If the large dog were to run past us, these hormone levels would drop and return to normal, as would our heart rate and blood pressure. Other systems would carry on with their regular actives. But when our fight-or-flight reaction is always turned on, when there is always a large dog running toward us, it becomes counterproductive. This long-term activation of our stress response system is called chronic stress. And the higher levels of cortisol associated with it have been linked to an increased risk of cardiovascular events, including heart attack and stroke.

“Chronic stress can lead to impaired cognitive function, increased risk of heart disease, high blood pressure and diabetes. It can also impair the body’s immune system and exacerbate any existing illnesses.” says Dr. Callesen. “Normal stress is temporary, situational in nature and usually resolves on its own. Chronic stress is much more severe and can lead to health problems if not diagnosed and treated.”

Chronic stress can pop up in many different scenarios — from relationship strains to on-the-job aggravation to unrelenting depression or anxiety. Current events can also play a role. A recent study by the American Psychological Association found that nearly half of Americans believe their lives have become more stressful over the past two years, citing the pandemic, the war in Ukraine and inflation as their main concerns.

Chronic stress can increase inflammation, and inflammation is linked to factors that can harm your heart, such as high blood pressure and lower HDL cholesterol (the “good” cholesterol). Chronic stress can also increase our risk for heart disease in more subtle ways.

“When you’re constantly stressed, you tend to not sleep well,” says Dr. Callesen. “You’re also more likely to eat high-fat, high-cholesterol foods or engage in other heart-damaging behaviors such as smoking, drinking too much alcohol or using drugs.”

By both defusing stress and managing the unhealthy behaviors it triggers, we can break the connection and help minimize our body’s heart-damaging reactions to it.

5 Ways to Manage Stress and Protect Your Heart
Want to turn your chronic stress around and help protect your heart in the process? Dr. Callesen recommends these five simple tips:

1. Focus on the things you can control: This helps us to stay positive and laugh more. Laughter has been found to help reduce artery inflammation and increase “good” HDL cholesterol.

2. Exercise: One of the best ways to melt away stress and lower your blood pressure is through regular physical activity.

3. Practice mind-body techniques: Meditation, yoga and tai chi activate the parasympathetic nervous system, which calms the brain and body.

4. Strengthen and maintain relationships: Having a strong support network can reduce your stress level and help you take better care of yourself, too.

5. Take a break from electronics: You can’t escape from stress when it follows you everywhere. Unplug from your phone, computer and TV, even if it’s just for 15 minutes.

If you’re struggling with stress, Dr. Callesen suggests talking to your primary care provider to discuss treatment options — including medication, if necessary — for treating high blood pressure or sleep issues or getting a referral to a mental health professional.

“Stress can be effectively treated using counseling and medication, if needed,” he says. “Typically, medications targeting anxiety and depression are commonly prescribed.”

Most importantly, realize that stress is a normal human reaction that happens to everyone — even the experts.

“I absolutely get stressed, but doing something active helps me to relax,” says Dr. Callesen. “I find walking my two dogs, Emmett and Stella, helps me to decompress. It forces me to get outdoors and all three of us sleep better that night.”

Laura Hahnefeld is director of marketing and communications for Jewish Family & Children’s Service.

Jewish Family & Children’s Service (JFCS) is one of Maricopa County's largest integrated behavioral and primary care health providers. It offers primary care ranging from pediatrics to geriatrics, behavioral counseling, therapy for mental health and virtual care options. To learn more or to get started as a new patient at one of its four healthcare centers, visit the locations page on the JFCS website. All AHCCCS plans are accepted.