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Why stress is bad for your heart and how to save it from damage

Doctors worry about what all the extra long-term anxiety during the pandemic is doing to our hearts.
There’s a strong heart-brain connection, which can be disturbed by stress, doctors say.
There’s a strong heart-brain connection, which can be disturbed by stress, doctors say.Getty Images
/ Source: TODAY

What’s on your mind can take a heavy toll on your heart.

Mental stress can increase the risk of heart disease, yet we often don’t think about the brain-heart connection when it comes to preventing a heart attack, focusing on the physical body instead.

One-third of Americans don’t know stress can increase the risk of developing heart disease, a new Cleveland Clinic survey found.

That could be a costly mistake, especially after two years of pandemic stress that has affected most everyone. Doctors worry about what all that extra long-term anxiety is doing to our hearts.

“To be honest, the effects are probably immeasurable. We are going to see fallout and it will take us years to catch up and figure out exactly what that fallout looks like,” cardiologist Dr. Susan Cheng told TODAY. She’s the director of public health research at Cedars-Sinai’s Barbra Streisand Women’s Heart Center and Smidt Heart Institute in Los Angeles.

“Even if somebody has what appears to be a healthy heart, maybe even no risk factors — maybe their blood pressure is OK, their cholesterol is OK, they don’t have diabetes — in situations like that, the heart can still be susceptible to stress, especially when stress levels are really high.”

Sometimes, that can appear as subtle palpitations or chest discomfort that doesn’t easily get caught by routine, conventional testing, Cheng noted.

For people who do have risk factors that create the setup for heart problems to develop, stress can be “the match that lights the fire” or “the trigger that sparks the domino effect” of going down the wrong path, she said.

For those who already have heart problems, the anxiety could be deadly. When mental stress triggered ischemia — a condition where the heart muscle isn’t getting enough blood — in patients with stable coronary heart disease, it was “significantly associated” with an increased risk of death or heart attack, a study published last fall in JAMA found.

“We know inherently that stress does bad things,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, Colorado.

“I would say that people who are under chronic stress always tend to seem to do worse.”

He sees many people in his clinic whose heart health has been adversely affected during the pandemic, including concerns about palpitations and high blood pressure, either because they’ve had COVID-19 or because of the stressful environment the crisis has created. When there’s more stress than usual, people are at the breaking point, Freeman noted.

How stress affects the heart

There’s a very strong heart-brain connection, which can be disturbed by stress, Cheng said.

One extreme example is takotsubo cardiomyopathy, or broken heart syndrome, where the death of a loved one or another harrowing experience can cause a person’s heart to change shape, leading to chest pain and other symptoms of a heart attack but without clogged arteries.

Chronic everyday stress also takes a toll, triggering and promoting inflammation. It can lead to high blood pressure, which can increase the risk for heart attack and stroke, the American Heart Association noted.

Psychological stress is a risk factor for increasing triglycerides and LDL “bad” cholesterol, studies have found.

Stressful events also typically bring on unhealthy coping strategies, such as drinking more alcohol, eating more comfort foods or taking up smoking — a cascade of behaviors that aren’t the best for cardiac health, Freeman said.

Primary care doctors and cardiologists probably don’t discuss the role of stress enough when they talk to patients about heart disease risks, he added.

“Medicine is all about hard endpoints, but at the end of the day, we as human beings are squishy and soft and so it’s hard to quantify stress,” Freeman said.

How to protect your heart from stress:

Exercise, especially in nature, to relieve stress: “Getting in those 30 minutes every day of exercise is absolutely critical for not only physical well-being but for mental well-being,” Freeman noted. Going for a walk outdoors allows you to enjoy the healing power of nature, the concept behind forest bathing.

Find time to focus on yourself: This is quiet time where you can reset amidst the stress, Cheng said. If you’re busy rushing around picking up kids and going from one obligation to another, she recommended getting to your next appointment 10-15 minutes early, sitting in your car in the parking lot, turning off phone notifications and re-calibrating. “If you can do it once a day, amazing. If you can do it just a few times a week, I find that’s the first step towards (de-stressing),” she said.

Freeman had similar advice: “Meditate, go for a walk, do a walking labyrinth, look at the snowfall, look at the stars, whatever you have time for. And when you’re doing that, cast off that accumulated stress,” he said.

Watch for warning signs that stress is affecting your heart: They include an increased heart rate, butterflies in the stomach, sweating, palpitations and shortness of breath. It’s normal to feel stress in the moment during a stressful situation, but that fight-or-flight response should go away as things settle down. If it doesn’t and you feel shortness of breath doing regular daily activities, like walking up a flight of stairs or walking two blocks along flat ground, let your doctor know, Cheng said. If you’re developing chest pain in the middle of an argument, stop arguing right then and seek medical attention, Freeman added.

Forgive yourself: Don't let setbacks or mistakes eat at you, he advised. Did you do everything you could? Did you go the extra mile? If the answer is yes, let go as much as you possibly can.

“Life is full of stresses so I always tell people, ‘You’re never going to find anybody who’s 100% stress-free,’” he noted. “It’s important that we all deal with that stress in a way that works for us.”