How Anxiety & Stress Contribute To Heart Problems

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If you took a casual Instagram poll of your friends, more of them are likely to be anxious out than not. Worse? They probably think it's not something they need to, uh, stress out about. But being chronically stressed can have an impact on your overall health, and experts say stress is particularly bad for your heart. While a little stress can be good for motivation, too much can risk overtaxing your cardiovascular system.

“Stress is a commonly recognized risk factor for heart disease," Dr. Robert Greenfield M.D., a cardiologist and medical director at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center, tells Bustle. The higher your stress levels, the more intensely your heart might feel it, even if you think your stress is "normal."

This is particularly an issue for women. "Heart disease is the number one killer of women," Dr. Suzanne Steinbaum M.D., D.O., a preventative cardiologist and Go Red For Women spokesperson, tells Bustle. "Yet the symptoms are often dismissed for less life-threatening conditions like acid reflux or normal aging." In women, the symptoms of a heart attack can include shortness of breath, nausea or vomiting, and back or jaw pain — and they can sometimes go unrecognized.

Stress isn't just in your head — it can be a direct precursor to these physical symptoms. Here's how stress can negatively impact your heart health.

1. It Increases Your Risk Of Cardiovascular Problems Over 45

The more stress you experience over the course of your life, the more exhausted your heart becomes. That can heighten your risk of cardiovascular issues. A study of nearly 250,000 people published in Circulation in 2018 found that there's a link between stress and a higher risk of cardiovascular issues like strokes past the age of 45, particularly in women.

The reason for this, Dr. Greenfield tells Bustle, is stress on the physical heart itself. "Stress, frustration, and anger are all risk factors for heart issues," he tells Bustle. "They raise both adrenaline and cortisone, which have detrimental effects for the heart and blood vessels by disrupting the smooth lining of the blood vessels, which is called the endothelium."

The endothelium needs to function properly to help the heart work. A study in 2014 published in Global Cardiology Science & Practice found that the endothelium can be damaged by anything from smoking to — you guessed it — stress.

2. Gender Plays A Role In Stress-Related Heart Problems

Studies show that cardiovascular health problems linked to stress might be particularly pronounced in people assigned female at birth. A study published in Gender & The Genome in 2018 found that stress may cause higher risk of cardiovascular disease in women than men, though men are more likely to die of stress-related heart issues overall.

Types of stress may matter: small studies have shown that women are more vulnerable to heart issues linked to emotional distress than men. Work stress definitely affects female-bodied people too. The Women's Health Study, run by Harvard University, announced in 2010 that women who work in high-stress occupations are 40% more likely to experience heart disease than less-stressed people.

3. So Does Race

Women of color are more vulnerable to heart issues than white women, according to research. A study of over 25,000 American women in the Women's Health Study published in Circulation in 2018 found that women of color experienced more psychological stress over the course of their lives, and were also more likely to have poor cardiovascular health.

Race has a complex relationship with health, but racism-related stress is a factor. People in groups targeted by racial discrimination are more likely to experience cardiovascular issues, the American Psychological Association noted in a study in 2016.

4. Socioeconomic Status Matters, Too

Income can affect your stress levels a lot. "Socioeconomic status may increase stress and affect access to basic living necessities, medication, doctors and the ability to adopt healthy lifestyle changes," Dr. Steinbaum tells Bustle. In all high-income countries, according to a study published in The Lancet in 2019, lower socioeconomic status affects cardiovascular disease risk. The less income a person earns, the more stress they experience, and the harder their heart has to work.

5. Anti-LGBTQ Discrimination Is Also A Source Of Stress

Being the subject of anti-LGBTQ bias can be a particular kind of stress that hurts heart health. Gay and bisexual men showed elevated signs of heart disease compared to the general population in a study published in American Journal Of Preventative Medicine in 2013, and another study of the LGBTQ community as a whole published in American Journal Of Public Health in 2017 found that being non-heterosexual raised risk of heart issues in people of all genders. The American Heart Association noted in 2019 that medical treatment for heart problems can actually cause stress for LGBTQ people, particularly for transgender people at risk of being mistreated by their doctors themselves.

5. Stress-Related Sleeplessness Can Hurt Your Heart

If you've been having trouble sleeping because of a stressful period at work, it may be putting your heart at risk, Dr. Steinbaum says. A study published in European Journal Of Preventive Cardiology in 2018 found that workers with hypertension were more likely to experience heart problems when they were stressed at work — largely because their stress was causing them to sleep poorly. Poor sleep caused by financial stress can impact the heart, too; research published in Cardiovascular Research in 2019 showed that lack of sleep plays a role in the higher cardiovascular disease rates in low-income people.

6. Alleviating Stress Can Help The Heart

Just as stress can hurt the heart, employing stress-busting techniques is helpful for heart health, according to studies. A small study published in Experimental Biology in 2018 found that a single mindfulness meditation session, designed to lower stress levels, improved heart health markers in people with anxiety, though a lot more work needs to be done to see if this could be helpful for other types of stress. The Journal of the American Heart Association published a statement in 2018 saying that meditation seemed to improve some cardiovascular health outcomes, so lessening stress is definitely worth exploring as a way of improving heart health.

If you're concerned about how your stress levels might be affecting your heart, it's a good idea to talk to your doctor. "It’s important for women to be their own advocates and speak up if something feels off within their bodies," Dr. Steinbaum says. Nobody knows your body better than you do.

Studies cited:

Caceres, B. A., Brody, A., Luscombe, R. E., Primiano, J. E., Marusca, P., Sitts, E. M., & Chyun, D. (2017). A Systematic Review of Cardiovascular Disease in Sexual Minorities. American journal of public health, 107(4), e13–e21. doi:10.2105/AJPH.2016.303630

Durocher, J.J., Marti, H., Morin, B., Wakeham, T.R. Single session mindfulness meditation reduces aortic pulsatile load and anxiety in mild to moderately anxious adults. The FASEB Journal 32 (1_supplement), 714.19-714.19

Hatzenbuehler, M. L., McLaughlin, K. A., & Slopen, N. (2013). Sexual orientation disparities in cardiovascular biomarkers among young adults. American journal of preventive medicine, 44(6), 612–621. doi:10.1016/j.amepre.2013.01.027

Jackson, C. A., Sudlow, C. L., & Mishra, G. D. (2018). Psychological Distress and Risk of Myocardial Infarction and Stroke in the 45 and Up Study. Circulation: Cardiovascular Quality and Outcomes, 11(9). doi: 10.1161/circoutcomes.117.004500

Li, J., Atasoy, S., Fang, X., Angerer, P., & Ladwig, K.-H. (2019). Combined effect of work stress and impaired sleep on coronary and cardiovascular mortality in hypertensive workers: The MONICA/KORA cohort study. European Journal of Preventive Cardiology, 204748731983918. doi: 10.1177/2047487319839183

Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. (2019). Journal of the American Heart Association, 8(2). doi: 10.1161/jaha.117.004176

Peña, M. S. B., Mbassa, R. S., Slopen, N. B., Williams, D. R., Buring, J. E., & Albert, M. A. (2019). Cumulative Psychosocial Stress and Ideal Cardiovascular Health in Older Women. Circulation, 139(17), 2012–2021. doi: 10.1161/circulationaha.118.033915

Petrovic, D., Haba-Rubio, J., de Mestral Vargas, C., et al. The contribution of sleep to social inequalities in cardiovascular disorders: a multi-cohort study. Cardiovasc Res. 2019 Nov 22. pii: cvz267. doi: 10.1093/cvr/cvz267.

Stringhini, S., & Bovet, P. (2017). Socioeconomic status and risk factors for non-communicable diseases in low-income and lower-middle-income countries. The Lancet Global Health, 5(3). doi: 10.1016/s2214-109x(17)30054-2

Taylor, J. L., Makarem, N., Shimbo, D., & Aggarwal, B. (2018). Gender Differences in Associations Between Stress and Cardiovascular Risk Factors and Outcomes. Gender and the Genome, 2(4), 111–122. doi: 10.1177/2470289718820845

Widmer, R. J., & Lerman, A. (2014). Endothelial dysfunction and cardiovascular disease. Global cardiology science & practice, 2014(3), 291–308. doi:10.5339/gcsp.2014.43

Williams, D. R., Priest, N., & Anderson, N. B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 35(4), 407–411. doi:10.1037/hea0000242

Experts:

Dr. Robert Greenfield M.D.

Dr. Suzanne Steinbaum M.D.