Is stress hurting your heart?

It’s no secret that stress is bad for us. Chronic stress can have a negative effect on just about every part of your body, from muscles and bones to digestion. It’s particularly bad for your heart.

Cardiologists have long known that stress can increase blood pressure in patients who already have high blood pressure. But a new study, published in the journal Hypertension indicated that stress can be causative as well as exacerbating to an existing condition. The study followed more than 400 people, ages 48 to 87, who participated in a 12-hour overnight urine test between July 2004 and October 2006. 

Researchers analyzed participants’ urine for levels of norepinephrine, epinephrine, dopamine and cortisol, which are all known as biomarkers of stress. They then followed the patients through June 2018 to see if they developed hypertension or experienced cardiovascular events. The study found that over six and a half years of follow up, every doubling of the four stress hormone levels was associated with a 21 to 31 percent increase in developing high blood pressure. Over a median of 11 years, each doubling of cortisol was also associated with a 90 percent increase risk of cardiovascular events or strokes.

Cardiologist Lawrence McAuliffe, MD, at Cape Cod Healthcare Cardiovascular Center in Hyannis had a few reservations about the usefulness of the study, with the first one being logistical. The urine test itself isn’t easily replicable with actual patients, he said.

“You wouldn’t do random urine screenings for these biomarkers just to identify a person who was stressed so you could follow them downstream to see if they ever develop hypertension so you could treat the hypertension and prevent an eventual cardiovascular event,” he said. “So random screening wouldn’t be helpful. Not to mention it’s somewhat inconvenient. It’s at least a 12-hour urine collection.”

The other objection Dr. McAuliffe had with the study is that the information it revealed is somewhat obvious. It’s fairly intuitive that living in a chronic stressful environment for years on end is not healthy for a lot of reasons, both psychologically as well as physiologically, he said.

“It would not be surprising at all that those biomarkers would be elevated in individuals who were under stressful circumstances,” he said. “It’s sort of intuitively obvious, like if you put your finger in a vise and close the vise, you’ll say, ‘ow, ow.’ These biomarkers are the body’s ‘ow’ and they are measurable.”

It’s also fairly obvious that someone who developed hypertension as a result of stress, would then go on to have a higher risk of cardiovascular events. Hypertension is one of the known risk factors of adverse cardiac events that could manifest in conditions like heart attack and stroke, he said.

A Better Way to Find Out

Dr. McAuliffe noted that there is a much less complicated way to tell if a patient is experiencing stress in their life: simply ask them.

“If you’re a good doc, you should be able to get a good history to elucidate from your patient that in fact there’s stress in their life, whether it’s financial, family, health, environmental or work-related,” he said. “Just go down the list of psycho-social life stressors. If you’re a good doc, you should be able to identify that and intervene for stress management strategies.”

Dr. McAuliffe always asks his patients what is going on in their lives and with their families. He said even casual conversations can illuminate if a patient is facing undue life stress or prolonged grief. If they are, he refers patients to a social worker or mental health provider.

“You shouldn’t have to get a urine test to find out that your patient is under duress,” he said. “A good caregiver should be able to tease that information out from their patients and provide them with guidance and direct them to people and resources to help them.”

In addition to seeking help from a mental healthcare professional, the National Institute of Mental Health offers these tips to reduce stress in your life:

• Recognize your body’s response to stress. Symptoms like trouble sleeping, an increased use of alcohol or drugs, irritability and depression can indicate you are experiencing stress.
• Exercise regularly. Even just a daily 30-minute walk can improve your mood and your health.
• Incorporate relaxation techniques like meditation, breathing exercises or yoga into your daily life.
• Learn to say “no” if your life is overbooked.
• Set goals and priorities so your daily activities are things that are meaningful to you.
• Stay socially connected with other people.
• Ask for help from family, friends or a religious organization, if you are feeling overwhelmed.
• Seek help right away if you are having suicidal thoughts or feeling hopeless. The National Suicide Prevention Hotline is free, and someone is available to talk to you 24 hours a day, seven days a week. Their number is 1-800-273-TALK (8255).