New study takes a fresh look at stress and the heart l Expert Opinion

A colleague recently sent me a text message saying: “Did you see this study? I feel you might have an interesting take on it.”

The study, “Association of Mental Stress-Induced Myocardial Ischemia with Cardiovascular Events in Patients with Coronary Heart Disease” appeared in the Journal of the American Medical Association. Ischemia is when there isn’t enough blood nourishing the heart with oxygen. It usually happens because of blocked coronary arteries, and can lead to a heart attack.

The accompanying editorial bore the even more intriguing subtitle: “When the Mind Controls the Fate of the Heart.”

This observational study looked at a diverse population (34% women, 40% Black). Mental stress-induced ischemia occurred in 16% of participants, conventional stress ischemia 31%, and both in 10%. After five years of follow-up, the primary endpoint of death or heart attack occurred in 17%. In short, the presence of mental stress showed a significant correlation with bad cardiac outcomes with a strong association between ischemia caused by mental stress and the chance of having a future cardiac event

The mental stress given to the participants in this study consisted of a 12-hour fast followed by having two minutes to learn a three-minute speech that they gave in front of at least four other people.

It was not surprising to me that this study, and others like it, showed that mental stress worsens cardiac disease. The real question is how to deal with it. I have struggled with combatting the stress component of heart disease for many years. I spent more than 20 years running an intensive lifestyle education program in Philadelphia called Change of Heart. This program met (with 25 to 50 participants) twice every week for four hours for 10 weeks. Participants met with me, a dietitian, an exercise physiologist, and a psychologist every session. The exercise, diet and information sessions were wildly successful and effective. The stress related portion, not so much.

Part of the problem was finding the right person to teach stress-reducing techniques. The first person who tried it was a disaster. He was a clinical psychologist who created an entire manual just for the program regarding the negative effects of emotional stress on the heart. Most of his manual was devoted to his decayed relationship with his father. This led him to believe all stress originated from problems with the paternal-child bond. People rapidly began to lose interest in this approach, shifting uncomfortably in their chairs. I quickly found another clinical psychologist for the next session. She was much better, but still not what the program needed.

I began working instead with relaxation technique instructors. Yoga, tai chi, and massage became integral to the program, and successfully helped manage stress. Several good studies have supported the use of these and other modalities to reduce stress and its effect on heart disease.

More research is needed to further demonstrate not just the causality between stress and heart disease, but the benefits to be gained with treatment. My experience has shown that relaxation modalities such as yoga or running are helpful but are not for everybody. Picking the technique that is right for you might be one of the most important things to do in life.

This is a wordy answer to my colleague’s brief question. The short version: Physicians and other health care providers need to emphasize the important interaction between body and mind and encourage their patients to adapt lifestyle changes promoting individual strategies to deal with it.

I no longer run the Change of Heart Program, but I developed an enormous respect and appreciation for the importance of stress reduction to prevent heart disease. It should be a pillar of any lifestyle program and of everyday life. It is nice to see the science begin to catch up to what seems obvious – that stress and the development of heart problems are irrevocably linked and need more attention.

David Becker is a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown. He has been in practice for more than 25 years.