mental stress – Cardiac Wellness Institute

As a Preventive Cardiologist, the question I get asked most often is this:

“I (or someone I know) have no bad habits and have not had any health problems in the past, but ended up with a heart attack. How come doctor?”

My immediate response is that there are 9 risk factors for serious heart and blood vessel disorders like heart attack and stroke. In fact, each of these 9 are independent risk factors which can cause disease by itself and when present in combination poses a very high risk of fatal heart disease.

The 9 cardiovascular risk factors: The Framingham (1) and the INTERHEART (2) studies are both landmark research works that have clearly identified the cardiovascular risk factors in all populations. The image below depicts the 9 risk factors that we should all be aware of and should watch out for.

A questionnaire-based survey was conducted this World Heart Day by Cardiac Wellness Institute to study the presence of behavioural risk factors for heart disease among college-going women in Chennai. Of the 554 students aged 15-30 years who responded to this survey, almost 40% reported to be chronically stressed. We have also noted a similar trend of staggeringly high rates of chronic mental stress among young corporate employees. Intensive lifestyle modification supervised by medical professionals has proven effective in changing dietary, exercise, sleep and stress-related risk factors in all age groups including young adults.

Hypertension, Diabetes and Dyslipidemia are the three silent killers which can only be identified by routine health check up. All 3 conditions often co-exist in the same individual but do not cause any symptoms leading to a very high risk of sudden death. Simple tests like blood pressure measurement and blood sugar and lipid level analysis will throw light on your risk profile. Mild variations from normal and early stage of disease can be managed with lifestyle changes alone but more severe abnormalities will require medications in addition to lifestyle changes.

Unhealthy diet, Inadequate exercise, Obesity, Mental stress along with tobacco use and alcohol abuse are the risk factors that are soaring high in our population. Spreading awareness about the ill-effects of these lifestyle choices is the first step in curbing them. The second and most crucial step is providing the right tools to help people modify their risky behaviour. Exercise training, meal planning guidelines, stress management techniques, goal-setting to become fit, and professional help to quit smoking and drinking are some ways we help individuals succeed in making these difficult but salient changes that impact their health in a very positive way.

If you have a family history of cardiovascular disease, that is your parents or siblings have had a heart attack, stroke or other cardiac problems, you need to be even more vigilant about the 9 risk factors and take all steps to lead a heart-healthy lifestyle.

Action Point 1 If you are over 40 years old and have not had a medical check yet, it is time you saw your doctor for a cardiovascular risk assessment. If you have had a doctor check up more than 2 years ago, you need to repeat one now.

Action Point 2 If you are over 20 years old and think you have 1 or more of the above risk factors, you should get a doctor’s opinion and blood examination every 5 years.

Action Point 3 If you have been taking medicines for any of the above risk factors, you need to revisit the problem along with your doctor to understand the response to medications and the need for lifestyle modification to reduce and eventually even stop medicines if all parameters are well controlled.

What is stress?

The word stress has become synonymous with mental stress, which is nothing but a psychological imbalance triggered by environmental factors. We’ve all experienced one or more stressful situations during our lifetime – work deadlines, competitive exams, lack of support, financial crisis, separation of a loved one, family pressure – and so on and so forth. The question at hand is “can these be life-threatening?” And the answer is “yes”.

Let me explain myself. Stress can be acute or chronic; positive or negative; obvious or hidden and, most importantly, well-managed or poorly-managed. In other words, stress can be benign when short-lived, constructive, identified, acknowledged and appropriately managed. And malignant when not.

Stress and the heart

There are 9 modifiable risk factors for heart attack of which stress (grouped under psychosocial factors) is the most sinister; it is not only the most difficult to diagnose but also the only factor that can potentially cause all of the other factors (all 8 of them shown in the image below; you can enlarge the image by clicking on it).

And there are 2 other important mechanisms of stress induced heart disease namely coronary vasospasm and stress cardiomyopathy. We will discuss these entities in a separate blog post.

A real-life example

We recently provided cardiac rehab for a 44-year-old gentleman who had suffered a critical heart attack and had undergone angioplasty with stenting. He came to us 2 weeks after discharge and was very worried about his health. Both he and his wife were confused, anxious and upset. They were concerned about the future of their family, which included 2 young children and elderly parents. We began by explaining to them the cause for his heart attack; his lifestyle risk factors were lack of exercise and unhealthy eating habits, his metabolic risk factors were obesity, dyslipidemia and diabetes and his newly-diagnosed risk factor was uncontrolled severe stress related to the financial woes of his construction business. The point that these were all modifiable risk factors and that he could lead a very healthy and normal life moving forward was their only consolation. And he was determined to do all he could to ensure a strong heart and a good health, for his own sake and that of his family. And so began his journey to a successful cardiac rehab program, enriched with behaviour modification and stress management sessions, psychological counselling and diet education, supervised exercise and risk factor management training.

At the end of the rehab program, he was confident about his health and was motivated to adhere to a healthy lifestyle for a lifetime. He enrolled in a maintenance plan for continued healthcare support. His wife was convinced that this was a life-changing program for her husband and that her family’s health was now guaranteed due to all the knowledge and awareness she had gained from us.

Stress mantras

So, remember these simple stress mantras for a healthy life.

Stress does not come from outside; it is your own response to the outside world
Do not be afraid of stress; do not ignore stress
Be aware of your stress triggers
Try to avoid or overcome the recurring triggers
Manage your stress appropriately
Get professional help if necessary
There is no one size fits all solution to manage stress, each individual is different