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You live in NYC. You work long hours. Your boss is impossible. Are you a set up for a heart attack? Urban legion says "Yes, stress will hurt your heart”. But what is the science behind this? In recent years there has evolved a whole new field called behavioral cardiology to address this is question. And the answer is “probably”.
There are multiple observational studies that show that work stress can increase one's risk of heart disease and stroke by 10-40%. Other life stressors such as social isolation, low emotional support, and economic stressors have been similary shown to have negative health effects. However, since the gold standard of scientific studies (a randomized controlled study) has not yet been performed the certainty behind this association has not been completely affirmed. Because of the difficulty in randomizing people to high stress or low stress situations and then studying them, this study is unlikely to happen. So even if not solidly proven, there is a strong suggestion of a link between stress and heart disease.
The exact biological mechanisms that explain the effects of psychological stress on the heart have not been worked out. Contrary to another urban legend work stress has not been shown to cause high blood pressure. And there are conflicting studies as to whether negative life events increase the likelihood of the development or growth of atherosclerotic plaques. It is likely that negative psychological states influence multiple biologic (activation of stress hormones - cortisol and adrenaline) and behavioral processes (increased alcohol intake or lack of exercise) that confer risk.
Given the current state of the evidence it certainly makes sense for people to consider stress as a significant risk factor for poor health outcomes. Activities that are known to decrease stress are exercise, adequate sleep, engagement with others and relaxation techniques such as meditation. The jury is out as to whether stress interventions improve cardiac outcomes but they certainly will help you feel better.
Jill Silverman MD