Globe & Mail, April 22,2006

Stress Management Vital

By Jane Mundy

Just about everyone says their lifestyle is stressful. And they also know that too much emotional stress can lead to heart disease. But the jury is still out on whether or not stress in itself causes heart disease or in the way stress is handled. So before you read any further, pat the dog or curl up with the cat, sit comfortably, take a deep breath and say to yourself, I am. Then exhale slowly and say to yourself relaxed.

Dr Baker is a psychiatrist who specifically treats cardiac patients and is spokesperson for the Heart & Stroke Foundation. “Stress is part of life so accept it and don’t overact,” he advises. “Work out what you can handle or it will take its toll.”

“We do know that mental stress causes bad behaviour,” says Dr. Chris Buller, cardiologist at VGH. ”Even though there is no hard evidence to link stress and heart disease, there are common sense links, such as eating too much, smoking or finding yourself in a funk.” And Dr. Baker points out that new studies directly link depression to heart disease.

The medical profession agrees that management is crucial and prevention is the cure. “You have to realize that stress and heart disease is an accumulative process and intervention, especially in the early stages, will have more of a potential long term impact than waiting until it may be too late,” says Dr. Ross Beringer, ER physician at St. Paul’s Hospital.

“Stress comes in a variety of forms and is most harmful if it is continual,” says Sandy Barabe, former National President, Canadian Council of cardiovascular nurses. But if you can manage it, not all stress is bad. “Stress is required to make us produce, such as deadlines; it increases wakefulness and alertness, and one person’s stress may not be another’s,” adds Barabe.

Physiology

Stress increases heart rate which is related to the ‘fight or flight’ response. This response releases substances into the blood, primarily catecholamine, that narrow blood vessels so the heart pumps harder and resistance is greater.

This chronic effect increases blood pressure and blood cholesterol, causing more stress on the heart and an increased risk of heart disease. Stress also increases the aggregation of platelets which can precipitate a blood clot in the heart.

What you can do

“Anything that promotes inner relaxation and takes your mind somewhere else, such as breathing, yoga and meditation will reduce stress,” says Dr. Beringer. Anger is a major contributor to stress and can cause blood pressure to soar.

Try to recognize your own emotions and calm down before you react. “Anger management or any form of physical exercise will have a benefit to stress reduction and cardiovascular risk reduction.”

“Acknowledge when you are stressed, re-focus and go to a happy place,” Sandy Barabe advises. “When I have a deadline looming I feel stressed and irritable, and have difficulty concentrating on the task at hand. I’ll take a mental break and do something different, maybe get outside, go for a walk.”

“A co-worker might be able to identify your stress, not necessarily you. Talk to friends and workers and get other impressions of how you are behaving and modify accordingly,” says Dr. Beringer. At the very least, listen. Next time you get stressed ask yourself this question: Am I in imminent danger? Chances are that you aren’t. So slowly breathe in…then out. And relax.

SIDEBAR: Are some people more prone to stress than others?

“Some people put other’s needs before their own, possibly to their detriment,” says Barabe. “Feelings of hopelessness are linked high with depression and then you don’t take care of yourself.”

“We see more people in ER who are type A personalities, i.e., aggressive driven and non-negotiators, but these people tend to be more aware of what can happen to them long-term,” says Dr. Ross Beringer. Whereas laid back and mellow types may not change and may not believe they have a problem.

“We are getting better at recognizing early symptoms of angina, mainly seen in 55-65 year old men. I think that, along with the physiological differences, men are also less likely to take heed of stress management and tend to ignore earlier symptoms – they just hope it will get better and go away, whereas women tend to seek professional help and join a yoga class.

“We often see people obese and sedentary working too hard and may have acquired other habits that go hand in hand with stress.” says Dr. Beringer.

“As well, people in shift work, especially night shifts, are more prone to heart disease and have decreased life expectancies. There are two schools of thought to explain this: they aren’t getting enough sleep or people who are attracted to working night shift may have other habits, such as drinking and smoking.”

Dr. Baker cites two models used in job stress: too many demands, too little control, and effort and reward – if you put a lot of effort in you should be rewarded accordingly. Those who don’t have enough rewards are more likely to have heart attacks.