View the Heart Disease Slideshow

Heart disease and stress introduction

Are stress and heart disease related? Does stress increase the risk of heart disease? Stress is a normal part of life. But if left unmanaged, stress can lead to emotional, psychological, and even physical problems, including: 

How Does Stress Increase the Risk for Heart Disease?

Medical researchers aren't sure exactly how stress increases the risk of heart disease. Stress itself might be a risk factor, or it could be that high levels of stress make other risk factors (such as high cholesterol or high blood pressure) worse. For example, if you are under stress, your blood pressure goes up, you may overeat, you may exercise less, and you may be more likely to smoke.

If stress itself is a risk factor for heart disease, it could be because chronic stress exposes your body to unhealthy, persistently elevated levels of stress hormones like adrenaline and cortisol. Studies also link stress to changes in the way blood clots, which increases the risk of heart attack.

Does Stress Affect Everyone the Same?

No. People respond in different ways to events and situations. One person may find an event joyful and gratifying, but another person may find the same event miserable and frustrating. Sometimes, people may handle stress in ways that make bad situations worse by reacting with feelings of anger, guilt, fear, hostility, anxiety, and moodiness. Others may face life's challenges with ease.

Learn to Relax and Sleep Well

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Dennis Lee, MD

We're born with the instinct to relax and sleep when our bodies or minds need a break. Over the years, it becomes necessary to control and even suppress these natural urges to rest, since we must remain alert as we attend school, learn professions, go to work, or care for a family. Many people spend years conditioning themselves to perform well despite feelings of tiredness. While no one would argue that suppressing tiredness can be a necessary skill, it can impair our ability to actually "let go" and relax when we do find the time.

Relaxation is also a uniquely individual activity. Napping or just doing nothing might be your idea of relaxation, but this amount of inactivity might drive someone else crazy. Others may relax by participating in sports or undertaking physical challenges, but some people would find these activities stressful. Whatever your idea of relaxation, the following tips can help you retrain and regain some of those lost relaxation skills...

What Causes Stress?

Stress can be caused by a physical or emotional change, or a change in your environment that requires you to adjust or respond. Things that make you feel stressed are called "stressors."

Stressors can be minor hassles, major lifestyle changes, or a combination of both. Being able to identify stressors in your life and releasing the tension they cause are the keys to managing stress.

Below are some common stressors that can affect people at all stages of life.

  • Illness, either personal or of a family member or friend.
  • Death of a friend or loved one.
  • Problems in a personal relationship.
  • Work overload.
  • Starting a new job.
  • Unemployment.
  • Retirement.
  • Pregnancy.
  • Crowds.
  • Relocation.
  • Daily hassles.
  • Legal problems.
  • Financial concerns.
  • Perfectionism.

What Are the Warning Signs of Stress?

When you are exposed to long periods of stress, your body gives warning signals that something is wrong. These physical, cognitive, emotional and behavioral warning signs should not be ignored. They tell you that you need to slow down. If you continue to be stressed and you don't give your body a break, you are likely to develop health problems like heart disease. You could also worsen an existing illness.

Below are some common warning signs and symptoms of stress.
Physical signsDizziness, general aches and pains, grinding teeth, clenched jaws, headaches, indigestion, muscle tension, difficulty sleeping, racing heart, ringing in the ears, stooped posture, sweaty palms, tiredness, exhaustion, trembling, weight gain or loss, upset stomach
Mental signsConstant worry, difficulty making decisions, forgetfulness, inability to concentrate, lack of creativity, loss of sense of humor, poor memory
Emotional signsAnger, anxiety, crying, depression, feeling powerless, frequent mood swings, irritability, loneliness, negative thinking, nervousness, sadness
Behavioral signsBossiness, compulsive eating, critical attitude of others, explosive actions, frequent job changes, impulsive actions, increased use of alcohol or drugs, withdrawal from relationships or social situations

How Can I Cope With Stress?

After you've identified the cause of stress in your life, the next step is to learn techniques that can help you cope with stress while fighting heart disease. There are many techniques you can use to manage stress. Some of which you can learn yourself, while other techniques may require the guidance of a trained therapist.

Some common techniques for coping with stress include:

  • Eat and drink sensibly. Abusing alcohol and food may seem to reduce stress, but it actually adds to it.
  • Assert yourself. You do not have to meet others' expectations or demands. It's OK to say "no." Remember, being assertive allows you to stand up for your rights and beliefs while respecting those of others.
  • Stop smoking. Aside from the obvious health risks of cigarettes, nicotine acts as a stimulant and brings on more stress symptoms.
  • Exercise regularly. Choose non-competitive exercise and set reasonable goals. Aerobic exercise has been shown to release endorphins (natural substances that help you feel better and maintain a positive attitude.)
  • Relax every day. Choose from a variety of different techniques (see below).
  • Take responsibility. Control what you can and leave behind what you cannot control.
  • Reduce causes of stress. Many people find life is filled with too many demands and too little time. For the most part, these demands are ones we have chosen. Effective time-management skills involve asking for help when appropriate, setting priorities, pacing yourself, and taking time out for yourself.
  • Examine your values and live by them. The more your actions reflect your beliefs, the better you will feel, no matter how busy your life is.
  • Set realistic goals and expectations. It's OK, and healthy, to realize you cannot be 100% successful at everything all at once.
  • Sell yourself to yourself. When you are feeling overwhelmed, remind yourself of what you do well. Have a healthy sense of self-esteem.
  • Get enough rest. Even with proper diet and exercise, you can't fight stress effectively without rest. You need time to recover from exercise and stressful events. The time you spend resting should be long enough to relax your mind as well as your body. Some people find that taking a nap in the middle of the day helps them reduce stress.

How Can I Keep a Positive Attitude?

A positive attitude and self-esteem are good defenses against stress and heart disease because they help you view stress as a challenge rather than a problem. A positive attitude keeps you in control when there are inevitable changes in your life. A positive attitude means telling yourself there are things you can do to improve certain situations and admitting that sometimes there's nothing you can do. To maintain a positive attitude during a stressful situation (or to prepare yourself for a potentially stressful situation), keep these tips in mind:

  • Stay calm. Stop what you're doing. Breathe deeply. Reflect on your choices.
  • Always tell yourself you can get through the situation.
  • Try to be objective, realistic and flexible.
  • Try to keep the situation in perspective. Think about the possible solutions. Choose one that is the most acceptable and feasible.
  • Think about the outcome: Ask yourself, what is the worst possible thing that can happen? (Chances are that won't happen)
  • Tell yourself that you can learn something from every situation.

How Can I Reduce My Stressors?

While it is impossible to live your life completely stress-free, it is possible to reduce the harmful effects of certain stressors on you and your heart. Here are some suggestions:

  • First identify the stressor. What's causing you to feel stressed?
  • Avoid hassles and minor irritations if possible. If traffic jams cause you stress, try taking a different route, riding the train or bus, or car-pooling.
  • When you experience a change in your life, try to continue doing the things that you enjoyed before the change occurred.
  • Learn how to manage your time effectively, but be realistic and flexible when you plan your schedule.
  • Do one thing at a time; concentrate on each task as it comes.
  • Take a break when your stressors compile to an uncontrollable level.
  • Ask for help if you feel that you are unable to deal with stress on your own.

How Can I Learn How to Relax?

In order to cope with stress, especially if you have heart disease, you need to learn how to relax. Relaxing is a learned skill -- it takes commitment and practice. Relaxation is more than sitting back and being quiet. Rather, it's an active process involving techniques that calm your body and mind. True relaxation requires becoming sensitive to your basic needs for peace, self-awareness, and thoughtful reflection. The challenge is being willing to meet these needs rather than dismissing them.

There are a number of relaxation techniques, including:

  • Deep breathing. Imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed.
  • Progressive muscle relaxation. Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice. (Stop any movements that cause pain!) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.
  • Guided Imagery. Guided imagery, or mental imagery relaxation, is a proven form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind -- a "mental escape." Identify your self-talk, that is, what you are saying to yourself about what is going on with your illness or situation. It is important to identify negative self-talk and develop healthy, positive self-talk. By making affirmations, you can counteract negative thoughts and emotions.
  • Relax to music. Combine relaxation exercises with your favorite music. Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio tapes, which provide music and relaxation instructions.
  • Biofeedback. Biofeedback helps a person learn stress-reduction skills by using various instruments to measure temperature, heart rate, muscle tension, and other vital signs as a person attempts to relax. The goal of biofeedback is to teach you to monitor your own body as you relax. It is used to gain control over certain bodily functions that cause tension and physical pain. If a headache, such as a migraine, begins slowly, many people can use biofeedback to stop the attack before it becomes full blown.
  • Yoga. Many types of yoga teach you how to relax while also helping posture and flexibility. Consult with your doctor before starting a yoga program.

Once you find a relaxation method that works for you, practice it every day for at least 30 minutes. Taking the time to practice simple relaxation techniques gives you the chance to unwind and get ready for life's next challenge.

Can What I Eat Help Fight Stress?

Your body is able to fight stress and heart disease better when you take the time to eat well-balanced meals. Eat a variety of foods each day, including lean meats, fish, or poultry, enriched or whole grain breads and cereals, fruits and vegetables, and low-fat dairy products.

About 55%-60% of your daily intake of calories should come from carbohydrates, no more than 25%-30% from of your caloric intake should come from fat and 10%-15% should come from protein.

Guidelines for Healthy Eating to Fight Stress

  • Eat a wide variety of healthy foods.
  • Eat in moderation -- control the portions of the foods you eat.
  • Reach a healthy weight and maintain it.
  • Eat at least 5 to 9 servings of fruits and vegetables per day.
  • Eat food that is high in dietary fiber such as whole grain cereals, legumes, and vegetables.
  • Minimize your daily fat intake. Choose foods low in saturated fat and cholesterol.
  • Limit your consumption of sugar and salt.
  • Limit the amount of alcohol that you drink.
  • Make small changes in your diet over time.
  • Combine healthy eating habits with a regular exercise program.

What if Sleep Problems Are Contributing to my Stress

If you cannot sleep and it's causing you stress or making it worse, try these tips:

  • Establish a regular sleep schedule. Go to bed and get up at the same time every day.
  • Make sure your bed and surroundings are comfortable. Arrange the pillows so you can maintain a comfortable position.
  • Keep your bedroom dark and quiet.
  • Use your bedroom for sleeping only; don't work or watch TV in your bedroom.
  • Avoid napping too much during the day. At the same time, remember to balance activity with rest during recovery.
  • If you feel nervous or anxious, talk to your spouse, partner, or a trusted friend. Get your troubles off your mind.
  • Listen to relaxing music.
  • Talk to your doctor before taking any sleeping aid.
  • Take diuretics or "water pills" earlier, if possible, so you don't have to get up in the middle of the night to use the bathroom.
  • If you can't sleep, get up and do something relaxing until you feel tired. Don't stay in bed worrying about when you're going to fall asleep.
  • Avoid caffeine.
  • Don't exercise within two to three hours of bedtime.

SOURCES:

Reviewed by the doctors at The Cleveland Clinic Heart Center.

Reviewed by Robert J Bryg, MD on January 24, 2008

'Portions of this page © The Cleveland Clinic 2000-2004

Last Editorial Review: 1/24/2008

Subscribe to MedicineNet's Heart Health Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

Reviewed on 1/24/2008
References
SOURCES:

Reviewed by the doctors at The Cleveland Clinic Heart Center.

Reviewed by Robert J Bryg, MD on January 24, 2008

'Portions of this page © The Cleveland Clinic 2000-2004
Stress Quiz: Test Your Emotional IQ

Health Solutions From Our Sponsors