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How Stress Damages Your Heart

Article at-a-glance:

  • Anxiety is an overlooked contributor to cardiovascular disease
  • Chronic anxiety can have cumulative effects on our physiology that may lead to a higher risk of heart disease
  • Anxiety is correlated with a higher risk of heart attacks or other incidents such as bypass surgery
  • Anxiety and obesity present a double whammy as both leads to the release of inflammatory molecules known to contribute to heart disease risk
Anxiety Word Cloud

Psychoneurimmunology researches the mind-body connections, including how the brain, immune and nervous systems influence each other.1 One of the best-studied connections is how your emotions effect heart health and your heart attack risk. The impact is so profound that people can die from a broken heart when an emotionally devastating event occurs. There’s even a name for this: Tako-Tsubo Syndrome.2 But it doesn’t have to be a major life event that damages your heart. Depression doubles the risk of a heart attack and increases your risk for dying from any cause.3,4

More research is now recognizing stress as a modifiable risk factor for heart disease. And that’s important because in the U.S., one-quarter of all Americans suffer from an anxiety disorder at some point in their lives and cardiovascular diseases are the leading cause of death in the United States.5,6

Unfortunately, both high stress and heart disease share symptoms—palpitations (feeling like your heart is beating too hard or fast, skipping a beat or fluttering), chest tightness, and shortness of breath. And the type of stress doesn’t seem to matter. Increased heart disease risk is associated with generalized anxiety disorder, phobias, post-traumatic stress disorder, and panic disorder.7 Possible mechanisms are emerging, from dysfunction of the autonomic nervous system that regulates heart rate, to molecules that may be involved in mediating anxiety such as adrenaline, serotonin, and inflammation.8,9,10,11

Most importantly, over time these processes damage blood vessels and are associated with increased risk for coronary heart disease (CHD), high blood pressure, stroke and death. Men with the highest level for anxiety caused by phobias have a 377% increased risk for fatal heart attacks compared with men without anxiety.12 But even less severe types of anxiety increase risk. Other studies have confirmed the increased risk for heart attacks in both men and women, even when the anxiety is less severe.13,14

While the American Heart Association (AHA) guidelines don’t yet recognize anxiety as a risk for heart disease, European guidelines acknowledge anxiety as an independent risk for heart attacks, strokes, and angina (chest pain caused by blockages in coronary arteries).15

Anxiety Increases Heart Disease Risk

When you’re anxious, your heart races and blood pressure goes up. This puts an extra strain on your heart. Even temporary anxiety increases blood pressure. This was recognized as far back as the 1980s when researchers monitored 90 individuals with borderline hypertension (higher than 120/80). Blood pressure was monitored for 24 hours and was higher during both angry and anxious states; the greater the emotional intensity, the larger the blood pressure swing.16

A 2010 review of twenty studies found that individuals who were otherwise healthy but suffered from high anxiety had an increased risk for severe coronary artery blockages or heart attacks.17 And another study of over 49,000 young Swedish men entering the military who were then followed for more than 37-years found that any diagnosed anxiety disorder was associated with a 217% increase in coronary heart disease and 251% increased risk for heart attacks.18

Anxiety can also worsen pre-existing cardiovascular disease. Imaging studies revealed that blood flow to the heart is temporarily reduced in up to 70% of patients with pre-existing heart disease who experience psychological stress, and over time this is associated with a higher risk of dying.19 A blend of anxiety and depression in response to stressful life events or childhood trauma has been linked to increased arterial stiffness, which is a risk factor for hypertension and cardiovascular disease.20

Panic disorder (a disorder marked by panic attacks, feelings of terror when there is no real danger) is associated with changes in heart structure and function—10% of sufferers have arrhythmia, and overall have lower exercise tolerance and oxygen consumption than those without the condition.21 Panic attacks have been linked to heart disease. One review of the Women’s Health Initiative Observational Study, which looked at 3,369 postmenopausal women for an average of about five years, found that a recent history of full-blown panic attacks was linked to a nearly four-fold increased risk of heart attacks.22

Anxiety and Obesity

Anxiety can derail a healthy lifestyle, leading to overeating, excess alcohol consumption, a poor diet full of unhealthy comfort foods and sweets, as well as lower amounts of exercise. The result, not surprisingly, can be excess weight, which compounds a person’s health risks. It’s a given that weight is a risk factor for cardiovascular disease.23 And as is becoming apparent, anxiety may be a factor as well. But the two together create a double whammy.

Both anxiety and obesity release inflammatory molecules, creating a harmful feedback loop. Chronic anxiety may stimulate the sympathetic, fight-or-flight nervous system response, with its flood of stress hormones like norepinephrine or cortisol.24 One study of nearly 850 Greek men and women found that higher anxiety scores correlated with higher levels of molecules that cause inflammation, such as C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin-6 (IL6), homocysteine, and fibrinogen, which is a protein that makes the blood stickier and can promote unhealthy blood clotting.

But obesity on its own can also contribute to increased inflammation. Excess fat releases similar inflammatory chemicals such as TNF and IL6.25 Thus, inflammation causes, and is caused by, obesity and anxiety and underlies aspects of cardiovascular disease such as coagulation (sticky blood) and hardening of the arteries (atherosclerosis).

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References

[1]Littrell J. The mind-body connection: not just a theory anymore. Soc Work Health Care. 2008;46(4):17-37 [Article]

[2]Sinning C, Keller T, Abegunewardene N, Kreitner KF, Münzel T, Blankenberg S. Tako-Tsubo syndrome: dying of a broken heart? Clin Res Cardiol. 2010;99(12):771-780 [Article]

[3]Chaddha A, Robinson EA, Kline-Rogers E et al. Mental Health and Cardiovascular Disease. Am J Med. 2016 Nov;129(11):1145-1148. [Article]

[4]Van der Kooy K, van Hout H, Marwijk H et al.   Depression and the risk for cardiovascular diseases: systematic review and meta-analysis. Int J Geriatr Psychiatry 2007; 22: 613–626 [Article]

[5]Kessler RC, Berglund P, Demler O et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593 [Article]

[6]Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121: 586-613. [Article]

[7]Cohen BE, Edmondson D, Kronish IM. State of the Art Review: Depression, Stress, Anxiety, and Cardiovascular Disease. Am J Hypertens. 2015 Nov;28(11):1295-302. [Article]

[8]Ferrier C, Cox H, Esler M: Elevated total body noradrenaline spillover in normotensive members of hypertensive families. Clin Sci (Lond) 1993; 84: 225–230. [Article]

[9]Pitsavos C, Panagiotakos DB, Papageorgiou C et al. Anxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study. Atherosclerosis 2006; 185: 320–326. [Article]

[10]Butler J, O’Halloran A, Leonard BE: The Galway Study of Panic Disorder. II: Changes in some peripheral markers of noradrenergic and serotonergic function in DSM III-R panic disorder. J Affect Disord 1992; 26: 89–99. [Article]

[11]Hood, S. SSRIs as Antihypertensives in Patients With Autonomic Panic Disorder. Psychiatric Times Feb 2009. [Report]

[12]Thurston RC, Rewak M, Kubzansky LD. An anxious heart: anxiety and the onset of cardiovascular diseases. Prog Cardiovasc Dis. 2013 May-Jun;55(6):524-37 [Article]

[13]Janszky I, Ahnve S, Lundberg I, Hemmingsson T. Early-onset depression, anxiety, and risk of subsequent coronary heart disease: 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol. 2010;56(1):31-37. [Article]

[14]Nabi H, Hall M, Koskenvuo M, et al. Psychological and somatic symptoms of anxiety and risk of coronary heart disease: the health and social support prospective cohort study. Biol Psychiatry. 2010;67(4):378-385. [Article]

[15]Perk J, De Backer G, Gohlke H et al. European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33:1635–1701. [Article]

[16]James GD, Yee LS, Harshfield GA. The influence of happiness, anger, and anxiety on the blood pressure of borderline hypertensives. Psychosom Med. 1986 Sep-Oct;48(7):502-8. [Article]

[17]Roest AM, Martens EJ, de Jonge P et al. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 2010; 56:38–46 [Article]

[18]Janszky I, Ahnve S, Lundberg I et al T. Early-onset depression, anxiety, and risk of subsequent coronary heart disease: 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol 2010; 56:31–37. [Article]

[19]Krantz DS, Burg MM. Current perspective on mental stress-induced myocardial ischemia. Psychosom Med 2014; 76:168–170. [Article]

[20]Bomhof-Roordink H, Seldenrijk A, van Hout HP et al. Associations between life stress and subclinical cardiovascular disease are partly mediated by depressive and anxiety symptoms. J Psychosom Res. 2015 Apr;78(4):332-9. [Article]

[21]Katerndahl DA. The association between panic disorder and coronary artery disease among primary care patients presenting with chest pain: an updated literature review. Prim Care Companion J Clin Psychiatry. 2008;10(4):276-285 [Article]

[22]Smoller JW, Pollack MH, Wassertheil-Smoller S et al. Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women’s Health Initiative Observational Study. Arch Gen Psychiatry. 2007 Oct;64(10):1153-60 [Article]

[23]Akil L, Ahmad HA. Relationships between obesity and cardiovascular diseases in four southern states and Colorado. J Health Care Poor Underserved. 2011;22(4 Suppl):61-72. [Article]

[24]Star K. Is panic disorder caused by a chemical imbalance? Very Well Mind. Sept 2020. [Report]

[25]Ellulu MS, Patimah I, Khaza’ai H et al. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017;13(4):851-863. [Article]

[26]Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6): e12710 [Article]

 

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