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Stress and Cardiovascular Disease in Women

By Antonette J. Brigidi, MD, Internal Medicine
The Chester County Hospital

Published: January 19, 2009

Sometimes stress can positively enhance our lives, but at its extreme, stress may lead to exhaustion and poor health. An estimated 75% to 90% of doctor's visits are stress related, at a cost of $200-300 billion annually in the United States. Consider this in relationship to cardiovascular diseases (CVD), such as high blood pressure, coronary heart disease, or stroke. CVD is the leading cause of death in the US with more women than men dying from it each year. Despite a steady decline among men in the last 25 years, this number has remained stable for women. In that time, the medical community has acknowledged the impact of stress and psychosocial factors on CVD.

Traditional risks like smoking, high blood pressure, high cholesterol and diabetes are accountable for the largest burden of the disease. However, other factors can contribute to the development and progression of CVD. Negative emotional states, including depression, anger, hostility, and anxiety, are associated with increased risk and poor outcomes of CVD. Job strain and occupational stressors are especially predictive in younger men, whereas the chronic, daily stress and care giving has greater influence in women. Factors such as limited social networks, support and conflict resolution also increase CVD.

Stress affects our body through hormonal and inflammatory pathways. It disturbs the normal circadian rhythm of cortisol production (the stress hormone), which can lead to high blood pressure, elevated cholesterol, insulin resistance, obesity and metabolic syndrome - all precursors to CVD. Serotonin is crucial to regulation of mood and emotion, and dysfunction can manifest as depression and anger. Additionally, serotonin plays a key role in the function of platelets, which are involved in development of blood clots and blockages along blood vessels. Stress can stimulate inflammation creating risk factors for deposits in the vessels. These factors, called cytokines, which can induce fatigue, lack of enjoyment, and other symptoms of depression, are currently being researched.

There are simple ways to manage stress. Exercise is an excellent way to let out steam with clear cardiovascular benefits. Exercise controls blood pressure, blood sugar and is a key component for weight management. Studies have shown that poor capacity for exercise is a predictor of death in asymptomatic women to an even greater degree than men. Improving exercise tolerance can decrease this risk by almost 20%. Aim for 30 minutes most days of the week.

Yoga, meditation, guided imagery and biofeedback are excellent stress-reduction techniques proven to decrease all causes of death, specifically heart attack and stroke. One study has shown the degree of blood pressure reduction by meditation in middle-aged and older adults is equivalent to that of medications. Drink plenty of water and eat a healthy diet focusing on the nutrients and the building blocks your body needs. Also, get a good night's rest. Sleep can be hard to come by in our fast-paced lives, but our bodies need seven to eight hours nightly to restore and repair damage done during the day. With adequate rest, you will think more clearly and be more productive. Sleep improves our immune function, allowing us to recover from illness and to fight off the potential infections. Lastly, visit friends and relatives, or get involved in your community. Social support can diminish the effects of stress on blood pressure in women and on cortisol levels in men.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

Last Updated: 7/27/2009