Achy Breaky Heart

The human heart does not like surprises. In the month after 9/11, incidents of dangerous heart rhythms in cardiac patients around New York City more than doubled. After a major earthquake in Taiwan in 1999, hospitalization for heart attacks skyrocketed around the epicenter. Even an isolated, private event — the sudden death of a spouse, for instance — can bring on grief so severe that sometimes our hearts, quite literally, break.

We all know the shock of the unexpected is stressful. And researchers have long suspected that stress harms the body. But partly because individual reactions to stress are so variable, solid clinical evidence linking emotions to actual heart attacks and other coronary disease has been elusive. But that’s changing. New studies suggest that both chronic strain at work and bad relationships put people at a markedly increased risk of heart trouble. As a result, researchers are calling more insistently for doctors to include the diagnosis and treatment of stress in routine care for patients with heart conditions and for those at risk. “It’s not enough to give typical medicine,” says Dr. Kristina Orth-Gomer, who has been studying stress and cardiology for 25 years and works at Stockholm’s Karolinksa Institute. “We have to develop the simple, core questions that identify these patients, and then investigate what treatments or preventative tools we have at hand.”

In the past two months, international medical journals have published a flurry of review papers and studies on the link between fatal heart disease and stress. In an article in the Journal of the American Medical Association, researchers in Quebec reported that first-time heart-attack patients who returned to chronically stressful jobs were twice as likely to have a second attack as patients who found their work to be relatively stress-free. In another study published in October in the Archives of Internal Medicine, University of London researchers said that British civil servants with stormy intimate relationships had a 34% higher risk of heart disease than those with more placid personal lives. The emotions at play in tense marriages can do cumulative damage to organs and tissues that may leave people at greater risk of illness, the authors wrote. “There is a fair amount of evidence” linking stress and disease, says Sheldon Cohen, a psychology professor at Carnegie Mellon University who authored a recent paper about the negative effects of stress on heart disease and illnesses like depression and HIV/AIDS, “enough to start asking whether reductions of stress would reduce disease outcomes.”

Getting doctors to incorporate stress diagnosis and treatment into their practices won’t be easy. It’s unusual for cardiologists to evaluate their patients’ feelings about a taxing job or a difficult relationship. Part of the problem is that most doctors don’t have the time to ask probing questions. “It’s ironic that as we’re getting a broader picture of how important stress levels are to physical health, we’re simultaneously cramming appointments into shorter and shorter periods of time,” says Dr. Daniel Brotman, director of the Hospitalist Program at Johns Hopkins Hospital. Brotman, too, believes an undeniable link exists between stress and heart disease. But given that most people cope with stress just fine, he says it’s unrealistic to ask overworked doctors to screen every patient for an emotional condition that’s common in modern life. “We say to ourselves as physicians, ‘Well, there’s not a lot I can do about the fact that your wife left you,'” Brotman says.

What can be changed, however, is the way doctors listen and react to their patients’ physical concerns. If a woman complains of chest pain, for example, but says it only bothers her when she’s feeling tense or pressured — and not on the treadmill or climbing a flight of stairs — her doctor should interpret her anxiety as a genuine risk factor, says Brotman. “The trigger is emotional, and physicians tend to blow that off,” he says.

Even if doctors become more aware of chronic stress as a precursor of heart trouble, the question of what to do about it has yet to be answered. While there are plenty of stress-reduction techniques — meditation and exercise are two common remedies — there has been little scientific evaluation of their effectiveness. Cohen, the Carnegie Mellon professor, says researchers should conduct clinical trials in order to identify the best treatments and to determine whether patients fare better when given those treatments. But even if such trials received funding, they could take years to complete. In the meantime, the best advice to those worried about the effect their hectic lives are having on their hearts may be this: try not to stress out about it.