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When you hear “heart health,” diet and exercise are often the first things to come to mind. But there’s something else that’s equally important to manage: stress.
Chronic stress is now recognized as a major risk for heart disease, which means that finding ways to cope with stress is as important as staying active and eating healthy.
How does stress affect the heart?
It’s not possible to entirely avoid stress. It can often even be a useful tool to help you get to that appointment on time or to meet that work deadline. Except in rare cases, your body’s response to it does not automatically harm your health — in fact, the stress response evolved to help people survive a threat or dangerous situation. The technical word for the body’s response to stress is “allostasis.”
“Humans developed allostasis to promote physiological balance and adaptation to the environment,” says Peter Vitaliano, PhD, a professor of psychiatry and psychology at the UW School of Medicine Department of Psychiatry and Behavioral Sciences, who studies how stress affects our health. “It is actually great for dealing with acute stresses, which is what we were designed for in our physiology.”
The problem comes when your body can’t calm down and move out of an allostatic response — say, sitting in I-5 traffic day after day to get to an exhausting job to afford living in a city like Seattle (exhale). That’s when a normal stress response becomes chronic stress. The negative health effects of being chronically stressed are sometimes called allostatic load.
“Chronic stress is very different from acute stress because your body is not given the option of bouncing back right away as it does with acute stressors,” says Vitaliano.
Being constantly subjected to allostatic load directly and indirectly affects your heart health. Here are some of the ways it can lead to cardiovascular problems:
Inflammation
First, staying in a constant state of stress increases inflammation in the body.
“Inflammation can cause heart disease of various types, but most commonly coronary artery disease, which causes heart attacks, arrhythmias, and sometimes heart failure,” says Jill Steiner, MD, a cardiologist at the UW Medicine Heart Institute.
Inflammation damages blood vessels and increases plaque buildup over time, aka atherosclerosis, which blocks blood flow to the heart.
High blood pressure
Part of your body’s allostatic response to stress is the activation of the sympathetic or “fight or flight” branch of your autonomic nervous system, which releases hormones like adrenaline and cortisol into your bloodstream. Again, this isn’t a problem when responding to an acute stressor, but when your autonomic nervous system is constantly producing stress hormones, it can lead to high blood pressure and increase your cholesterol levels. These conditions can also damage your blood vessels and make you more susceptible to heart disease.
Vitaliano has studied many groups who experience chronic stress, including caregivers for spouses with Alzheimer’s. In one study, he measured the participants’ urinary cortisol levels and found those who were caregiving for a spouse with Alzheimer’s had significantly higher levels than the control group of people who were similar in age, gender, education, race and income, but had healthy spouses.
In a similar study, he found that caregivers had dramatically higher blood pressure when subjected to an emotional stressor than the control group of non-caregivers. People whose blood pressure spikes higher and takes longer to come down are at higher risk for cardiovascular disease.
Unhealthy behaviors
Another major risk from chronic stress is coping mechanisms that compound the negative effects on heart health. These include drinking a beer or glass of whiskey at the end of a long day, smoking a cigarette, overindulging in comfort foods, and not having the time or motivation to exercise or for good sleep hygiene.
“Those are not great coping habits, and when we know that these are also behaviors that cause heart disease, that’s even worse,” says Steiner.
Problem-focused coping versus avoidant coping
So, how do you better manage chronic stress in your life? There isn’t an easy answer. Everyone reacts to stress differently, Vitaliano explains. However, he has identified two broad ways people cope with stress: avoidance and problem-solving.
Avoidance includes many of the unhealthy behaviors above, like drinking alcohol, as well as blaming others for your problems or being in denial that they exist. Avoidance coping is not good for your cardiovascular — or overall — health.
“Problem-focused coping is trying to come up with a plan of action to deal with whatever your stressor is,” says Vitaliano. “It requires an investment of energy to figure out what you have to do to get from where you are to where you want to be.”
Some people are better equipped for problem-solving and can manage huge amounts of stress (think air traffic controllers), but anyone can work to get better at it.
Here is some advice for how to use problem-focused coping:
Break down the problem
The first step is to be aware that you are experiencing stress that’s not going away on its own and breaking down what’s causing it.
“If it’s a complex thing that you're dealing with that's causing you chronic stress, try to break it into smaller parts and then try to take action with those smaller pieces,” says Vitaliano. “If it’s a work thing, try to characterize what the problem is: Is it a time constraint? Is it a people problem? Is it the physical setting?”
Once you’re able to look at your stress and what’s causing it, it can feel a lot less overwhelming, and solutions might seem a lot clearer and more feasible.
Manage the stressor
The next step is to address the source of the stress. This could be something major or something more incremental.
"Maybe it’s quitting that job or leaving that relationship,” says Steiner. “But you don't need to remove yourself from the situation completely if there's some way to just decrease that stress.”
It could be time to try couples therapy if the stress is coming from your marriage or relationship. If it’s work-related stress, maybe you can talk to your boss about taking a mental health day or a longer break if necessary.
Practice self-care
If you’re not able to remove yourself from the stressor, you can still take care of your mental health and well-being. It might sound cliché, but taking small chunks out of your day for self-care can go a long way toward responding better to stress.
“Stress management techniques like mindfulness or meditation or breathing exercises are often really helpful,” says Steiner.
And even small amounts of exercise and movement can both help with stress and improve your cardiovascular health.
Find support
Depending on your situation, you might have more or less access to social support than others, but it’s important to try to find someone to talk to. If you don’t feel comfortable talking to your boss, maybe a co-worker can lend an ear. If you don’t have a close friend near you, maybe you can invite a neighbor over.
”Seeking support could be getting answers to questions, but also seeking support emotionally, having someone that could say to you, ‘I understand things are bad, but there are things you can do,’” says Vitaliano.
Make sure you have pleasure in your life
One last important part of coping: “Making sure that you have pleasure in your life — not just an absence of the stressor, but to have something that actually gives you pleasure,” says Vitaliano.
So, think about what gives you joy: Maybe it’s planning a long weekend vacation or just finding some caregiving support for an afternoon so you can take an afternoon to golf with a friend or go shopping.
Chronic stress can make you feel helpless and it might be impossible to avoid the source of it. But even small actions to manage stress can have a meaningful effect on your heart health — and your overall well-being.
