STRESS – The Epidemic
of Modern Society

Stress + Heart Disease

Prof. Dr. med.
Paul J. Rosch

Clinical Professor of
Medicine and Psychiatry,
New York Medical College
Adjunct Clinical Professor
of Medicine in Psychiatry
University of Maryland
School of Medicine

Leading stress expert
of our time
and official successor
of Prof. Dr. Hans Selye –
the founder of the
stress research

What’s The
Connection –
What Can You Do
About It?

Dear Pa­tient:

Many of you have proba­bly read or heard about the harm­ful ef­fects of emo­tional stress on the car­dio­vas­cu­lar sys­tem, and phy­si­cians fre­quently warn their heart pa­tients to be care­ful to avoid or re­duce this as much as pos­si­ble.
I would like to ex­plain why this is so im­por­tant, and how you can learn to mini­mize stress re­lated dam­age.

The close re­la­tionship be­tween stress­ful emo­tions and heart dis­ease has been rec­og­nized since an­tiq­uity. In fact, the an­cient Greeks and other early cul­tures be­lieved that the heart, rather than the brain, was the seat of emo­tions. We still de­scribe peo­ple as be­ing “bro­ken hearted” fol­low­ing some se­verely stress­ful event, such as the loss of a loved one. Peo­ple who are gen­er­ous have a “heart of gold”, or are “good hearted”, while “heart of stone” and “cold hearted” de­scribe op­po­site tem­pera­ments. Be­ing brave is to be “stout hearted”, and if you are timid, you are “faint of heart”. The heart was viewed as be­ing the es­sence of life. And, if you want to “get at the heart” of any­thing from an ar­gu­ment or an ap­ple, you go to its “core”, which comes from cor, the Latin word for heart.

One of the prob­lems in study­ing the re­la­tionship be­tween stress­ful emo­tions and the heart, is the dif­fi­culty sci­en­tists have in de­fin­ing stress, much less be­ing able to meas­ure it ac­cu­rately.


Af­ter all, ex­actly what is stress?

Al­though it had been used in phys­ics for hun­dreds of years, the term as it is com­monly used to­day, was es­sen­tially coined only 60 years ago, by Hans Se­lye, a bril­liant Ca­na­dian re­sear­cher.
He used it to de­scribe a se­ries of re­sponses in labo­ra­tory ani­mals sub­jected to se­verely dis­turbing physi­cal or emo­tional threats, which, if per­sis­tent, pro­duced ul­cers, heart at­tacks, hy­per­ten­sion, arthritis, kid­ney dam­age, and other dis­eases. Se­lye rea­soned that if stress could do this in his ex­peri­men­tal ani­mals, then per­haps it played a simi­lar role in pa­tients suf­fer­ing from these dis­or­ders, which he re­ferred to as „Dis­eases of Ad­ap­ta­tion”. While his re­search was ini­tially of in­ter­est pri­mar­ily to other ba­sic sci­en­tists, Se­lye’s the­ory and con­cepts stead­ily spread into all bran­ches of clini­cal medi­cine, and „stress” even­tu­ally be­came a popu­lar buzz word.

A 1983 cover story in TIME maga­zine re­ferred to stress as “The Epi­demic of the Eight­ies”, and nu­mer­ous sur­veys have shown that the prob­lem has pro­gres­sively wors­ened since then. It’s dif­fi­cult to get through the day with­out read­ing or hear­ing some­thing about “stress”.


Why all the sud­den fuss?

Af­ter all, stress has been around since Adam and Eve were in the Gar­den of Eden. Is it be­cause there is much more stress to­day? Is it be­cause the na­ture of con­tem­po­rary stress is some­how dif­fer­ent, and more dan­ger­ous? Or is it be­cause sci­en­tific re­search has in­creas­ingly con­firmed the im­por­tant in­flu­ence of stress in nu­mer­ous dis­eases, and uncov­ered the me­chan­ics of ac­tions re­spon­si­ble for its di­verse ef­fects on physi­cal and men­tal health? All of these are un­doubt­edly in­gre­di­ents. It is es­ti­mated that 75-80 per­cent of all vis­its to pri­mary care phy­si­cians in the U.S. are for stress re­lated com­plaints, and it is dif­fi­cult to think of any ill­ness rang­ing from the com­mon cold to can­cer, in which stress could not play a con­tribu­tory role.

The ma­jor source of stress for adults stems from work­place pres­sures. Four out of five Ameri­can work­ers de­scribe their jobs as be­ing “very stress­ful”, and the World Health Or­gani­za­tion re­cently de­clared that job stress has now be­come a “world­wide epi­demic”.

Some peo­ple use it to de­scribe an un­pleas­ant cir­cum­stance, like loos­ing your job, while oth­ers view stress to refer to the way such chal­lenges make you feel (an­ger, fear, de­pres­sion), symp­toms you ex­peri­ence (an­gina, pal­pi­ta­tions, stom­ach pain, di­ar­rhea, head­ache), or even ill­nesses that seem to re­sult from this (heart at­tack, stroke, ulcer). Stress is also very dif­fer­ent for each of us.


How­ever, stress sig­ni­fies dif­fer­ent things to each of us.

Things that are very dis­tress­ful for one in­di­vid­ual may be pleas­ur­able for an­other, or have lit­tle sig­nifi­cance ei­ther way.
That can be read­ily il­lus­trated by ob­serv­ing pas­sen­gers on a steep roller coaster ride. Some are hunched down in the back seats with their eyes shut, jaws clenched, and white knuck­led as they clutch the re­tain­ing bar. They can’t wait for the ride in the tor­ture cham­ber to end so they can get back on solid ground and get away.

But up front are the wide-eyed, ex­hila­rated thrill seek­ers, yell­ing, and rel­ish­ing eve­ry steep plunge, who ac­tu­ally race to get on the very next ride! And in be­tween you may find a few with an air of indif­fer­ence or non­cha­lance that seems to bor­der on bore­dom. So, was the roller coaster stress­ful? Ob­vi­ously, it’s dif­fer­ent strokes for dif­fer­ent folks.

The roller coaster ride is a use­ful anal­ogy for sev­eral rea­sons. What dis­tin­guished the pas­sen­gers in the back from those in the front was the sense of con­trol they per­ceived over the event. While nei­ther group had any more or less con­trol, their per­cep­tions and ex­pec­ta­tions were quite dif­fer­ent. Thus, al­though you can’t de­fine stress ob­jec­tively, all of our ani­mal and hu­man re­search con­firms that the sense or feel­ing of be­ing out of con­trol is al­ways dis­tress­ful.


That’s what stress is all about.
Roller coaster rides, jobs, and peo­ple,
are not in­her­ently stress­ful.

It’s often how we per­ceive them. As with the roller coaster, we often cre­ate our own stress be­cause of faulty per­cep­tions, and that’s some­thing you can learn to cor­rect. You can teach peo­ple to move from the back of the roller coaster to the front, and no­body can make you feel in­fe­rior with­out your con­sent.

In “The Bro­ken Heart: The Medi­cal Con­se­quences of Lone­li­ness”, Dr. James Lynch pro­vides some com­pel­ling ex­am­ples and sta­tis­tics about the re­la­tionship be­tween the stress of be­reave­ment and lone­li­ness with heart dis­ease. The best vali­dated rat­ing scale used to meas­ure the se­ver­ity of stress places death of a spouse at the top with a value of 100, fol­lowed by loss of other im­por­tant re­la­tionships like di­vorce (73), mari­tal sepa­ra­tion (65), and going to jail and death of a fam­ily mem­ber (63). Get­ting a traf­fic ticket (14) is at the bot­tom of this list of some 43 other stress­ful events. Stress lev­els are de­ter­mined by add­ing up the to­tal of how many of these have been ex­peri­enced over the pre­vious 12 months.

Thou­sands of sci­en­tific stud­ies have con­firmed that the higher the score, the greater the like­li­hood that you will be­come sick dur­ing the next six to twelve months. Wid­owed in­di­vid­uals die at rates three to twelve times higher for all the lead­ing causes of death within a year or two fol­low­ing the loss of their mate than mar­ried con­trols.

Car­diac deaths are es­pe­cially high dur­ing the first six months of be­reave­ment. A greater risk for heart at­tacks has also been dem­on­strated for a va­ri­ety of other stress­ful emo­tions, in­clud­ing de­pres­sion, anxi­ety, fright, hos­til­ity, and an­ger, es­pe­cially when you keep your an­ger sup­pressed.

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