Mindful of the heart

Editor's note: This article was originally published in The Star Online.

Mindful of the heart

By LIM WEY WEN

Our state of mind matters more to the health of our hearts than we may think.

THE list of risk factors for heart disease emailed to me by senior consultant psychiatrist Prof Ainsah Omar looked run-of-the-mill, but for two factors: “Type A personality, and stress”.

Until recently, the effects of these two as risk factors for heart disease have been mostly observational and retrospective. Building a good support system can also go a long way in helping you handle stress better.

In the Los Angeles earthquake in 1994, half of all immediate deaths were found to be due to cardiac arrests – five times greater than a usual day.

Soon after, many other incidents indicated that physical and emotional triggers, such as environmental disasters and vigorous physical exercise (particularly in those who are already at risk), can precipitate heart attacks.

Two years ago, a landmark global study – the INTERHEART study – managed to provide us with some numbers.

Using questionnaires, researchers compared 15,152 cases of heart attacks to 14,820 controls in 52 countries to find out if risk factors for heart attacks impact people of different races or from countries differently.

One notable finding was that psychosocial risk factors were more common amongst those who had heart attacks. You can reduce stress levels by just making the effort to laugh.

From the study findings, it was estimated that if psychosocial risk factors alone (including stress and depression) were eliminated, 32.5% of heart attacks could be prevented.

The same study estimated that eliminating lifetime smoking alone would reduce heart attacks by 35.7%. Eliminating hypertension would reduce heart attacks by 17.9% and eliminating obesity would reduce the incidence by 20.0%.

Who knew preventing a heart attack could also be just one positive thought, or therapist, away?

Type As and stress

You really can’t miss a Type A if you come across one. They are highly-strung, competitive, impatient, brash and sometimes rude.

And you can see why they are stressed out. Their workaholic tendencies take a toll on their health and their constant pursuit of perfection often leads to disappointments.

As Jeanie Lerche Davis wrote in the medical information website WebMD, “The classic Type A personality – competitive, impatient, uptight – is a heart attack waiting to happen. And that heart attack will likely happen sooner rather than later.”

A little stress is actually good for you. It helps you stay energetic, motivated and alert. In emergencies, stress also prepares you to respond adequately to danger, protecting you from harm.

But when stress levels remain high or when an individual fails to adapt to the stress, the stress response systems in the body will be continuously activated, resulting in persistent high levels of stress hormones and elevation of blood pressure, heart rate and contractility (the contraction of heart muscles), says Prof Ainsah, who is also the Deputy Dean of Research and Postgraduate Studies at the Faculty of Medicine, Universiti Teknologi Mara (UiTM).

“These will be detrimental to the heart,” she adds.

Stress pulls the trigger

The role of stress in heart attacks can generally be described with this analogy: your diet, lifestyle or genetic tendencies to get a heart attack loads the gun, and stress pulls the trigger.

Although it does not directly cause the onset of a heart attack the way a sudden blockage or narrowing of the heart arteries does, it sets the stage for them to happen.

First of all, stress is associated with some behaviours that increase a person’s risk of heart attacks.

Psychological stress is one of the important factors associated with smoking. Some eat excessively to cope with stress and negative emotions, leading to obesity – an important risk factor not only for heart disease, but also for a myriad of other diseases.

Secondly, stress involves biological changes within our body where stress hormones and biochemicals that can trigger increased blood pressure and heart rate are released.

“(Stress) can also increase lipid and triglyceride levels which cause hyperlipidaemia and increases the risk of developing heart disease,” Prof Ainsah says.

Besides, UK researchers have also found evidence that stress can trigger the release of high levels of clot-forming platelets – little cell fragments that can form clots in the coronary arteries.

Dealing with stress

We should take note that stress is not equivalent to stressful situations. While stressful situations may give rise to stress, your response to these situations partly determines your stress levels and how much they affect you.

“Personality determines how one reacts to stressful situations,” Prof Ainsah says.

Take Type A personalities as an example. Besides being aggressive, highly motivated and competitive, people who carry the trait are also easily worried, anxious and unable to express their anger and dissatisfaction frankly.

“If you are a person with Type A personality, you need to modify your attitude and avoid (being) extremely perfectionist,” Prof Ainsah advises.

It is alright to set high expectations, but one should be able to accept failures if the expectations are not met, she adds.

Workaholics, she says, should also ensure they have adequate time for rest and recreational activities.

Even with increasing evidence that stress does have a role to play in heart attacks, stress reduction has yet to be endorsed as a specific recommendation to prevent heart attacks.

The American Heart Association (AHA), in its short write-up on stress and heart attacks, says current data don’t yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease.

The variation of stressors and the way they affect people contribute to the difficulty in designing studies to evaluate the effects of stress and the efficiency of stress reduction in preventing heart attacks.

Of those that have been carried out, the AHA says that studies using psychosocial therapies to prevent second heart attacks are promising and people who feel depressed, anxious or overwhelmed by stress after a heart attack or stroke should talk to their doctor or other healthcare professional.

Or, you could try to laugh more often.

“Research has demonstrated that laughter reduces stress through various mechanisms,” Prof Ainsah says.

Laughter reduces stress by reducing levels of stress hormones (cortisol, noradrenaline) and releases anti-stress biochemicals such as endorphins.

On top of reducing blood pressure and pulse rates that were raised during stress, the reduction of stress hormones also allows the immune system to function properly.

Anti-stress biochemicals like endorphins, on the other hand, can elevate people’s moods and make them perceive less stress.

If you’re not sure you could lighten up your mood alone, surround yourself with happy people because just like laughter, moods are contagious too. Building a good support system can also go a long way in helping you handle stress better.

“Every one of us is bound to face stress, especially in the modern, challenging world,” Prof Ainsah says.

“We may not be able to control our life stressors, but we can change the way we perceive stress.”

Indeed, a positive state of mind could be your ticket to a healthy heart too.