Stress and the heart (page 1 of 4)
First page | Previous page | Next page | Last page
The role of stress in the causation of coronary heart disease is one of the most controversial and hotly debated issues in cardiology. Opinion surveys have consistently shown that the general public believes stress is an important cause of heart disease. Stress is also widely held to be the major cause of heart attack by the survivors of myocardial infarction (heart attack) and their close relatives. The directors of Human Resource departments and senior managers are therefore often reluctant to allow coronary heart disease patients to return to work for fear of worsening their condition. In marked contrast to these views, cardiologists and cardiovascular epidemiologists continue to argue that smoking, hypertension, hyperlipidaemia, diabetes, lack of exercise and obesity are much more important risk factors for the development of coronary heart disease than emotional or psycho-social stress.
Problems of studying stress in heart disease
This controversy has been difficult to resolve because stress is a nebulous concept that is difficult to define and virtually impossible to measure. Moreover, there are often potentially confounding links between psycho-social stress and conventional risk factors such as smoking and a sedentary lifestyle. In biological terms, stress is perhaps best considered as a source of excessive sympathetic nervous (adrenergic) stimulation, leading to the release of catecholamines into the blood, which may be acute or chronic. High catecholamine concentrations increase cardiac work by increasing heart rate, blood pressure and myocardial contractility; it is, therefore, easy to construct biologically plausible hypotheses linking stress to the pathogenesis of heart disease. This concept has been given further credibility by a recent paper describing significant but reversible left ventricular dysfunction induced by acute emotional stress.
First page | Previous page | Next page | Last page
