Level of Mental Stress May Help Doctors Predict Heart Attack
For the latest portion of the study, 78 of these 79 patients were monitored
for three to four years with respect to incidences of cardiac events, defined
as minor or major surgery, nonfatal heart attacks, or fatal heart attacks.
Twenty-eight cardiac events occurred during follow-up, and patients with
ischemia brought on by mental stress experienced a cardiac event significantly
more frequently than those without mental stress-induced ischemia (20 patients
vs. eight, respectively).
"Our patients have been telling us for years that stress causes heart
attacks," says Diane Becker MPH, ScD, who reviewed the study for WebMD.
"Likewise, as health care providers, we have long known that mental stress
is not good for people with known coronary disease. Sadly, we do not have
effective treatments for stress. There is not one ounce of solid and
generalizable evidence that we can reverse this process. Thus, clinically, we
simply work with people to lower the stress in their lives through relaxation
and simplifying their lifestyles. [We also] pay attention to what patients tell
us and help them make good life choices. This in no way should be interpreted
to mean that people should stop working or take medications."
"Worse," Becker says, "I would hate to see this have legal
ramifications where someone could hold another person or employer liable for a
stress-induced coronary disease event. We simply do not know enough about how
to manage stress or whether this will affect outcomes. We simply can offer
plain, common-sense recommendations. The old 'take it easy' advice is still all
we have." Becker is a professor of medicine and director of the Center for
Health Promotion at Johns Hopkins University.
However, Gottdiener, who is currently director of cardiac noninvasive
imaging at St. Francis Hospital in New York, may have better news. "Right
now," he says, "there's consideration being given to a therapeutic
trial of mental stress-induced ischemia, where some of the possibilities
include everything from behavioral therapy to psychoactive drugs. If [we] can
block the ability of mental activation ... [to] produce ischemia, we can
probably improve the outcome in a lot of people."
This research received funding from the National Institutes of Health and
the Uniformed Services of the Health Sciences in Bethesda, Md.
- Ischemia, or lack or blood flow to the heart, is a common cause of heart
disease that is often measured with exercise testing.
- About half of patients who experience ischemia during exercise also
experience it during mental stress, and this group of patients is more likely
to suffer adverse cardiac events.
- Physicians can advise patients to lower stress through relaxation and
simplification of lifestyle, but further research is being conducted to learn
more about stress reduction.