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Level of Mental Stress May Help Doctors Predict Heart Attack

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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.

Vital Information:

  • 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.
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