The Coronary Artery Disease Risk Factor You May Have Overlooked

Medically Reviewed by James Beckerman, MD, FACC on November 10, 2021
7 min read

Annoyed by constant indigestion and other nagging symptoms, Marybeth Neyhard of Broomall, PA, went to see a doctor in July of 2017. “I said, ‘If this is what 65 feels like, I don’t like it,’” recalls Neyhard, who soon got some troubling test results.

A scan of her coronary arteries showed she had several significant blockages, and instead of going on a planned London vacation with her husband, she headed to an operating room, where she ended up having emergency bypass surgery.

Neyhard, the oldest of six siblings and a married mom of three grown children, woke up to find she had quite a lot of company. “My whole family was around me,” she says. Neighbors rushed over with well wishes and meals, and friends both near and far checked in to see how she was doing.

When she spotted a sign in the hospital elevator for a monthly women’s support group at the Lankenau Heart Institute, she decided to go to the next meeting.

“I’m not the kind of person who’s afraid to reach out,” says Neyhard, who’s determined to do whatever it takes to avoid a second surgery. “I don’t want to be a repeat offender.”

Keeping up connections -- and forming new ones -- is a critical part of cardiac rehab for patients like Neyhard, says Yale professor Matthew Burg, PhD, a clinical psychologist who researches how stress and emotional factors affect cardiovascular disease.

Years of scientific studies have demonstrated a clear pattern. “Social support is good, and not having it is bad,” Burg explains. For folks who don’t feel like they have anyone to turn to or rely on, the risk of adverse events can double, he says.

Here’s what you need to know about social support, why it’s such a big deal for your heart, and how to make sure you have people to help you through tough times.

For decades, scientists have understood that the mind and body are connected, explains Kim Feingold, PhD, founder and director of cardiac behavioral medicine at the Bluhm Cardiovascular Institute at Northwestern. These links show up with many medical conditions and are particularly pronounced in people with heart disease.

“This is the disease [where] it’s most evident that how we behave, think, and feel impacts our physical health,” Feingold says. Not only do things like depression, anxiety, stress, and social isolation feel bad, but they’re also linked to having other health problems.

Social support plays into each of these factors. “We’re social animals. It’s in our DNA,” Burg says. That’s why we take great comfort in knowing there are people who can help nearby -- it can help them know that if something goes awry, they’ll be OK, he says. When we don’t have that reassurance, it’s stressful.

“The question is, How does that stress get under your skin?” says Kevin Larkin, PhD, who directs the Behavioral Physiology Laboratory in West Virginia University’s Department of Psychology. The answer: Through your head.

When you feel stressed out, your brain takes in that information and sends signals to the rest of your body. Research shows that these reactions, including the resulting inflammation, likely contribute to heart issues and other health problems.

The term “social support” is tricky to define because it means so many things.

As Burg notes, sometimes you need very practical assistance: “If my car breaks down, is there someone I can call? Are there people who can do shopping for me?”

Emotional needs are just as pressing, Feingold says. She points to the importance of laughing, sharing stories, and being able to hash out problems.

And when it comes to changing lifestyle behaviors -- like quitting smoking or getting fit -- that can call for another kind of support. “If you find a buddy to exercise with, you’re more likely to achieve your goals,” Feingold says.

In some cases, a spouse can provide many or all of these types of support. But not always, says Burg, who has seen married patients still score low on a social support scale. He says it’s common for wives to excel as caregivers when their husbands have heart problems, and for the opposite to be true when the roles are reversed. “The man isn’t stepping up to help or altering expectations,” he says.

Of course, plenty of men are great at providing social support. In any partnership, one person may feel more supported than the other or be better at social support, not just in husband-and-wife couples.

Neyhard has encountered similar situations among the members of her support group, as well as women whose families resist putting heart-healthy foods in the fridge or on the dinner table. “Maybe they’re supportive initially, but they’re not about to change their diet because she has to,” she says.

So it may be important to branch out beyond your existing networks to get the full spectrum of support you need.

When clinical psychologist Valerie Hoover meets with people who have heart disease, she encourages them to consider whether they may have more support than they realize.

“If they say, ‘I don’t have people I can turn to,’ I have them generate a list of everybody they know -- friends, family, neighbors -- and whether they go to that person,” says Hoover, PhD, a clinical assistant professor of cardiovascular medicine at Stanford University.

“There tend to be different ‘Aha’ moments for patients. When they sit down and write out that list, they’re surprised about how many people are in their lives.”

The next step is probing how comfortable they are asking for that support.

“A lot of people have this idea that it says something negative about them, or it’s weak to ask for help,” Hoover says. She tries to get them to see it another way. She asks them to think of times when people have turned to them for help in the past, and how that felt rewarding.

When it’s time to actually ask for help, Hoover encourages them to be as specific as possible. (For example, rather than asking your partner to do more around the house, you could offer a concrete task to perform, like making dinner.) Follow up  on that request with gratitude and appreciation, Hoover suggests.

Some people may write out their list of social ties and find it’s pretty short. The two most common situations, explains Burg, are people who’ve never made many connections and those who once had social circles that have since fallen apart.

“Maybe there’s an older woman whose husband has died, her friends have moved south, and her kids live remotely,” Burg says. For someone with that profile -- or someone who finds it hard to trust others -- it can be stressful to tell them to just go out and make friends. And that stress, he points out, isn’t good for their hearts either.

Feingold’s advice: Take your time and figure out ways to make connections that feel right for you. “Cultivating social support is practical and possible, but it’s a process,” she says.

One way to start is to look for common shared interests, perhaps through a hobby, a book club, or a place of worship.

“Challenging yourself to step out of your comfort zone might initially feel awkward,” Feingold says. But it's worth it. These types of groups provide not just potential friends, but also a chance to establish new routines and a motivation to leave the house every day.

In a support group, you may connect with people who’ve faced similar challenges. “They can relate and swap resources,” Feingold says. “They understand each other in a way that other people can’t.”

That’s been true for Neyhard. Her support group gives her the chance to discuss topics she would normally rather avoid.

“When I go to lunch with my friends, I’m not going to talk about my dietary choices,” she says. But with her support group, she doesn’t hesitate to ask questions and share recipes. “It gives me an outlet to talk about all of this health stuff without ruining the party.”

Social distancing and the reduction of many in-person activities over the past 2 years have had clear consequences.

High blood pressure and stress disorders are blossoming in this environment,” Larkin says. He’s particularly concerned about the long-term effects on college students, who have missed the chance to build relationships that often last for decades and provide a framework for making and keeping friends into adulthood.

For many older adults, the pandemic has made it challenging to keep up existing ties and form new ones.

Feingold sees a silver lining: Online support groups have boosted access for folks who hadn’t been able to attend in person before. Attendance is up in the group Larkin runs. She chalks that up to easier logistics. “They don’t have to drive downtown, find a parking spot, and drive home,” she says.

Looking for help online can work well, Hoover agrees. But what matters most is the level of support you’re ultimately getting.

“A like on a Facebook post isn’t a conversation,” she says. Your heart needs more than that.