Ways to Tame Stress When You Have CAD

Medically Reviewed by James Beckerman, MD, FACC on November 02, 2021
10 min read

Stress is a basic instinct for all animals -- humans too. It’s the body’s fight or flight response for fending off danger. It presses the “pause” button on our bodily functions and puts all our energy toward the threat at hand. And it’s not always bad. In fact, it might even save your life.

“Acute stress is something that we want,” says Alyssa Vela, PhD, a clinical health psychologist in Chicago. “If you didn’t have that reaction in the body, you might just walk out onto Michigan Avenue and not pay attention to any of the cars or buses driving past.”

The trouble happens when our stress response is activated around the clock, says Kim Feingold, PhD, Vela’s colleague at Northwestern’s Bluhm Cardiovascular Institute, where their small team helps people adjust after a heart disease diagnosis. That includes managing stress.

“Activating our stress response is appropriate and healthy when there’s an impending threat,” Feingold says. “But when we get cut off in traffic, or we’re on hold for a long time with an insurance agent, or we’re getting spam calls at an inconvenient time, or we’re having an argument, our body is not in jeopardy the same way that it was thousands of years ago, when our stress response was created. Yet we continue to activate our stress response in these situations.”

Under stress, your heart rate and blood pressure rise. Inflammation kicks in. Your blood vessels contract.

Constant stress levels raise your risk of many health issues, including coronary artery disease (CAD). “That stress response is just not designed to be turned on all the time,” Vela says.

The cardiac behavioral medicine team at Northwestern Medicine's Bluhm Cardiovascular Institute uses this two-pronged approach to stress management:

  1. Avoid stress before it happens. This is about cutting down on the number of times the stress response kicks in during everyday life. You can’t zero it out, but are there stresses you can avoid?
  2. Manage stress when it shows up. This includes raising your stress threshold so that you aren’t always dialed up to 10.

“One of the most important things, and it sounds so basic, is protecting our foundation,” Feingold says.

Your foundation is made up of your essential needs like sleep, nutrition, and exercise. By protecting those building blocks, she says, we give ourselves the best chance of handling challenges when we go out into the world.

Sleep may be the most critical piece of the puzzle, Vela says, because it gives us the energy to do the other essentials like exercising and eating well.

“If you don’t get enough sleep, your reserves are lower,” she says. “You just don’t have as much tolerance for those little things.”

Do this: Relax your mind before bed, spend time in the daylight, turn off screens, keep a solid sleep schedule, and make your bedroom an ideal sleeping place -- quiet, dark, and comfy.

Do you really need to scroll while in bed? Being glued to your phone also interferes with your sleep.

“With the rise of technology and social media, especially with the pandemic, we’ve been seeing more and more [people] staying up looking at Instagram and TikTok and whatever else is on our screen into the hours of the morning,” Vela says. “That is very much impacting people’s mood and their cardiovascular health.”

On top of this, the constant flurry of activity at our fingertips is hard on our brains.

Do this: Take time every day to put down your phone, ignore texts and emails, and simply be in the present.

If you constantly dwell on stressful thoughts, schedule a “worry time” each day to sit with difficult, challenging, or negative thoughts.

Do this: If a worry comes up, make a note, postpone it to your worry time, and continue to focus on the present. Then, when worry time arrives, you can address the things that are stressing you out, or simply sit with your feelings and reflect.

At the end of worry time, set aside the stress and try to change gears. By leaning into your worries for a designated time, you can learn to get those things off your chest and move forward.

Most things don’t truly warrant a full-blown fight-or-flight response. By learning how to prioritize our stress reaction, we can save our stress for times that we really need it.

“If something happened to my child, or to my health, that might be worth my body getting all worked up,” Feingold says. “But the person who cut me off in traffic is actually not jeopardizing anything really important. So maybe if I prioritize what’s important, I can allocate my stress response to those things.”

The idea of setting priorities also applies to everyday tasks. 

Do this:

  • Prioritize your long to-do list. Try to avoid getting stressed out if, for example, you’ve used up all your energy paying bills and need to go to bed without doing the dishes.
  • Have compassion for yourself. “It’s about giving yourself permission to focus on your needs, which a lot of people don't do,” Feingold says.

Stress happens, Feingold says, when our demands exceed the resources we think we have. So one part of stress management is taking action to use your resources.

“If there’s a stress, and we recognize that we have the appropriate or sufficient tools to handle that stress, then it’s not a stress, it’s actually a challenge," Feingold says.

Imagine, for example, that you’re taking a college final exam tomorrow. If you’ve missed classes, stayed up all night partying, and haven’t studied, you might view the exam as a stress.

Your classmate, on the other hand, has gotten enough sleep, gone to class, and given themselves ample time to study. They’ll probably see the same exam quite differently.

By arming themselves with enough resources, your classmate has turned a potential stress into a challenge -- or at least, less of a stress.

The same concept applies at work. Job stress can play a role in heart disease risk, even at a job you love.

Do this:

  • Find ways to remove demands and access your resources at work.
  • Take the breaks you’re entitled to and use them to do something you enjoy.
  • Ask your employer about an employee assistance program (EAP) that exists to help you manage stress and anxiety.
  • Delegate some work or tap into colleagues for support.
  • Remind yourself of what you can do.

Feingold says that her patients often forget how capable they are. “We tend to overestimate the demands of a situation. We make it into this big mountain, and it just feels paralyzing,” she says. “More importantly, we underestimate our own resources to cope with a challenge.

“We’re remarkably resilient as human beings. There’s very few things we cannot withstand.”

Let’s face it: Some stress is unavoidable. So we need skills that balance things out.

“I like to think about stress and coping in the sense of the Scales of Justice,” Vela says. "If our stress scale is tipped over and weighing down, then we need to either remove some of the stress from the scale or add coping skills to the other side.”

Not every strategy will work for every person. The trick is finding what works for you.

Meditation is a great way to look inward and regain control of your emotions. Taking regular opportunities to relax your body and mind, even just for a few minutes, can lower your blood pressure.

Yoga, which goes hand in hand with meditation, is another way to calm your mind and center your thoughts, but it can also reduce your blood pressure, lower blood glucose and cholesterol, and strengthen your body. It can also help some people quit smoking.

It all boils down to breathing deeply, Vela says. “When we think of meditation, it becomes this big, complicated thing, and it certainly can be. But simple, deep, diaphragmatic breathing [or breathing from your belly] is really what the evidence shows is the most important thing.”

Physical activity is an excellent way to burn off stress.

Here’s how it happens: When you get moving, your body releases chemicals called endorphins. These feel-good hormones are a powerful defense against stress. Exercise can also distract you from your worries and help you "reset" your brain.

You can get active in almost any environment, whether it’s hiking up a mountain or doing stretches in your living room.

Try to think outside the box. Walking your dog, roller skating, dancing, jumping on a trampoline, snowboarding, playing with your kids -- there are countless great ways to get your heart rate up.

But it’s not just about exercise. Even just getting up from your desk chair to stretch can relieve stress.

“Part of it is just changing your blood flow, going from sitting to standing, changing your position,” Vela says.

We’ve all done it: headed straight for our comfort foods -- or a drink, or a cigarette -- when stressed. But that usually backfires, and there’s a better option.

Foods high in sodium and saturated fat cause plaque buildup in your arteries, which causes CAD. People may also smoke or drink too much alcohol for stress relief. Both of these can damage your heart.

Be mindful of what you put into your body when you’re stressed. Watch your portion sizes, especially with alcohol and with processed foods. If your plate looks empty, load it up with fruits and veggies.

If you order takeout, split it into multiple meals. Try to find tasty, healthier substitutions, like whole wheat bread instead of white, sugar-free sparkling water instead of soda, or low-sodium versions of your favorite sauces.

You don’t have to deprive yourself. Emotional eating can be harmful, says Vela, but it’s all about balance. “It’s about having a healthy relationship with food,” she says. “Every once in a while, if it’s been a bad day, and having a cookie makes you feel really good and joyful, that’s OK too.”

For people with heart disease, a positive attitude is linked to a lower risk of dying. People who find optimism, gratitude, mindfulness, and satisfaction in life have lower blood pressure, more balanced blood sugar, less inflammation, and lower cholesterol.

It’s not clear which comes first: Their outlook or their better health. And it’s not to say that the “negative” emotions are bad. It’s normal and even healthy to feel anger or sadness in some situations. You just don’t want to get stuck in them.

Simply by having a good laugh, you can lower your stress hormones, reduce inflammation in your arteries, and feel calmer.

Find ways to be thankful in your everyday life. At work, for example, Feingold says that finding small, positive things can get you through a lot. “Even in a toxic work situation, you might be able to pull away, no matter how small, some pieces of gratitude,” she says. Like, ‘this is paying the bills.’”

Try to think of positive things that happened throughout the day. Maybe someone enjoyed a presentation you put together, or you got to have your favorite meal for lunch. “You can train yourself to look for that every day,” Feingold says. “You’re reflecting on the small, positive moments.”

Seek refuge from stress in things that bring you joy.

You might socialize after a hard day, visit an art museum, take a bubble bath, help others, go for a nature walk, or journal. Try a new hobby that you’re curious about. If you don’t enjoy it, switch to something else.

Depression or anxiety go hand-in-hand with both chronic stress and heart disease. They can make it harder for you to even figure out what you enjoy, says Vela.

At the Bluhm Cardiovascular Institute, they use a technique called behavioral activation. This involves taking 10 minutes a day to do something that either could be or has been pleasurable.

“If you’re depressed, maybe nothing feels particularly happy or pleasurable to you right now,” Vela says. “But what has felt good or pleasurable to you in the past that you might be willing to try, at this lower threshold, on a consistent basis?”

Depression and anxiety are mental health conditions that can be treated. You can start with your doctor or a licensed therapist. Give your mental health as much attention as your physical health. It’s that important, especially when you have heart disease.

Ultimately, what matters is that you are finding stress management strategies that work for you.

“The goal is to activate your parasympathetic nervous system, which is your relaxation response,” Feingold says. “That can get activated by doing anything that you enjoy, and it doesn’t need to be lying on a hammock reading a book. For some individuals, that would make them go bonkers because they don’t relax by doing things that are passive.” For those people, playing a sport might be much more relaxing than yoga or meditation.

“Gardening, cooking, drumming, painting, yoga, reading, doing improv, singing -- if you’re doing something that you enjoy, you’re finding that place where your body gets to settle down.”