Stress Vs Cholesterol and Other "Risk Factors" For Coronary Heart Disease

It has long been recognized that severe or sudden emotional stress could result in a heart attack or sudden death. Walter Cannon at Harvard first delineated the mechanisms responsible for this in the early part of the last century. (Cannon 1914) Cannon's studies demonstrated that responses to the stress of acute fear resulted in a marked increase in sympathetic nervous system activity and an outpouring of sympathin (adrenaline) that prepared the animal for lifesaving "fight or flight." His later studies of the mechanism of "bone pointing" or "voodoo" death also implicated excess secretion of hormones from the adrenal medulla into the blood stream as the most likely cause of fatal arrhythmia. (Cannon 1942) Hans Selye's formulation of the stress concept in the late 1940’s provided further insight into the role of pituitary and adrenal cortical hormones in mediating damaging cardiovascular responses to stress.

His subsequent research included the experimental production of "metabolic cardiac necroses," in which direct biochemical injury to heart muscle rather than occlusion of the coronary vessels was the causative factor. (Selye 1958) Since then, it has been observed that stress can cause accelerated atherosclerosis and coronary occlusion that is associated with elevated cholesterol, triglycerides, and free fatty acids, increased fibrinogen, haptoglobin, plasma seromucoids, platelet aggregation and adhesiveness, polycythemia, and accelerated blood clotting. We have also become increasingly aware of the important role of stress-induced coronary vasospasm in the production of clinical symptoms and disease.

Even more significant has been the identification of myocardial infarction in the absence of significant coronary occlusion due to excessive release of norepinephrine at myocardial nerve endings. This has been shown to produce a specific type of microscopic myocardial damage that appears to be identical in laboratory animals as well as humans who have succumbed to sudden cardiac death as a result of an acutely stressful situation. (Cebelin, Hirsch 1981) There is also abundant evidence that severe and acute emotional stress following an earthquake or other natural disaster or the loss of a loved one can result in hypertension, a heart attack or sudden death.

In 1982, the disappointing results of the seven-year, $115 million MRFIT study were published in the Journal of the American Medical Association. MRFIT is an acronym for Multiple Risk Factor Intervention Trail, which was designed to show the beneficial effect of stopping smoking and lowering cholesterol and blood pressure. (Multiple Risk Factor Intervention Trial Group 1982)

Type A Coronary Prone Behavior

In 1959, a paper by Meyer (Mike) Friedman and Ray Rosenman appeared in the Journal of the American Medical Association entitled "Association of specific overt behavior patterns with blood and cardiovascular findings: Blood cholesterol level, blood clotting time, incidence of arcus senilis and clinical coronary artery disease." (Friedman & Rosenman, 1959) The subtitle linking specific behavioral traits with things like blood cholesterol, clotting time, arcus senilis and coronary disease that had no apparent relationship to each other must have seemed strange to many readers. Neither of these two cardiologists had any expertise in psychology, which may have been fortuitous, since they had no preconceived notions. What they did have was an unusual combination of curiosity, diagnostic acumen and a bio-psychosocial approach to the patient as a person, rather than someone to be treated in a cookbook fashion based on laboratory tests, symptoms or signs.

As noted, psychiatrists and others interested in psychosomatic disorders had previously described certain personality characteristics in heart attack patients. However, it was not possible to prove that these had any causal relationship since such idiosyncrasies could have resulted from the illness rather than vice versa. Friedman and Rosenman were the first to explain why specific behaviors could cause heart attacks and contribute to coronary artery disease.

At the time, animal studies had led to the widespread assumption that heart attacks were due to occlusion of a coronary artery by atherosclerotic deposits resulting from elevated blood cholesterol levels. This, in turn, was primarily the consequence of increased fat and cholesterol intake. Support for this was reinforced by research showing that the significant variation in mortality rates from coronary heart disease in different countries showed a clear correlation with fat consumption. The greater the amount of saturated fat and cholesterol in the average diet the higher the blood cholesterol and death rate from heart disease in that country. Such individuals exhibited certain characteristic activity patterns, including.

1.    Self-imposed standards that are often unrealistically ambitious and pursued in an inflexible fashion. Associated with this are a need to maintain productivity in order to be respected, a sense of guilt while on vacation or relaxing, an unrelenting urge for recognition or power, and a competitive attitude that often creates challenges even when none exist.

2.    Certain thought and activity styles characterized by persistent vigilance and impulsiveness, usually resulting in the pursuit of several lines of thought or action simultaneously.

3.    Hyperactive responsiveness often manifested by a tendency to interrupt or finish a sentence in conversation, usually in dramatic fashion, by varying the speech, volume, and/or pitch, or by alternating rapid bursts of words with long pauses of hesitation for emphasis, indicating intensive thought. Type A persons often nod or mutter agreement or use short bursts of laughter to obliquely indicate to the speaker that the point being made has already been anticipated so that they can take over.

4.    Unsatisfactory interpersonal relationships due to the fact that Type As are usually self-centered, poor listeners, often have an attitude of bravado about their own superiority, and are much more easily angered, frustrated, or hostile if their wishes are not respected or their goals are not achieved.

5.    Increased muscular activity in the form of gestures, motions, and facial activities such as grimaces, gritting and grinding of the teeth, or tensing jaw muscles. Often there is frequent clenching of the fist or perhaps pounding with a fist to emphasize a point. Fidgeting, tapping the feet, leg shaking, or playing with a pencil in some rhythmic fashion are also common.

6.    Irregular or unusual breathing patterns with frequent sighing, produced by inhaling more air than needed while speaking and then releasing it during the middle or end of a sentence for emphasis.

It was also noted that coronary prone patients tend to be very competitive and often overly aggressive. They are usually in a hurry and consequently eat, talk, walk and do most other activities at a more rapid pace. Type A's are generally more concerned with the quantity rather than the quality of their work, try to do too many things at once, are frequently preoccupied with what they are going to do next, and tend to have few interests outside their work.

Stress and Heart Disease

There are many relationships between stress, heart disease and sudden death has been recognized since antiquity. The incidence of heart attacks and sudden death have been shown to increase significantly following the acute stress of natural disasters like hurricanes, earthquakes and tsunamis and as a consequence of any severe stressor that evokes "fight or flight' responses.

 Coronary heart disease is also much more common in individuals subjected to chronic stress and recent research has focused on how to identify and prevent this growing problem, particularly with respect to job stress. In many instances, we create our own stress that contributes to coronary disease by smoking and other faulty lifestyles or because of dangerous traits like excess anger, hostility, aggressiveness, time urgency, inappropriate competitiveness and preoccupation with work.

These are characteristic of Type A coronary prone behavior, now recognized to be as significant a risk factor for heart attacks and coronary events as cigarette consumption, elevated cholesterol and blood pressure. While Type A behavior can also increase the likelihood of these standard risk factors, its strong correlation with coronary heart disease persists even when these influences have been excluded. However, there is considerable confusion about how to diagnose and measure Type A behavior and numerous misconceptions about which components are the most as indicated in the Interview with Dr. Ray Rosenman, one of the co-authors of the Type A behavior concept.

Emotions, Behavioral Traits and Heart Disease

The appreciation that different emotions could have powerful influences on the heart and the recognition of some intimate but poorly understood mind-heart connection is hardly new. Aristotle and Virgil actually taught that the heart rather than the brain was the seat of the mind and soul and similar beliefs can be found in ancient Hindu scriptures and other Eastern philosophies.

Some 2000 years ago, the Roman physician Celsus unwittingly acknowledged this mind-heart relationship by noting that "fear and anger, and any other state of the mind may often be apt to excite the pulse." Our earliest uses of the word heart clearly indicate its conceptualization as the seat of one's innermost feelings, temperament, or character. Broken-hearted, heartache, take to heart, eat your heart out, heart of gold, heart of stone, stouthearted, are just a few of the words and phrases we still use that vividly symbolize such beliefs.

William Harvey, who discovered that the circulation of the blood around the body through vessels was due to the mechanical action of the heart also recognized that the heart was more than a mere pump. As he wrote in 1628, "every affection of the mind that is attended either with pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart."(Harvey, 1628) During the 18th century, John Hunter, who elevated surgery from a mechanical trade to an experimental science, suffered from angina, and being a keen observer complained, "my life is in the hands of any rascal who chooses to annoy and tease me." He turned out to be somewhat of a prophet, since it was a heated argument with a colleague that precipitated his sudden death from a heart attack.

With respect to personality and Type A behavioral traits, Von Düsch, a 19th century German physician, first noted that excessive involvement in work appeared to be the hallmark of people who died from heart attacks. (Von Düsch, 1868) He did not imply that job stress was the culprit, but rather that such individuals seemed to be preoccupied with their work and had few outside interests. Over 100 years ago, Sir William Osler, an astute clinician, succinctly described the coronary-prone individual as a "keen, and ambitious man, the indicator of whose engines are set at 'full speed ahead". (Osler, 1892) He later wrote that he could make the presumptive diagnosis of angina based on the appearance, demeanor and mannerisms of the patient in the waiting room and how he entered the consultation room.

Tips Avoid Coroner Heart

1. Investigates blood pressure regularly

2. Don't smoking

3. Investigates does you have diabetes, and controls rate blood glucose if when you having Diabetes

4. Maintains normal body weight

5. Low diet of saturated cholesterol and fat

6. Athletic regularly

7. Lessens impact stress by the way of relaxation

8. Does inspection of health regularly