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Link Found Between Mental Stress and Heart Fatalities

Ischemia can cause a threefold increase in risk of death

MONDAY, March 25, 2002 (HealthDayNews) -- Not only is mental stress bad for your heart, but also it can actually kill you if you have a heart condition.

A study in the latest issue of Circulation shows that psychological stress can inhibit the flow of blood to the heart, a condition called ischemia, and increase the risk of death for those with coronary artery disease.

"Patients who had ischemia in response to mental stress had a three-fold increase in the risk of death compared to people without mental stress," Dr. David S. Sheps, lead author of the study and associate chief of the division of cardiovascular medicine, University of Florida Health Sciences Center, Gainesville, said in a prepared statement.

The finding adds to a growing body of evidence that links mental stress with creating or exacerbating heart problems.

However, Rozanski adds, it's important to keep in mind that the average person is not at risk of having a heart attack upon hearing bad news.

"This particular study looked at a subgroup of patients with known coronary artery disease," Rozanski. "This is not something that's relevant for the average lay person. It's more of a marker for patients who were functionally sicker."

This latest study looked at 196 patients (170 men and 26 women), all of whom had either experienced a heart attack or had a more than 50 percent narrowing of at least one major coronary artery. All also had exercise-induced ischemia.

Each participant was given an exercise stress test followed by a psychological stress test, in which they were asked to play a role in a scenario in which a close relative was being mistreated.

The University of Florida researchers used an imaging test called radionuclide angiography to see how the heart was working after the mental stress test. Dye was injected into the bloodstream to highlight red blood cells. The scientists then looked at computer-generated pictures to see how the heart was performing. The researchers were particularly interested in any "wall motion" abnormalities or changes in the heart's ability to pump blood.

Twenty percent of the patients showed evidence of the abnormalities.

Follow-ups done after 3.5 and 5.2 years showed that 17 patients had died. Forty percent of these patients had exhibited wall motion abnormalities during their earlier stress test. From that, the researchers calculated that patients with wall motion abnormalities had a 2.8 times higher death rate than those who didn't.

In his caution on the study's applications, Rozanski also says there's also an important distinction to be made between acute stress and chronic stress.

Normal individuals may be at higher risk for cardiovascular events if they're exposed to certain forms of chronic stress, such as depression, but not if they're exposed to a one- or two-time stressor. Individuals with cardiovascular conditions may be at higher risk from both types of stress, he notes.

What To Do

The American Heart Association says that while managing stress is a good strategy for overall health, "current data do not yet support specific recommendations using stress management as a therapy for cardiovascular disease."

For more information on stress and heart disease, visit these American Heart Association sites: Managing Stress and Stress and Heart Disease

SOURCES: Alan Rozanski, MD, director, nuclear cardiology, St. Luke's-Roosevelt Hospital, and professor of medicine, Columbia University College of Physicians and Surgeons, New York City; March 26, 2002, Circulation
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