If you ask most physicians what causes heart attacks they will likely mention things like heredity, smoking, high blood pressure, high cholesterol, etc. But if you ask the lay public what causes heart attacks, the answer you most often get is one word: stress.

Stress can cause heart attacks. Why did it take physicians so long to recognize this fact? It is because stress is hard to measure. Stress is not an event, but an individual's response to the event. What may be stressful to one person may be stimulation for another. Therefore it is difficult to design a study to measure stress. Yet natural catastrophes have convinced the medical community that stress can cause heart attacks. For example, on the day of the earthquake near Northridge, Calif., in 1994, more people died of heart attacks than of trauma. Likewise, during the Scud missile attacks on Israel during the Gulf War, more Israelis died from heart attacks than from trauma. We know that stress can cause heart attacks. The question is does stress cause attacks only in susceptible individuals, does chronic stress make us susceptible, or both? Is being a Type A personality a cardiovascular risk? At one time, it was thought to be, but most successful people are Type A. A Type A personality is time-conscious, goal-orientated, a perfectionist, and somewhat intolerant of those who are not. However, it has been shown by Sarver Heart Center researcher Theodore Dembrosky, PhD, and others that it is not being Type A that is the risk, but the hostility component that Type A personalities sometimes have. Type A people who are not hostile are not at increased risk.

Other markers of stress are a low socioeconomic status (money can buy a lot of amenities that decrease stress), lack of a social support system (common for those who are hostile as others do not enjoy being in their company), being single or divorced (married people live longer), and lack of religious commitment (those who attend religious services live longer than those who do not).

Our bodies have two physiologic responses to stress, the acute response and the chronic response. The acute response is mediated via increased levels of adrenaline or epinephrine and noradrenaline or norepinephrine. It is part of the “fight or flight” reaction and can be very helpful when one is in real danger. It is not helpful if it is triggered by unreal or extremely unlikely events—like a terrorist's attack. As Franklin D. Roosevelt said the last time our nation was severely threatened, “The only thing we have to fear is fear itself.”

The chronic response to stress is thought to be mediated via increased levels of systemic cortisols and decreased levels of serotonin in the brain. It is characterized by a persistent feeling of hopelessness—a sense of being trapped and helpless to get what one really wants out of life. Chronic stress can lead to destructive behavior, such as smoking, excess alcohol, and the use of addictive drugs. Both acute and chronic stress can have other unwanted effects, like increasing one's cholesterol and blood pressure.

Is stress always bad? Some stress can be helpful, such as when it results in appropriate behavior—getting an assignment done, getting to a meeting on time, etc. As Donald Tubesings, co-author of “Seeking Your Healthy Balance,” wrote: “Finding the right amount of stress is like adjusting the strings of a violin.” A certain amount of tension is necessary to make beautiful music, but too much tension and the string breaks. Implicit in the idea that stress is not an event but our reaction to the event is the fact that you have a choice in how you react to stress.
To deal with stress, several steps are necessary: recognition that you are stressed; identifying the sources of stress; and determining the elements that are in your control, i.e. the resources available to help in the solution, possible solutions and selection of acceptable and accessible solutions. At times professional help and medications are advisable. But most of the time, each person finds his or her own way of dealing with stress.

During difficult times in our lives, if my wife or I brought up some new problem beyond our control the other would say, “I refuse to take on that worry,” and we would laugh and go on with our lives. It really seemed to help by keeping the worry outside of our minds. We also learned some time ago the value of prayer and do this regularly together. At times our prayers include the spirit of “The Serenity Prayer” by Reinhold Nieburh, which asks God to grant us the courage to change the things we can, the serenity to accept the things we cannot change and the wisdom to know the difference. Another way of decreasing stress is exercise. Ken Cooper, MD, the “Father of Aerobics,” tells of the man who was so depressed that he decided to kill himself by running until he dropped dead. The first evening he ran until he could run no more and finally had to nearly crawl home. Determined, the man tried again and again, until finally he began feeling so much better his depression was cured and he continued running for his mental health. Other ways of dealing with stress include family connections, hobbies, having listening and supportive friends or organizations and volunteer activities. When asked how one should deal with depression, noted American psychiatrist Karl Menninger responded: “Go across the tracks and help someone less fortunate than you.” Controlling stress can make you less vulnerable to a wide range of problems … from heartaches to heart attacks!