Does Stress Cause Heart Disease?

Why the challenges we face in life can impact our risk of heart disease.

Does stress cause heart disease?

The short answer is ‘Yes’.

But if you want to know why and what you can do about it, you should read the rest of this article.

First, let’s define some terms.

Stress is the collective response (biochemically, cognitively, etc.) to the adversity you face in life.

When adversity is a challenge you take on willingly (e.g., Competitive Sport), it can prompt you to rise to the occasion and perform at your best.

When adversity is set upon you unwillingly, and you lack the necessary skills to address the situation (e.g., a Natural disaster), it can result in a rapid drop in performance and a high level of perceived distress.

If you reflect on the most remarkable things you have ever done or are most proud of, I can guarantee you it was likely stressful.

When you rise to the level of the situation and perform at your best, these are often the times of your life you look back on with the most pride.

Stress, then, is not inherently bad.

It is our maladaptive response to it that causes most of the problems, particularly in situations where we have little to no control over the adversity that has caused it.

This is particularly true when it is chronic stress.

As humans, we are designed to perform at our best when the occasional Sabre-Tooth tiger jumps out of the bushes.

But not the chronic low-grade stress that modern life tends to cause.

Twenty-five years ago, it took the assassination of a major political leader to constitute as ‘Breaking News’, now all it takes is an errand tweet of someone in the public eye.

Bring back the real emergencies, I say!

But What About Stress & Heart Disease?

The link is real.

For both acute and chronic stress.

When stress is included in the risk factor profile for a future heart attack, it comes in third on the list after abnormal cholesterol and smoking¹.

The challenge with those experiencing high levels of stress is that it also likely tracks with other poor health metrics.

While studies attempt to correct for these influences, it can be very hard to do.

Regardless of what is driving the effect, it is clear that experiencing high levels of stress is associated with worse outcomes.

If you take someone who has multiple risk factors for heart disease, including diabetes, smoking, abnormal cholesterol and high blood pressure, they have a 42 times higher risk of a heart attack compared to someone who does not have any of these factors.

No real surprise there.

But if you add psychosocial stress to that mix above, the risk goes from 42 times higher to 182 times higher.

So yes. Stress causes heart disease.

+PS = Psychosocial Stressors

But what constitutes ‘Psychosocial Stressors’?

In the study shown, people were asked to rank stress levels from low to high in 5 areas.

1. Work

2. Home

3. General

4. Financial

5. Stressful Life Events.

Those who had several periods of high work stress had a 38% increased risk of a heart attack compared to having no significant stressful work periods.

For those who felt permanent stress at work, that risk increased to 114%².

The same increases in risk were noted for those who had increased levels of stress at home and in general, with permanently high levels again associated with a 117% increased risk.

These findings have been replicated multiple times.

High levels of stress have been linked to:

• 30% increased risk of stroke.

• 24% increased risk of coronary artery disease.

• 17% increased risk of early death from any cause³.

Acute Stressors

While exposure to chronic stress is clearly linked to worse cardiovascular health, what about acutely stressful events?

The answer is yes, there is a relationship.

And pretty much every doctor can recall an event where a patient experienced a suddenly stressful event and had a cardiac event.

That event might have been a heart rhythm issue or even a cardiac arrest.

Sudden heart failure has been well described after the death of a loved one and is known as Takatubo Cardiomyopathy after the shape of a Japanese octopus fishing pot.

This is more commonly known as ‘Broken Heart Syndrome.

In the hours after the 911 attacks on the World Trade Centre in New York, the rates of cardiac arrest more than doubled.

Similar patterns have also been seen after major earthquakes and missile attacks in the Middle East⁴.

But it’s not just natural disasters and war that have been linked to a higher risk of events.

Watching the World Cup is associated with a two-fold increased risk of dying from heart disease.

Receiving a cancer diagnosis is associated with a more than five-fold increased risk of a cardiovascular event⁵.

But why does stress cause more cardiovascular events?

It is likely down to a number of factors, including⁶:

• Elevations in blood pressure & heart rate.

• Increased clotting.

• Immune activation

• Release of stress hormones.

Reducing Stress. Reducing Risk.

This is a tough problem to solve.

As it very much depends on the context and cause of what is driving the stress in your life.

In terms of reducing acutely stressful events, it is very hard to plan your life to ‘avoid major natural disasters’ for instance.

No one sets out on their day with the intent of getting caught up in a major terrorist attack.

Of course, if that is your intent, you have some other very serious issues to worry about.

The key is trying to understand where stress is an issue in your life.

Work?

Home?

Relationships?

Financial?

Often, we can feel overwhelmed by a tsunami of problems when, in fact, it is just one or two that really need our attention.

In my experience, even just starting to work on the problem or having the difficult conversation can make all the difference.

Structured therapies, including cognitive behavioural therapy and talk therapies, have been linked to significant improvements in cardiovascular risk, including⁷:

12% Reduction in cardiovascular events

19% Reduction in all-cause mortality.

There is no doubt that stress in its maladaptive form increases the risk of future heart disease.

The challenge is that increased stress levels can come in many forms, and addressing them is complex.

But if you feel that stress is an issue, there are things that can be done.

Usually, it is not a problem you solve on your own; it typically requires assistance from family, friends, colleagues, and health professionals.

We can never eliminate entirely the adversity we will face in life.

The flood will always come.

But we must make every effort to be prepared when it does.

And when we feel like we are drowning, we must reach out to those who can keep us afloat.

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When You Are Ready. Here Is How I Can Help.

If you are looking for a formula for optimal heart health.

All the right information that cuts through the noise.

All the right tests and what the results mean.

How to properly define your risk.

How to massively reduce your risk using a lifestyle-first approach.

Then the Heart Health Formula is what you need to understand the framework of prevention and work with your own doctor to put it in place.

Click here or on the image below for more information.

1. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 953-962

2. INTERHEART investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):953-62.

3. Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries. JAMA Netw Open. 2021;4(12):e2138920.

4. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc. 2019 Sep;94(9):1852-1864.

5. Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol. 2018 Apr;15(4):215-229

6. Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol. 2018 Apr;15(4):215-229.

7. Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England, European Heart Journal, Volume 44, Issue 18, 7 May 2023, Pages 1650–1662,