A new study conducted in Sweden has found that stress-related disorders are associated with an increased risk for multiple types of cardiovascular disease. The research, which is entitled Stress related disorders and risk of cardiovascular disease: population based, sibling-controlled cohort study was published on 10th April 2019 in the British Medical Journal (BMJ).
The authors report that the association was independent of family background, history of somatic/psychiatric diseases, and psychiatric comorbidity.
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For the study, Unnur A Valdimarsdóttir (University of Iceland) and colleagues used data available from the Swedish National Patient Register to compare individuals diagnosed with stress-related disorders between 1987 and 2013 with their unaffected siblings and matched individuals from the general population.
The team identified 136,637 individuals with stress-related disorders including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions; 171,314 siblings without any stress disorders and 1,366 370 matched controls.
All participants were followed for up to 27 years for the incidence of cardiovascular disease including ischaemic heart disease, cerebrovascular disease, thrombosis, hypertension, heart failure, arrhythmia and fatal cardiovascular disease.
During the first year of follow-up, people with stress-related disorders had significantly higher rates of cardiovascular disease compared with their siblings: 8.1 versus 4.9 events per 1000 person-years. When compared to the general population, people with stress-related disorders had, on average, 8.5 events versus 4.3 per 1000 person-years.
In the sibling-based comparisons, the greatest increase in risk was seen for heart failure during the first year after the diagnosis of any stress-related disorder.
“We saw [about] a 60 percent increased risk of having any cardiovascular events,” says Valdimarsdóttir, who adds that this figure fell to around 30% in the longer term.
Lifestyle and chronic disease expert, Simon Bacon, from Concordia University, says the findings “are quite consistent with other studies,” also suggesting that stress, anxiety and depression all increase the risk of cardiovascular events.
Bacon says that everybody experiences the fight-or-flight response, where the heart rate increases and blood pressure rises when we experience a scare, for example.
“You have that immediate activation,” which Bacon says is good in the short-term as it enables people to flee or take action when they need to. However, problems begin if a person starts to experience these stress response “activations” in the absence of any such threat.
“When people have stress disorders, these systems are being activated at all the wrong times,” he explains. Taking PTSD as an example, he adds “you can get very exaggerated stress responses just thinking about something that happened.”
Professor of Medicine at McGill University, Dr Ernesto Schiffrin, says repeated and persistent stress responses occurring over the long term activate the immune system and cause inflammation, which can set the stage for atherosclerosis (narrowing of the arteries).
When arteries narrow, blood flow becomes restricted, which increases the risk of cardiovascular events such as heart attack and stroke.
Reducing the risk of stress-related illness
Schriffin advises that people follow a healthy diet, attempt to have good relationships, have a good attitude, spend time in nature, and exercise: “I think exercise is critical,” he concludes.
Surrounding yourself with people that you enjoy spending time with, whilst also making time for activities such as meditation, can be instrumental in reducing stress and preventing the onset of stress-related disorders.
If you are struggling with mental health issues, help is available. A list of useful organizations in the UK can be found here and NAMI, the USA national alliance on mental illness can be accessed by clicking here.