To what extent is emotional stress repsonsible for coronary thromboses?

I see Ken Lay just died of a cornary. I imagine he was experiencing a good deal of emotional stress in the past few years, given what he has at least been convicted of doing. Is there any good evidence that such pressure raises the odds of having such a heart attack? I know what the street says. I’m wondering what the data say. Qagdop? Any decent researchers? I can’t find anything direct. xo, C.

A quick Google Scholar search turns up several reviews that purport to conclude that the evidence supports several psychosocial variables as risk factors for hear disease. I have not reviewed the reviews. The following is available FREE at the journal’s web site: Rozanski A, Blumenthal JA, Kaplan J.Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999;99:2192-217.

An excerpt of the abstract follows:
“Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress.”

“The importance of maximizing the efficacy of behavioral interventions is underscored by the
recognition that psychosocial stresses tend to cluster together. When they do so, the resultant risk for cardiac events is often substantially elevated, equaling that associated with previously established risk factors for CAD, such as hypertension and hypercholesterolemia.”

For mechanisms, look here for an interesting little study (and quite recent too) (Alas, you need a subscription for the full text).

For more proof of the phenonmenon, look here andhere.

If it’s not too late, I don’t know how I forgot this very recent and important paper from The Lancet which demonstrated the potent effect of “stress” in the genesis of myocardial infarction (i.e. heart attacks).

Don’t know that I’d call any of the citations “proof” per se, but you’ve provided some nice references. Nicely done. Thanks. (The one from Toronto requires registration, by the way,a nd I couldn’t get into it. ) The most recent one, the Lancet study, is a nice large one and gives some good indication that emotional condition is, indeed, correlated with heart attacks, and probably contributes to them. It’s curious that there is not more data on that topic, or that there is not more that is readily available. Since it’s common wisdom that “stress can cause a heart attack,” I would imagine that there would be a good bit of research either supporting such an assertion or contending it.

Apologies in advance for the fact that I don’t have any hard evidence or cites to supply… this year I’ve had a couple of interesting conversations with qualified medical people. One was a woman who had worked for over 25 years helping women with breast cancer. The other was an America ‘family doctor’ (what we in the UK would call a General Practitioner or GP). Both told me that, in general terms (looking at the population as a whole) the single biggest cause of ill-health was stress. More than genetic factors, diet or lifestyle. The breast cancer specialist said she didn’t even need to think about the question - she was 100% positive that stress, more than anything else, was the most significant contributory factor, and everything she knew from her 25 years + experience (she said) backed this up.

I freely admit that I have no medical training or qualifications whatsoever. However, I wasn’t at all surprised to hear what these two doctors had to say. And I also wouldn’t be the least bit surprised to learn that it applied to heart attacks as to any other kind of health problem.

Very interesting post. Particularly in light of several conversations I have had with my brother-in-law over the years. He’s a brilliant diagnostician - internist. Was for several years chief of medicine at a hospital on Chicago’s west side. He has claimed for many years that, bar none, the single leading cause of ill health was overweight and obesity. Claimed that more than anything else, it was the primary contributory factor to most of the illnesses that he saw. I don’t think he would have necessarily pointed to breast cancer as one of those, although I don’t know for sure. Still, it’s interesting that he had such a different view and such a similar sense of security about his view. xo, C.

I agree it’s interesting to compare different views, especially from people with relevant medical experience and qualifications, and I was fascinated by your post. I just want to add one point - some people might take the view that stress is the root cause of over-eating and obesity… ie they would see over-eating as more of a symptom or a consequence of some other underlying cause rather than seeing it as a cause of ill-health in and of itself. This is probably a simplistic view, but it’s one that I (in my medical ignorance and not claiming any special knowledge whatsoever) have some sympathy with. I think that stress is, or can be, the underlying cause of many, many diseases, disorders and problems that people have to deal with.

One of the difficulties is defining “stress”, then quantifying it. Some people seem to define “stress” as “any adverse event that happens to me,” which is how other people define “eh, it’s life”. Some define “stress” as “major surgery”. Most have a definition in between, but “it’s really stressful” means “a subjective sense of distress resulting from life events”. And subjective things that vary from person to person are remarkably difficult to test. Pain has been a problem for this exact reason. We all know what it is, we all know when we feel it, but it varies tremendously person to person, and quantifying what relieves it has been a thorny tangle. Stress is worse b ecause we don’t all agree when we feel it… or to what degree.

If you think about it as an armchair experiment, it is remarkably difficult to quantify “stress” such that you can say “for a man of age 40 to 50, without previous disease, this would be stress of A level, B level, C level, D,” without which, you can’t say “is it associated with heart attacks”.

I think myself perhaps people could study the acute phase reactants (molecules in the blood that the body responds with when people are distressed, hurt, or starting to get sick) and see if those correlate with heart attacks. Think some of this research is going on already - there are very many acute phase reactants, though. And the fact that the acute phase reactants go up when you get ill from non-stress disease would really throw a wrench in the works.

I am not a whiz at experimental design. KarlGauss, any thoughts on how we would design an experiment to define and correlate stress with MIs?

I don’t know if Hans Selye was the first to suggest that stress is a self-perceived phenomenon, but clearly, something is only stressful if it has an effect on the individual. That’s why in most of the studies cited, stress was measured by self-reports, I assume. One cannot identify stress on an individual from the outside, unless one can identify the response to that stress. The stress, per se, is not stress until it creates some sort of reaction, I would say. Just as a stimulus is not a stimulus without a response. Or, maybe better, a cause is not a cause without an effect. Thus, stress is best identified by the subject.