Young women with heart disease may take a harder hit from mental stress compared with their male counterparts, a new study suggests.
The researchers said the effects of psychological stress, which don’t show up on heart patients’ regular medical tests, may partly explain why women with heart disease are more likely to die from heart attacks than are men with heart disease.
“There’s a very interesting paradox concerning young women and chronic heart disease,” said study researcher Dr. Viola Vaccarino, chairwoman of cardiovascular research and epidemiology at Emory University’s School of Public Health in Atlanta, Georgia. “They have higher mortality and complication rates after heart attacks compared with men of the same age,” despite having fewer risk factors for heart disease, she said.
In the study, 534 patients with coronary heart disease ages 38 to 79 underwent a mental stress test, as well as a conventional physical stress test, while their hearts were being monitored.
For the mental stress test, the researchers asked the patients to give a speech in front of a small group of people about a real-life event that they found stressful. On another day, the patients ran on a treadmill, which is a standard test for assessing the heart’s health during physical stress.
The researchers looked at patients’ hearts to measure any reduction in blood flow to the heart muscle itself, which is a common problem in people with heart disease, and which can lead to heart attacks.
The Heart scans showed “dramatic differences” between men and women during the mental stress test, particularly in younger people, Vaccarino said.
When under mental stress, women ages 55 and younger showed a reduction in blood flow to the heart that was three times that of men of the same age, according to the study.
The difference between men and women was smaller among people ages 56 to 64, but still women in that group showed a greater reduction in blood flow to the heart during mental stress compared with men of the same age.
There were no gender differences in patients 65 and older, the researchers found.
During the physical stress tests, however, men and women didn’t show much difference in blood flow changes to the heart, according to the study, which was presented on Monday (Nov. 17) here at the meeting of the American Heart Association.
“Women who develop heart disease at a younger age make up a special, high-risk group because they are disproportionally vulnerable to emotional stress,” Vaccarino said.
People in their late 30s, 40s and early 50s generally face considerable levels of stress in daily life as they manage working, raising children and sometimes caring for their parents, Vaccarino said. They are also vulnerable to the effects of depression on the heart’s health, she said.
Physicians should be aware of the importance of psychological stress in young and middle-age women with heart disease, and “ask the questions about psychological stress that often don’t get asked,” Vaccarino said.
Women with high levels of stress could benefit from counseling, stress reduction techniques and getting more exercise, she said.
“Probably the most useful measure is to encourage patients to exercise regularly, because that’s a measure that has been shown clearly to improve mental health and at the same time also physical health,” Vaccarino said.
Stress is inevitable. It walks in and out of our lives on a regular basis. And it can easily walk all over us unless we take action. Fortunately, there are many things you can do to minimize and cope with stress. Here are 10 ideas for handling stress without causing more strain and hassle.
1. Figure out where the stress is coming from.
Oftentimes, when we’re stressed, it seems like a big mess with stressors appearing from every angle. We start to feel like we’re playing a game of dodge ball, ducking and darting so we don’t get smacked by a barrage of balls. We take a defensive position, and not a good one at that.
By getting specific and pinpointing the stressors in your life, you’re one step closer to getting organized and taking action.
2. Consider what you can control—and work on that.
While you can’t control what your boss does, what your in-laws say or the sour state of the economy, you can control how you react, how you accomplish work, how you spend your time and what you spend your money on.
The worst thing for stress is trying to take control over uncontrollable things. Because when you inevitably fail — since it’s beyond your control — you only get more stressed out and feel helpless. So after you’ve thought through what’s stressing you out, identify the stressors that you can control, and determine the best ways to take action.
Take the example of a work project. If the scope is stressing you out, talk it over with your supervisor or break the project down into step-wise tasks and deadlines.
Stress can be paralyzing. Doing what’s within your power moves you forward and is empowering and invigorating.
3. Do what you love.
It’s so much easier to manage pockets of stress when the rest of your life is filled with activities you love. Even if your job is stress central, you can find one hobby or two that enrich your world. What are you passionate about? If you’re not sure, experiment with a variety of activities to find something that’s especially meaningful and fulfilling.
4. Manage your time well.
One of the biggest stressors for many people is lack of time. Their to-do list expands, while time flies. How often have you wished for more hours in the day or heard others lament their lack of time? But you’ve got more time than you think as Laura Vanderkam writes in her aptly titled book, 168 Hours: You Have More Time Than You Think.
We all have the same 168 hours, and yet there are plenty of people who are dedicated parents and full-time employees and who get at least seven hours of sleep a night and lead fulfilling lives.
Here are Vanderkam’s seven steps to help you check off your to-do list and find time for the things you truly enjoy.
5. Create a toolbox of techniques.
One stress-shrinking strategy won’t work for all your problems. For instance, while deep breathing is helpful when you’re stuck in traffic or hanging at home, it might not rescue you during a business meeting.
Because stress is complex, “What we need is a toolbox that’s full of techniques that we can fit and choose for the stressor in the present moment,” said Richard Blonna, Ed.D, a nationally certified coach and counselor and author of Stress Less, Live More: How Acceptance & Commitment Therapy Can Help You Live a Busy Yet Balanced Life.
Here’s a list of additional techniques to help you build your toolbox.
6. Pick off the negotiables from your plate.
Review your daily and weekly activities to see what you can pick off your plate. As Vanderkam asks in her book: “Do your kids really love their extracurricular activities, or are they doing them to please you? Are you volunteering for too many causes, and so stealing time from the ones where you could make the most impact? Does your whole department really need to meet once per week or have that daily conference call?”
Blonna suggested asking these questions: “Do [my activities] mesh with my goals and values? Am I doing things that give my life meaning? Am I doing the right amount of things?”
Reducing your stack of negotiable tasks can greatly reduce your stress.
7. Are you leaving yourself extra vulnerable to stress?
Whether you perceive something as a stressor depends in part on your current state of mind and body. That is, as Blonna said, ““Each transaction we’re involved in takes place in a very specific context that’s affected by our health, sleep, psychoactive substances, whether we’ve had breakfast [that day] and [whether we’re] physically fit.”
So if you’re not getting sufficient sleep or physical activity during the week, you may be leaving yourself extra susceptible to stress. When you’re sleep-deprived, sedentary and filled to the brim with coffee, even the smallest stressors can have a huge impact.
8. Preserve good boundaries.
If you’re a people-pleaser like me, saying no feels like you’re abandoning someone, have become a terrible person or are throwing all civility out the window. But of course that couldn’t be further from the truth. Plus, those few seconds of discomfort are well worth avoiding the stress of taking on an extra activity or doing something that doesn’t contribute value to your life.
One thing I’ve noticed about productive, happy people is that they’re very protective of their time and having their boundaries crossed. But not to worry: Building boundaries is a skill you can learn. Here are some tips to help. And if you tend toward people-pleasing, these tips can help, too.
9. Realize there’s a difference between worrying and caring.
Sometimes, our mindset can boost stress, so a small issue mushrooms into a pile of problems. We continue worrying, somehow thinking that this is a productive — or at least inevitable — response to stress. But we mistake worry for action.
Clinical psychologist Chad LeJeune, Ph.D, talks about the idea of worrying versus caring in his book, The Worry Trap: How to Free Yourself from Worry and Anxiety Using Acceptance & Commitment Therapy. “Worrying is an attempt to exert control over the future by thinking about it,” whereas caring is taking action. “When we are caring for someone or something, we do the things that support or advance the best interests of the person or thing that we care about.”
LeJeune uses the simple example of houseplants. He writes: “If you are away from home for a week, you can worry about your houseplants every single day and still return home to find them brown and wilted. Worrying is not watering.”
Similarly, fretting about your finances does nothing but get you worked up (and likely prevent you from taking action). Caring about your finances, however, means creating a budget, paying bills on time, using coupons and reducing how often you dine out.
Just this small shift in mindset from worrying to caring can help you adjust your reaction to stress. To see this distinction between worrying and caring, LeJeune includes an activity where readers list responses for each one. For example:
Worrying about your health involves…
Caring about your health involves…
Worrying about your career involves…
Caring about your career involves…
10. Embrace mistakes—or at least don’t drown in perfectionism.
Another mindset that can exacerbate stress is perfectionism. Trying to be mistake-free and essentially spending your days walking on eggshells is exhausting and anxiety-provoking. Talk about putting pressure on yourself! And as we all know but tend to forget: Perfectionism is impossible and not human, anyway.
As researcher Brene Brown writes in her book The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are, “Perfectionism is not the same thing as striving to be your best. Perfectionism is not about healthy achievement and growth” and it’s not self-improvement.
Nothing good can come from perfectionism. Brown writes: “Research shows that perfectionism hampers success. In fact, it’s often the path to depression, anxiety, addiction and life-paralysis [‘all the opportunities we miss because we’re too afraid to put anything out in the world that could be imperfect’].”
Plus, mistake-mistaking can lead to growth. To overcome perfectionism, Brown suggests becoming more compassionate toward yourself. I couldn’t agree more.