How chronic stress could affect heart health

Stress affects each person differently, but everyone experiences it at some point in their lives. Stress can be your reaction to situations in life, such as a new job, new responsibilities, or perhaps financial difficulties.

Sometimes emotional stress can be positive, like the stress that pushes you to pass an exam or meet a looming deadline. Other times, it can be harmful—especially if it's longstanding stressful situations like a demanding work environment or family situations. It's this chronic stress that can most be harmful to your health. Why? It has to do with how your body physically responds to stress.

When you are under stress, the body activates what's called the "fight or flight" response. Part of this response is the release of cortisol, also known as the stress hormone. When fight or flight is activated, the brain triggers the release of cortisol from the adrenal glands. Cortisol circulates throughout the body and affects many different processes, including the immune, digestive, and cardiovascular systems. Cortisol also raises your blood glucose levels.

The cortisol response is meant to be a short-term reaction to acute stress. When you have chronic stress, sometimes the body has a hard time going back to normal, and the fight or flight response continues. This chronic reaction to stress can lead to health problems like high blood pressure and increased heart rate, both of which cause the heart to work harder and raise the risk of heart disease. Chronic stress may also contribute to other health problems, including: 

• Decreased ability to fight off infections

• Digestive issues like an upset stomach and heartburn

• Trouble sleeping

• Decreased sex drive

• Decreased overall mental health

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Although more research is needed to explain the link between stress and cardiovascular disease definitively, several studies have shown that stress may affect heart health.

One study looked at over 11,000 cases of people who suffered their first heart attack to see what risk factors played a role (Rosengren, 2004). The researchers found that stressful life events (like a divorce, major illness, or death of a loved one) occurred more often in the prior year among the people with heart attacks than among those who did not have a heart attack. This indicates that psychological stress may increase the risk of heart attacks.

More research suggests that there is a link between stress and atherosclerosis, a significant risk factor for heart disease. Atherosclerosis is the build-up of plaques in the walls of the blood vessels that feed the heart. As the plaques get thicker, they can either rupture (leading to a heart attack) or cause progressive narrowing of the blood vessels, eventually causing coronary artery disease. Another study looked at over 17,000 female health professionals and found that women whose work is very stressful have a 40% increased risk of heart disease, including coronary artery disease and heart attacks, than those who worked in less stressful situations (Slopin, 2012).

Lastly, research by Harvard Medical School looked at medical residents working in the intensive care unit, which is generally a stressful rotation during residency. Researchers measured their white blood cell count (a marker of inflammation) during the rotation. Compared to when residents were off duty, their white blood cell counts were higher during the stressful rotation. Inflammation and white blood cells contribute to the development of atherosclerosis and heart disease, suggesting that stress may also increase the risk of cardiovascular disease (Heidt, 2014). 

There are several theories to explain how stress may affect heart health. Activation of the fight or flight response (also called the sympathetic nervous system) involves an increase in blood pressure and heart rate. Both of these factors have been implicated in heart disease. When your blood pressure and heart rate increases, your heart has to work harder to get the oxygen it needs. This puts strain on the heart, which can lead to further problems. The long-term stimulation of the sympathetic nervous system from chronic stress may also increase the risk of developing an abnormal heartbeat rhythm, which can be life-threatening. 

Another way stress can impact heart health is how we respond to it. Many people respond to stress with unhealthy habits—like overeating, increased alcohol or drug use, or lack of exercise—that actually increase the risk of heart disease. These behaviors can cause high blood pressure, high cholesterol, and increase your overall risk of heart disease, according to the American Heart Association (AHA, 2014).

It is almost impossible to live a stress-free life. However, there are many tactics you can take to help with stress management. For example, focus on aspects of your life that you can control and change—this has been found to minimize stress. Other recommended methods for coping with stress include (NIMH, n.d.): 

• Increase your physical activity

• Eat a healthy diet

• Try a relaxing activity like meditation, yoga, and breathing exercises

• Identify the aspects of your life that are under your control, like what you need to do now and what can wait. Learn to say no if you feel like there is too much on your plate

• Schedule time for yourself, to participate in a hobby, curl up with a good book, or just focus on yourself for a bit

• Have a support system: friends, family, community, religious organization, and others can be a source of help and support when you are feeling stressed

• Get professional help if you feel that you cannot manage your chronic stress on your own

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

January 15, 2021

Written by

Chimene Richa, MD

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.