There has been longstanding knowledge that stress can lead to cardiovascular disease. Although this is a known fact, it may not seem truly plausible until it affects someone you know. One night in college, I was up late studying for a test when I got a call from my dad. He informed me that my mom had experienced an aortic aneurism. Thankfully, it was relatively minor, they placed a stint and she was fine! As I learn more about the causes and effects of stress I think about what could have caused this scary event to occur. Although high blood pressure runs in our family, which was likely the major contributor, it was also a stressful period of time in her life. Sapolsky (2004) helped me to understand the significant role that this stress might have played in her cardiovascular event. Continual activation of the stress response can lead to chronically elevated blood pressure, or hypertension. Chronic elevation in blood pressure leads to increased need for muscle to control the flow of blood through your blood vessels. This causes vascular resistance, where the vessels become more rigid and resistant to blood flow. Blood pressure is now even higher, which can lead to damage of blood vessels and potentially lead to an aneurism. Thus, as my mom was under chronic stress, and was already prone to hypertension, the combination of these two could have been fatal…I am very thankful it was not! As I learned, stress can damage the inner lining of blood vessels, but additionally our body’s attempt to repair this damage can also lead to detrimental effects, such as atherosclerosis. Though the plaque buildup in atherosclerosis is mostly from mobilization of fat stores in the body, when in combination with poor diet (high fat/cholesterol) this could exacerbate CVD risk. As such, when these two factors of chronic stress and poor health behaviors are combined the effects synergize and elevate risk for CVD. It seems to be a viscous cycle where when we are under periods of high stress we neglect to take care of our bodies, when doing so could save us from detrimental health outcomes. Thankfully, my mom maintains a healthy diet, so she could check that risk factor off the list.
So what might make you more prone to developing stress induced CVD? Turns out that it may partly be due to your personality and how you approach everyday encounters. In a large prospective study, Newman et al. (2011) found that observed, or displayed acts of hostility were associated with a doubled risk of incident heart disease as compared to no hostility. My mom is not a hostile person, and does not generally exhibit aggressive behavior or anger towards others. As Newman and colleagues (2011) discussed, it could be that the presence of hostility increases CVD risk, regardless of severity. This idea was highlighted in the fact that any observed degree of hostility increased CVD risk, whereas no observed hostility did not and could serve a protective effect. However, as Whooley & Wong (2011) note, although hostility was predictive of CVD, since hostility is also associated with poor health behaviors such as physical inactivity or poor diet we cannot determine true cause and effect. However, regardless of whether hostility on its own causes increased risk of CVD, if it also has potential to increase unhealthy behaviors that too cause increased risk of CVD then this seems bad enough regardless of whether a true cause and effect relationship exists.
I have discussed what factors could have increased my mom’s risk of CVD, but what could have reduced it? My mom is generally a happy person, with high positive emotionality, which has been associated with lower risk for a variety of diseases. Interestingly, recent work from Tuck and colleague (2017) discovered that not only does trait positive affect reduce risk of CVD, but one’s ability to express positive emotions does as well…good thing my mom is an expressive person! I also wonder whether ability to deliberately express positive emotion is related to an individual’s emotion regulation tendencies? Or even whether cued ability to express positive emotion could be a form of emotional regulation as it may promote social interaction and support from others. Although this particular study did not measure one’s positive expressive ability during an acute stressor, could the ability to do so facilitate resilience, which may also contribute to reduced CVD risk? To be determined!
Newman, J.D., Davidson, K.W., Shaffer, J.A., Schwartz, J.E., Chaplin, W., Kirkland, S., & Shimbo, D. (2011). Observed hostility and the risk of incident ischemic heart disease. Journal of the American College of Cardiology, 58(12), 1222-8.
Sapolsky, R.M. (2004) Why zebras don’t get ulcers: A guide to stress, stress related diseases, and coping. New York: W.H. Freeman.
Tuck, N.L., Adams, K.S., Pressman, S.D., & Consedine, N.S. (2017) Greater ability to express positive emotion is associated with lower projected cardiovascular disease risk. J Behav Med.
Whooley, M.A., & Wong, J. (2011). Hostility and cardiovascular disease. Journal of the American College of Cardiology, 58(12), 1229-30.