Holistic Approaches to Heart Health: Stress Management

By Nicole L. Hatcher, DHS(c), MPAS, PA-C
Adjunct Professor, Kaplan University School of Health Sciences

Are you overwhelmed at school or work? Does the economic downturn have you stressed? Do you worry about the possibility of layoffs and home foreclosures? If the answer to any of these questions is yes, you aren’t alone. In 2009, the American Psychological Association (APA) conducted a nationwide online survey to determine stress levels in the United States and explore its impact on Americans. Nearly a quarter of Americans reported having high stress levels in the previous month and more than 42 percent of people reported that their stress had increased in the previous year. The top three stressors identified were money, work, and the economy.1

Stress has long been perceived as negative, but not all of it is bad for you. Actually, it is proven that low levels of intermittent stress can give you an energy boost, sharpen your senses, and improve memory as a result of the production and release of adrenaline and other hormones within the body. However, chronic, unrelenting stress can certainly impact you in ways that you may not be aware of. There is increasing evidence to suggest that stress can negatively affect heart health. Emotional stress activates many of the same physiologic pathways that are associated with inflammation, blood loss, infection, and trauma.2 These pathways can affect the heart acutely by precipitating heart failure, a heart attack, or an abnormal rhythm, or chronically by speeding up the formation of plaque in the coronary arteries. Major life changes along with the mental and emotional stress that are associated with them increase cardiac risk similar to traditional risk factors such as smoking, obesity, or hypertension.2

Americans are increasingly aware that stress is bad for them and agree that lower stress levels typically equate to good health.1 Unfortunately, in spite of growing awareness of the negative consequences of stress, Americans continue to participate in sedentary and sometimes unhealthy activities to alleviate their stress. Forty-four percent of Americans reported eating too much or eating unhealthy foods to cope with stress. Listening to music, reading, and watching television also ranked high on the list of stress relief activities.1

Believe it or not, for many people, stress has become a way of life. One of the greatest myths about stress is that you can’t do anything about it. For those who are affected by chronic stress, it is important to make lifestyle changes that will reduce the potential for an unhealthy heart. A study published in 2002 examined the effects of stress management on patients with established heart disease and evidence of mental stress induced ischemia. A total of 136 men were randomly assigned to 4 months of aerobic exercise 3 times per week or to a 1.5 hour weekly class on stress management in addition to their usual medical care. Follow up was performed at the completion of the treatment and then annually for a total of 5 years. The study concluded that stress management significantly reduces cardiac events as compared to usual care and exercise alone.3 The results suggest that effective stress management can positively impact heart health.

There are many ways to take the reins and get a handle on the stress that is weighing you down. It may very well save your life. The American Psychological Association recommends the following practical tips for managing chronic stress:4, 5

  • Learn your stress signals
    • Difficulty concentrating
    • Difficulty making decisions
    • Anger
    • Irritability or lack of control
    • Headaches
    • Muscle tension
    • Lack of energy
  • Determine if you handle stress in an unhealthy manner
    • Overeating
    • Smoking
    • Consuming alcohol
    • Inactivity/sedentary lifestyle
  • Find healthy ways to handle stress
    • Read
    • Get active/exercise
    • Meditate
    • Yoga
    • Talk with family and friends
  • Enhance your sleep quality
    • 7-8 hours of uninterrupted sleep
    • Minimize distractions at bedtime
    • Take a soothing bath
    • Avoid exercising or consuming large meals immediately before bedtime
  • Strive for a positive outlook
    • Don’t attempt to be perfect
    • Set realistic expectations and limits
    • See problems as opportunities for improvement
  • Seek additional help
    • Talk to your medical provider
    • See a psychologist or professional counselor


1. American Psychological Association (APA), Stress in America: 2009. Retrieved from http://www.apa.org/news/press/releases/stress-exec-summary.pdf.
2. D.J. Brotman, S.H. Golden, and I.S. Wittstein, “The cardiovascular Toll of Stress,” The Lancet, 370 (2007): 1089-1100.
3. J.A. Blumenthal et al.,”Usefulness of Psychosocial Treatment of Mental Stress-Induced Myocardial Ischemia,” American Journal of Cardiology 89 (2002): 164-168.
4. American Psychological Association (APA), “Stress won’t go away? Maybe you are suffering from chronic stress.” Retrieved from http://www.apa.org/helpcenter/chronic-stress.aspx
5. American Psychological Association (APA), “Stress Tip Sheet.” Retrieved from http://www.apa.org/helpcenter/stress-tips.aspx

C:\Documents and Settings\labinder\Local Settings\Temporary Internet Files\Content.Outlook\ZKT84ECI\dyer_prof_2009.jpgNicole Hatcher, DHS(c), MPAS, PA-C

Dr. Nicole Hatcher is an adjunct professor at Kaplan University’s School of Health Sciences and teaches the course Models of Health and Wellness. In addition, she works full-time as a physician assistant in cardiology in Norfolk, Virginia. Dr. Hatcher received a Bachelor of Science in Physician Assistant Studies from Howard University and a Master of Advanced Physician Assistant Studies from Oregon Health & Science University. She holds a Doctor of Health Science degree from Nova Southeastern University.

Kaplan Higher Education Corporation is a division of Kaplan, Inc., a subsidiary of The Washington Post Company.

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