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Mental Stress is a Factor That Contributes to Heart Disease Risk

By Dr. Eappen

Every day, scientists are learning more about how stress is a factor that contributes to heart disease risk. We have known for a long time that stress, especially chronic stress, is not good for us. But we’re just starting to understand the specific ways in which mental stress can harm our bodies. 

In particular, we know that stress can negatively affect our heart. Chronically elevated stress levels will lead to chronically elevated stress hormones (i.e., cortisol, norepinephrine, epinephrine). Over time, elevated stress hormones can be harmful to your health, especially your heart. Also, when you’re stressed, you’re less likely to sleep well, to exercise, and to make healthy food choices. All of these lifestyle changes can put your heart at risk.

And further, according to one study, mental stress is especially risky for some individuals who have coronary heart disease (CHD). CHD is a narrowing of the arteries supplying oxygen-rich blood to the heart.  Although more research needs to be done, this study underscores how important it is for all of us to be aware of the mental stressors in our lives and work to reduce their effects. Let’s consider the findings from the study and what conclusions can be drawn.

How Does Stress Affect the Heart?

The study had 918 participants (the mean age was 60 and 34% of the participants were women). Participants were asked to participate in two tests:

  • A standardized mental stress test (a public speaking task)
  • A conventional exercise stress test (i.e., the typical test you see on TV, where a person is hooked up to a machine while they run on a treadmill)

During the mental stress test, patients were given two minutes to prepare a speech and three minutes to deliver it in front of an audience of at least four people. Patients were told the audience would be evaluating their speeches. Their blood pressure and heart rate were monitored during the test.

During the physical stress test, patients were asked to jog on a treadmill for 20 minutes while their blood pressure and heart rate were monitored. For those who were unable to exercise, they received a pill to achieve similar results (a sort of pill-induced stress test).

By asking patients to complete these tests, researchers were interested in inducing myocardial ischemia (i.e., reduced or inadequate blood flow to the muscular wall of the heart). So how does stress affect the heart? Here are some findings

  • 147 (16%) of the 918 patients experienced reduced blood flow to their heart when they were asked to do the public speaking test (which is recognized in the field as a standardized method to induce mental stress in an individual).
  • 281 (31%) of the 918 patients experienced reduced blood flow to their heart when they had a conventional (exercise-based) stress test.  
  • 96 (10%) of the 918 patients experienced reduced blood flow to their heart during BOTH the mental stress and exercise stress tests.

Then they followed the patients for the next five years to determine whether these findings correlated with either death from a cardiovascular (heart-related) cause or a nonfatal heart attack. 


Among these patients with stable coronary heart disease (CHD), the presence of mental stress induced ischemia, compared to no mental stress-induced ischemia, was significantly associated with an increased risk of cardiovascular death or nonfatal heart attack over the next five years. In other words, a single mental stress event can negatively affect the hearts of many individuals with CHD; specifically, those who experienced reduced blood flow to their heart during the mental stress test in this study.

Here is some more specific data:  

  • Those who experienced reduced blood flow during BOTH the mental stress test and the conventional stress test were at the highest risk (8.1 per 100 patient year event rate)
  • Those who experienced reduced blood flow during the mental stress test alone saw the second highest risk (4.8 per 100 patient year event rate)
  • Those who experienced reduced blood flow during the conventional stress test alone saw the third highest and/or similar risk to the “no ischemia during both tests” group (3.1 per 100 patient year event rate)
  • Those who did not experience reduced blood flow during either test had the least risk (2.3 per 100 patient year event rate)

What does this study tell us about mental stress and the heart?

Although we can really only draw direct conclusions about a portion of those with coronary heart disease (CHD) from this study, it does reinforce the idea that mental stress can be just as much, if not more, of a health challenge than physical stress.

This study emphasizes, with the clearest evidence possible (i.e., nuclear imaging where you can actually see reduced blood flow to the heart), that mental stress can have an identifiable negative impact on your physical health. And consider that the heart events reported occurred after a single, five-minute mental stress test (two minutes to prepare the speech and three minutes to deliver it) that caused inadequate blood flow to the heart (in 16% of those tested). In other words, this was one brief test, examining the effects on one organ, during one snapshot of time. 

Now, imagine the varying diversity, frequency, duration, and severity of mental stressors that a person experiences throughout their lives, and what kind of impact those stressors may have, especially as they accumulate and especially as a person ages and becomes more frail, both physically and mentally.

Whether or not you have been diagnosed with CHD, this study should be a wake up call for how critical it is to not only build resilience so you can bounce back from the mental stressors in your life, but also do whatever you can to reduce close encounters with mental stress in your life.

Here’s what we know:

  • Stress is a factor that contributes to heart disease risk.This is just one study, but the results are powerful — just five minutes of mental stress can affect your heart.
  • When taking these findings into consideration, it’s also worth considering the effect of mental stress on physical health in general. The bottom line is if you want to live the longest, healthiest life possible, it’s worth looking beyond diet, exercise, and lowering your cholesterol. 
  • You should also take a hard look at the mental stressors you deal with and what you can do to minimize them (e.g., individual or family counseling, yoga, massage, extra sleep, relaxation or deep breathing exercises, more time off, more time with family, switching to a less stressful job, passing on that promotion, etc.). 
  • Reducing mental stress can improve your physical health as much as your mental health.
  • If you have coronary heart disease (CHD), stress management training, and treatment of anxiety/depressive disorders or any disorders that make you more susceptible to mental stress, are just as valuable as managing your diet, obtaining adequate aerobic exercise, and managing your blood pressure or cholesterol with medication. 

Every day, scientists are learning more about how our mental health affects our physical health. But we don’t need another study to tell us that avoiding mental stress is good for us. The only question left is what are you going to do to take better care of yourself so you can be there for your family?

Concerned about your mental stress levels? Contact our friendly team and make an appointment to talk. We are here to help you make the best decisions for your overall health.

About the Author

Seth Eappen, MD, is a board-certified adult, child and adolescent psychiatrist. Dr. Eappen completed medical school at the University of Illinois at Chicago and a residency at the University of Michigan, Ann Arbor. He completed his child psychiatry fellowship at MUSC in Charleston, SC, where he served as chief fellow. He is the founder of the Eappen Clinic, a private outpatient mental health practice with locations in Chicago and Oak Brook, IL.