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Journalism of Courage
Just when we are in the middle of conversations on the increasing trend of heart attack deaths among the young, there’s news of Breaking Bad actor Mike Batayeh passing off in his sleep because of a silent heart attack at 52. The latest series of deaths among apparently fit and disciplined people has raised questions about the one factor that we toss about casually but do not address seriously. It’s called stress. And if that is a big determinant of heart health, then we must prioritise its antidote. That’s called self-care.
“Your body has a natural mechanism to respond to stress in emergency situations, what we call the fight and flight response. That’s the time you experience rapid heartbeats and goosebumps. This is supposed to protect you while dealing with the crisis at hand. But if it’s constantly pressed into action, it can harm you. Hormones like cortisol and adrenaline are released in response to stress. Studies show that high levels of cortisol in the body from long-term stress can increase blood cholesterol, triglycerides, blood sugar and blood pressure. Worryingly stress can also cause changes in arterial plaque that sometimes comes off causing clots and making the blood stickier. So too many of these stress hormones can damage the heart and lead to body wear and tear,” says Dr Pravin Kahale, Consultant, Cardiology, Kokilaben Dhirubhai Ambani Hospital Mumbai.
WHY YOU CAN HAVE STRESS WITH NORMAL BP
Dr Kahale sees many patients in his clinic complaining of anxiety despite having a history of normal blood pressure. “Yet at the moment of complaint, their BP is elevated. The first question I ask them is if they have had a good night’s sleep. Nobody can ignore some sort of stress in today’s competitive world and the need to fulfil expectations. The question is what is your coping mechanism? Stress can even build up from physical causes like not getting enough sleep after a packed day. So try to control your sleep patterns at least,” says he.
Lack of rest and sleep is another compounding factor that increases stress levels in our hyperactive lives. “You may have a disciplined gym routine, eat the right food and claim to be taking care of your lifestyle markers. And just because your figures show up great in a clinical report, you think your body can take on anything. So, you party late, maybe binge-eat or drink and without sleeping much, show up at the gym the next morning to wear the calories out. So even a routine gym workout can be a trigger one fine morning because it comes after many days of a rushed, hectic routine and poor sleep. That’s how the body and mental stress catch up silently,” explains Dr Kahale. Sometimes people choose unhealthy ways like smoking frequently to deal with stress.
WHY WE NEED TO WATCH OUR EVERYDAY ROUTINES AND MAKE TIME FOR WINDING DOWN
Dr Pradeep Haranahalli, Consultant, Interventional Cardiologist, Manipal Hospital, Bengaluru, finds most of his patients fail to understand the need of winding down daily and think a mini-break can take care of their ills. “The daily pace of work stress matters. Many were surprised by the recent death of a cardiologist in Jamnagar at 41. In fact, recent data suggests that increased cardiovascular risk factors and heart attacks among physicians are at par with those from the general population. Even though they have knowledge of health and risk factors, the corresponding attitude to take corrective actions or corrective measures was missing among doctors, as per the study. The other factors contributing to the increased risk of heart attacks among healthcare professionals are self-sacrificing attitude, shift work, increased workload, stress of work when someone’s life is in your hands, sedentary lifestyle, obesity, and lack of time for personal care. These pretty much summarise the life of any modern day professional,” he says.
WHAT STUDIES SAY
Spikes in the stress hormone cortisol can lead to heart attacks and strokes even when people don’t have other risk factors for these cardiovascular events, such as high blood pressure, smoking, or a sedentary lifestyle, according to a study published in September 2021 in Hypertension.
The study focused on 412 adults without hypertension or cardiovascular disease who had urine tests for levels of four stress hormones, namely norepinephrine, epinephrine, dopamine and cortisol. As the levels of hormones doubled up in urine tests of subjects, their risk of developing hypertension rose by 21 to 31 per cent over a median follow-up period of 6.5 years. Over 11.2 years, about 5.8 per cent of the people in the study experienced cardiovascular disease events like heart attacks and strokes. The risk of these events climbed by 90 percent with doubling of cortisol levels in the urine tests regardless of whether or not people had other risk factors, like hypertension, smoking, obesity, diabetes, or being physically inactive. The correlation of two hormones, cortisol and dopamine, with hypertension was stronger for younger adults than for people 60 years and older, the study found. Previous studies have also linked work and personal stress to an elevated risk of both hypertension and cardiovascular disease events.
In 2019, a study in the BMJ, which followed 136,637 people diagnosed with a wide range of stress disorders for 27 years, found that 10.5 test cases in 1,000 got diagnosed with high blood pressure or events like heart attacks and strokes. That compared with 6.9 cases for every 1,000 people without stress disorders.
PRIORITISE SELF CARE
Both doctors say that corrective measures should now include making time for self-care with as much discipline as going to the gym. “Along with diet, sleep and exercise, people need to assess their work-life balance. And do not think that you can take things in your stride. You need to let your body and mind rest and build fruitful interpersonal relationships which can hold you together,” adds Dr Kahale.
