Stress and Heart Disease

stressed woman working at laptop in her dining room in the evening
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For years it has been “common knowledge” that people who are under a lot of stress have an increased risk of heart disease. But is this common knowledge correct? And if so, what kinds of stress increase your risk of heart disease, how does it increase your risk, and what can you do about it?

At least three things have made it difficult to sort out the effects of stress on the heart:

  1. People mean different things by “stress.”
  1. Some types of stress appear to be worse for the heart than others.
  2. How you respond to stress may be more important than the stress itself.

In recent years we have learned a lot about stress and heart disease. This brief review will help you learn what you need to know about it.

What Do People Mean When They Say Stress Causes Heart Disease?

When people refer to “stress,” they are often talking about two different things: physical stress, or emotional stress. Medical scientists who write about stress and the heart are often talking about physical stress. When cardiologists want to perform a “stress test,” they put you on a treadmill; they don’t falsely inform you that your dog has died.

But when most of us talk about stress and the heart, we are usually referring to the emotional variety.

Physical Stress and the Heart

Physical stress — exercise or other forms of physical exertion — places measurable and reproducible demands on the heart.

This physical stress is generally acknowledged to be good. In fact, the lack of physical stress (i.e., a sedentary lifestyle) constitutes a major risk factor for coronary artery disease. So this kind of “stress” is usually considered to be beneficial to the heart.

If you have significant underlying heart disease, however, too much physical stress can be potentially dangerous.

In a person who has coronary artery disease, exercise that is too intense can place demands on the heart muscle that the diseased coronary arteries cannot meet, and the heart becomes ischemic (i.e., starved for oxygen.) The ischemic heart muscle can cause either angina (chest pain), or a heart attack (actual death of cardiac muscle).

So physical stress — that is, exercise — is generally very good for you, and is generally to be encouraged (with appropriate precautions, if you have heart disease). And unless the exercise is extraordinarily excessive, physical stress does not actually cause heart disease.

Emotional Stress and the Heart

Emotional stress is generally the kind of stress people are talking about when they say that stress causes heart disease. “It’s no wonder she died,” you’ll hear people say, “with all the trouble he put her through.” But is it true? Did Ed really kill Elsie with all his gambling and drinking and staying out all hours of the night?

Everyone — even doctors — have the notion that emotional stress, if it is severe enough or chronic enough, is bad for you. Most even believe that this kind of stress can cause heart disease. But scientific evidence that it actually does so has been hard to come by.

Recently, however, enough evidence has accumulated to be able to say that certain kinds of emotional stress, in certain people and under certain circumstances, appears to contribute to heart disease. Under the right (or rather, wrong) circumstances, emotional stress may contribute to the development of chronic heart disease, or can help precipitate acute cardiac problems in people who already have heart disease.

It is important to realize, however, that not all emotional stress is the same, and not all of it is bad for us. Often, it is our response to the stress, rather than the stress itself, that causes problems.

The mechanisms by which emotional stress can contribute to heart disease are only now being elucidated.

Because it is impossible to avoid all emotional stress — not to mention undesirable — it is important for us to learn how to handle this stress to lessen its impact on our cardiovascular systems.


Denollet, J, Brutsaert, DL. Reducing emotional distress improves prognosis in coronary heart disease: 9-year mortality in a clinical trial of rehabilitation. Circulation 2001; 104:2018.

Rozanski, A, Bairey, CN, Krantz, DS, et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med 1988; 318:1005.

Shen BJ, Avivi YE, Todaro JF, et al. Anxiety characteristics independently and prospectively predict myocardial infarction in men the unique contribution of anxiety among psychologic factors. J Am Coll Cardiol 2008; 51:113.