A RECENT prospective study, that follows participants in real time, has shown that high levels of stress are associated with an increased risk of heart attack and stroke, collectively known as cardiovascular events.

Researchers tracked almost 120,000 patients from 21 countries over 10 years and found that those with excessive levels of stress had somewhere between 22 and 30 per cent greater risk of a cardiovascular event.

While this may not seem like anything surprising, or even new, this is one of the few studies to engage participants before a heart attack or stroke, whereas many previously relied on reported stress levels in those who had already had a major cardiovascular event, which itself may have significantly altered a person’s perception of how much pressure they were under.

Perhaps what we can now say is that stress can and should be viewed as a modifiable risk factor for the development of cardiovascular disease.

As with all conditions, there are risk factors which are fixed, typically gender, age and a family history of said illness, as well as those which are modifiable, which if addressed proactively can often decrease the likelihood of several diseases.

The most commonly cited ones are weight, exercise, tobacco and alcohol consumption.

There is no simple answer as to why stress is linked with a greater chance of heart attack and stroke. From a physiological standpoint, stress increases levels of the hormones adrenaline and cortisol, needed for the flight or fight response.

Although acceptable and indeed sometimes required in short bursts, chronically elevated levels of cortisol are linked with impaired blood sugar regulation and the development of diabetes, high blood pressure, disruption of the sleep wake cycle, and increased hardening of the arteries (atherosclerosis).

Yet the psychological aspects of prolonged stress must not be underestimated.

Poor mental health alters perception significantly such that those suffering do less to look after themselves. They are more likely to turn to maladaptive coping mechanisms such as smoking, alcohol and recreational substance use.

Even if experiencing a symptom of significant concern, such as chest pain or shortness of breath, they are less likely to seek appropriate or timely help, and may adopt a nihilistic approach.

You may feel this is a less appealing article for the season of good will, but the period of Christmas is traditionally associated with worsening levels of anxiety and stress as well as a large increase in the numbers of heart attacks and strokes.

While it may be obvious that the pressure to have the perfect Christmas causes heightened anxiety for many, the reasons behind the increased number of cardiovascular events are less clear. It may be a combination of factors, such as extra indulgence especially alcohol which can increase the chance of heart rhythm disturbance, forgetting to take necessary medications, or even ignoring red flag symptoms that may herald a heart attack or stroke.

No current article on stress would be complete without at least touching on the effects of Covid-19.

The phrase Post Pandemic Stress Disorder (PPSD) is used to describe the condition experienced by those who have had a significant decline in their mental health as a result of the situation we are living in.

You do not have to have suffered acute infection to develop PPSD, with experts advising it is more to do with the effects of restrictions, lockdowns and the massive uncertainties associated with living through a pandemic.

It may result in a significant rise in heart attacks and strokes.

Despite this, the steps toward a reduction in cardiovascular events and an improvement in both physical and mental health may still be within our reach.

By being less of a perfectionist, living in the moment, accepting that the past is the past, yet not worrying unnecessarily about the future, we may unburden ourselves of many of our stressors.

Doing something for ourselves even for half an hour a day, which can be something as simple as a short walk or diving into a novel, has often been advocated as a means of maintaining psychological wellbeing.

The answers to why some people have good mental health, despite significant adversity, often remain elusive, even to those blessed by this.

If you are suffering with mental or physical health issues, please do not ignore these, or worse suffer in silence hoping they will just go away.

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