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Psychological Stress and Cardiovascular Health in the COVID-19 Era

Gregory M. Weiss, MD, provides an overview of the impact mental stress can have on cardiovascular health during the ongoing pandemic.

We live in unprecedented times. The daily lives of busy Americans have always dealt with the stress of making a living while maintaining health with very little time to accomplish both. Enter the global pandemic of COVID-19. Since January of this year we have seen the global economy deteriorate amidst staggering infection rates and death tolls.

The stress of daily life has become, quite literally, a fight to stay alive and solvent. It has long been known that stress is associated with poor health but how can this knowledge be brought to bear on the impact of extreme stress during a pandemic on cardiovascular wellness?

In a recent article published in JAMA Network, Kim Smolderen, PhD, of Yale University, and colleagues from multiple centers looked at the impact of general stress on outcomes in patients with peripheral vascular disease (PVD). They followed patients with a new diagnosis of PVD and using established psychological measures, determined each patient’s relative stress over the subsequent year. Building on previous research that has shown a link between increased stress and poor quality of life in patients with PVD, Smolderen found that patients with higher levels of stress in the year following diagnosis were also at higher risk of dying.1

If we are to extrapolate this data to the general population, we could build a framework to understand how poor mental health, worry, and despair might lead to poor cardiovascular health. Chronic stress has been linked to lifestyle behaviors such as inactivity, drinking alcohol, smoking, and a tendency towards obesity all risk factors for cardiovascular disease. Worry tends to raise heart rate and blood pressure which over time also promotes poor cardiovascular health. Increased mortality, although an important concept, is somewhat intangible. Is there evidence that this stress contributes to specific cardiovascular conditions?

In another recent article also published in JAMA Network, Ankur Kalra, MD, of the Cleveland Clinic, looked at stress cardiomyopathy during the pandemic to see if there was a relationship. Stress cardiomyopathy, also known as Takotsubo syndrome, is a type of heart failure that can occur simply from extreme stress. Kalra compared patients presenting to the hospital for cardiac catheterization before COVID-19 with ones presenting during the pandemic. The results of the study showed a significant increase in stress cardiomyopathy, a real tangible condition, in patients presenting during the pandemic.2

While linking a higher level of generalized stress to increased rates of stress cardiomyopathy may seem obvious, there have been reports of direct viral cardiomyopathies related to COVID-19. These are only case reports that will require validation through peer reviewed research. This having been said, the authors of this study believe the intense psychological, social, and economic stress brought on by the COVID-19 pandemic are the most likely reasons for the increase in stress cardiomyopathy.2

We know that stress increases mortality in PVD and that COVID-19 related stress leads to more cardiomyopathy. The question now becomes; is this an opportunity to explore holistic stress reduction strategies aimed at preventing or minimizing the effects of COVID-19 era stress on cardiovascular wellness?

In a recent article published in the American Journal of Cardiology, Chayakrit Krittanawong, MD, of Baylor College of Medicine, sought to answer this question. Building on previous recommendations from the American Heart Association that meditation may be beneficial for patients with cardiovascular risk factors, Krittanawong reviewed national databases to see if meditation was associated with reductions in specific cardiovascular outcomes. The results of this study showed that meditation was independently associated with lower rates of high cholesterol levels, diabetes, stroke, hypertension, and coronary artery disease.3

These results offer a glimmer of hope in this challenging time. In the past meditation and stress reduction strategies have come and gone as fads and new age gimmicks. Through science and investigation born of unprecedented global suffering hope comes in the form of risk mitigation using a readily available, non-invasive, completely free of charge therapy one can take advantage of in their very own home.

Education is the key to success if stress reduction strategies are to be adopted by people already at risk for cardiovascular disease and those who may become at risk during the COVID-19 pandemic. Clinicians must spread the word to their patients whether it be through virtual consultations and E-visits or when they present to clinics and hospitals with health problems. Once patients are educated that meditation and other relaxation techniques may significantly improve their health a range of techniques should be offered to them tailored to individual patient needs and circumstances.

There is no doubt that we are facing one of the most challenging points in our history. The COVID-19 pandemic affects every aspect of our lives leading to extreme stress that goes beyond the viral infection. The good news is that there is hope. History teaches us that out of extreme adversity human beings rise to the challenge. Meditation and other relaxation techniques may help protect us now and in the future by reducing the risk of cardiovascular disease and even death.