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Stress—Yes, It Really Can Trigger a Heart Attack

Story at-a-glance -

  • More heart attacks and other cardiovascular events occur on Mondays than any other day of the week. This “Monday cardiac phenomenon” has long been believed to be related to work stress
  • Two recent studies shed light on the persistent link between stress and sudden heart attacks
  • In one, a group of German researchers found that as your stress level rises, so do your levels of disease-promoting white blood cells. This can lead to plaque rupture and myocardial infarction
  • The other study found that stress hormones cause the dispersal of bacterial biofilms from the walls of your arteries. This dispersal can allow plaque deposits to suddenly break loose, triggering a heart attack
  • Preventing heart disease involves reducing chronic inflammation in your body. Key tools are diet, exercise, sun exposure, and grounding to the earth. Effective stress management is another important factor

By Dr. Mercola

About one in every three deaths in the US is attributed to heart disease. The most common form of heart disease is coronary artery disease (CAD), which can lead to a heart attack.

Interestingly, more heart attacks and other cardiovascular events occur on Mondays than any other day of the week.1 This "Monday cardiac phenomenon" has been recognized for some time, and has long been believed to be related to work stress.

Many do not realize that the most common symptom of heart disease is sudden death from a heart attack. Oftentimes, there are no prior indications of a problem; signs like chest pain or shortness of breath, for example.

The good news is that heart disease, just like type 2 diabetes, is one of the easiest diseases to prevent and avoid, but you must be proactive! Below I'll discuss several important prevention strategies. Checking your susceptibility is also a good idea.

In a nutshell, in preventing cardiovascular disease and heart attacks, it is important to address chronic inflammation in your body. Proper diet, exercise, sun exposure, and grounding to the earth are cornerstones of an anti-inflammatory lifestyle. Effective stress management is another important factor for keeping a heart attack at bay.

Links Between Stress and Heart Attack Revealed

Two recent studies shed light on the persistent link between stress and sudden heart attacks. In one, a group of German researchers found that as your stress level rises, so do your levels of disease-promoting white blood cells.2, 3, 4 Co-author Dr. Matthias Nahrendorf explains:

"High levels of white blood cells may lead to progression of atherosclerosis, plaque rupture and myocardial infarction. The latter implies that a part of the heart muscle, which pumps the blood with every beat, dies off.

This may cause heart failure, either right away if the infarct is large, or later on through maladaptive processes. The heart tries to compensate for the loss of contractile muscle tissue but over time this compensation leads to a larger heart, which is weaker."

The other study, published in the online open-access journal mBio5, 6 found yet another way for sudden stress, emotional shock, or overexertion, to trigger a heart attack.

During moments of high stress, your body releases hormones such as norepinephrine, which the researchers claim can cause the dispersal of bacterial biofilms from the walls of your arteries. This dispersal can allow plaque deposits to suddenly break loose, thereby triggering a heart attack.

Stress contributes to heart disease in other ways as well. Besides norepinephrine, your body also releases other stress hormones that prepare your body to either fight or flee. One such stress hormone is cortisol.

When stress becomes chronic, your immune system becomes increasingly desensitized to cortisol, and since inflammation is partly regulated by this hormone, this decreased sensitivity heightens the inflammatory response and allows inflammation to get out of control.7

As mentioned earlier, chronic inflammation is a hallmark of heart disease. So, both chronic and acute stress can contribute to a sudden heart attack—depending on your underlying susceptibility... This makes having effective tools to address your stress levels a very important part of a heart healthy lifestyle.

How Susceptible Are You to Developing a Heart Disease and/or Suffering a Heart Attack?

When it comes to ascertaining your individual heart disease risk, the following three tests or ratio calculations will give you an idea of where you stand:

  • HDL to total cholesterol ratio. HDL percentage is a potent heart disease risk factor. Just divide your HDL level by your cholesterol. This ratio should ideally be above 24 percent.
  • Triglyceride to HDL ratio. High triglycerides are a potent risk factor for heart disease. In combination, high triglycerides and low HDL levels are an even bigger risk; this ratio is far more important to your heart health than the standard good vs. bad cholesterol ratio.
  • In fact, one study found that people with the highest ratio of triglycerides to HDL had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL.

    Calculate your triglyceride/HDL cholesterol ratio by dividing your triglyceride level by your HDL level. This ratio should ideally be below 2. So while you strive to keep your HDL cholesterol levels up, you'll want to decrease your triglycerides.

    You can increase your HDL levels by exercising and getting plenty of omega-3 fats like those from krill oil. Triglycerides are easily decreased by exercising and avoiding grains and sugars in your diet.

  • Iron levels: Iron is nature's rusting agent. If you have excessive levels in your body, you are at risk of major oxidation, or premature aging. Excess iron will also increase your risk of heart disease. If you are a man, or a woman in menopause, you should get your iron levels tested and, if they're too high, take steps to reduce them.

Lower Your Heart Attack Risk by Addressing Your Stress

Stress is so widespread as to be "pandemic" in today's modern world, but suffering ill effects from stress is not an inevitable fact. A lot depends on how you respond to these day-to-day stresses. And as you learn how to effectively decrease your stress level, your heart attack risk will be reduced as well.

There are many different stress reduction techniques. The key is to find out what works best for you, and stick to a daily stress-reduction program. One key strategy is to make sure you get adequate sleep, as sleep deprivation dramatically impairs your body's ability to handle stress and is yet another risk factor for heart attack. Besides that, other stress management approaches include:

Regular physical activity

Meditation: Taking even 10 minutes to sit quietly, such as during work breaks, can help decrease your feelings of stress and anxiety

Mindfulness training and breath work

Yoga: Health benefits from regular yoga practice have been shown to decrease stress, improve sleep, and immune function, and reduce food cravings, among other things

Social connectedness

Laughter and levity

Spend time in nature


Have more fun

EFT: Emotional Freedom Technique

My favorite tool for stress management is the Emotional Freedom Technique (EFT). It's an energy psychology tool that can help reprogram your body's reactions to everyday stress, thereby reducing your chances of developing adverse health effects. For a demonstration, please see the following video featuring EFT practitioner Julie Schiffman, in which she discusses EFT for stress relief. For serious or deep-seated emotional problems, I strongly recommend seeing an experienced EFT therapist, as there is a significant art to the process that requires a high level of sophistication if serious problems are to be successfully treated.

Cut Out Sugar to Protect Your Heart

As initially postulated by Dr. Yudkin in the 1960s, SUGAR is a primary dietary culprit in the development of heart disease, as it is profoundly inflammatory. To protect your heart health you need to take proactive steps to address your insulin and leptin resistance, which is the result of eating a diet too high in sugars and grains. So, to safely and effectively reverse insulin and leptin resistance, thereby reducing inflammation and lowering your heart disease risk, you need to:

  1. Avoid processed foods, sugar, processed fructose, and grains if you are insulin/leptin resistant. As a standard recommendation, I advise keeping your total fructose consumption below 15 grams per day until your insulin/leptin sensitivity and other heart disease risk factors (above) have normalized
  2. Eat a healthy diet of whole foods, ideally organic, and replace the carbohydrates (sugars/grains) with:
    • Large amounts of vegetables
    • Low-to-moderate amount of high-quality protein (think organically raised, pastured animals)
    • As much high-quality healthful fat as you want (saturated and monounsaturated from animal and tropical oil sources). Most people actually need upwards of 50-85 percent fats in their diet for optimal health—a far cry from the 10 percent currently recommended. Sources of healthful fats to add to your diet include: avocados; butter made from raw grass-fed organic milk; raw dairy; organic pastured egg yolks; coconuts and coconut oil; unheated organic nut oils; raw nuts and seeds; and grass-fed and finished meats

Another fat that is crucially important for heart health is animal-based omega-3. Omega-3 fats such as that found in krill oil help protect against heart disease and stroke by preventing the build-up of fatty deposits in your arteries. For more information about omega-3s and the best sources of this fat, please review this previous article.

Your Heart Needs Vitamin D

Being vitamin D deficient can massively increase your heart disease risk. Vitamin D is the only known substrate for a potent, pleiotropic (meaning it produces multiple effects), repair and maintenance seco-steroid hormone that serves multiple gene-regulatory functions in your body. This is why vitamin D functions in so many different tissues—one of which is your heart.

One 2009 study8 found that people with the lowest average vitamin D levels had a 124 percent greater risk of dying from all causes and a 378 percent greater risk of dying from a heart problem. Researchers from Finland also showed that when compared with the participants with the highest vitamin D, those with the lowest levels had a 25 percent higher risk of dying from heart disease or stroke. Arterial stiffness, a major risk factor for heart disease and stroke, is also associated with vitamin D deficiency. There are a number of physiological mechanisms triggered by vitamin D production through sunlight exposure that act to fight heart disease, including:

  • An increase in your body's natural anti-inflammatory cytokines
  • The suppression of vascular calcification
  • The inhibition of vascular smooth muscle growth

Fortunately, vitamin D deficiency is incredibly easy to fix. Ideally, you'll want to maintain a vitamin D level of at least 50 ng/ml year-round. For active treatment of heart disease, a level between 70-100 ng/ml may be warranted. For more information about how to safely and effectively optimize your vitamin D level, please see my previous article: "How Vitamin D Performance Testing Can Help You Optimize Your Health."

Exercise Is as Effective as Drugs Against Heart Disease

Exercise is one of the safest, most effective ways to prevent and treat heart disease. This common sense advice was again confirmed in a recently published meta-review conducted by researchers at Harvard and Stanford,9 which found "no statistically detectable differences" between physical activity and medications for heart disease. The only time drugs beat exercise was for the recovery from heart failure, in which case diuretic medicines produced a better outcome.

Previous research has shown that exercise alone can reduce your risk of cardiovascular disease by a factor of three.10 However, be aware that endurance-type exercise, such as marathon running or any other endurance aerobic activity, can actually damage your heart and increase your cardiovascular risk... Research11 by Dr. Arthur Siegel found that long-distance running leads to high levels of inflammation that can trigger cardiac events, and another 2006 study12 found that non-elite marathon runners experienced decreased right ventricular systolic function, again caused by an increase in inflammation and a decrease in blood flow.

That said, other research has clearly demonstrated that short bursts of intense activity (high intensity interval training or HIIT) is safer and more effective than conventional cardio—for your heart, general health, weight loss, and overall fitness. So, the key is to exercise correctly and appropriately, making certain you also have adequate recovery between sessions. HIIT mimics the movements of our hunter-gatherer ancestors, which included short bursts of high-intensity activities, but not long-distance running.

Basically, by exercising in short bursts followed by periods of recovery, you recreate exactly what your body needs for optimum health. This type of exercise will also naturally increase your body's production of human growth hormone (HGH)—a synergistic, foundational biochemical underpinning that promotes muscle and effectively burns excessive fat. It also plays an important part in promoting overall health and longevity.

Earthing—A Potent Way to Reduce Inflammation

Regularly walking barefoot, to ground with the earth, can have a profound impact on reducing inflammation in your body and reducing your risk of cardiovascular disease. When you do, free electrons are transferred from the earth into your body. This grounding effect is one of the most potent antioxidants we know of, and helps alleviate inflammation throughout your body.

Grounding also helps thin your blood by improving its zeta potential, which means it improves the negative electrical charge between your red blood cells thus repelling them and keeping your blood less likely to clot. In fact, grounding's effect on blood thinning is so profound if you are taking blood thinners you must work with your health care provider to lower your dose otherwise you may overdose on the medication. Research has demonstrated it takes about 80 minutes for the free electrons from the earth to reach your blood stream and transform your blood.

Take Proactive Steps to Protect Your Heart

The take-home message can be summarized as follows: if you want to prevent heart disease and its lethal companions—heart attack and stroke—you need to take some proactive steps to quell inflammation in your body, and address your stress. Tools such as EFT, which can help you rein in your day-to-day stress levels, can also help you respond to acute emotional upheaval and stress in a healthier way. As for eliminating chronic inflammation, key tools include:

  • A heart-healthy diet (avoiding processed foods, sugar/fructose and grains, making sure to replace these lost carbs with healthy saturated fats)
  • Exercise
  • Sun exposure to optimize your vitamin D
  • Grounding to the earth