- MUNICH -- Stress is a cause
of heart attacks after all and is nearly as important as smoking, according
to a study. Hudson
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- The Interheart study among 29,000 people in 52 countries,
half of whom had experienced a heart attack, found that "psychosocial
factors" increased the risk of a heart attack two and a half times
while smoking increased the risk nearly three times.
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- Doctors have argued for years about the importance of
stress in heart disease and have tended to take the view that if it does
have an effect it is something that can trigger a heart event in someone
already diagnosed.
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- The study suggests that stress may be a cause in its
own right. It looked at nine easily measured risk factors for heart disease,
including smoking, high blood pressure, diabetes, internal fat, lack of
exercise, consumption of fruit and vegetables, stress and high blood fats.
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- Psychosocial factors measure stress and psychological
health. Overall, the Interheart study, to be published in The Lancet tomorrow,
showed that high blood fats and smoking together could predict two thirds
of cases of heart attacks. It found that the increased risk to a population
of high blood fats was 49.2 per cent, current smoking was 35.7 per cent
and psychological factors 32.5 per cent.
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- Dr Salim Yusuf, professor of medicine at Michael G DeGroote
School of Medicine, McMaster University, Hamilton, Ontario, who led the
study, told the Society of Cardiology, meeting in Munich this week, that
they had found similar results in almost all parts of the world.
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- Prof Annika Rosengren, professor of cardiology at Goteborg
University, Sweden, who led the stress aspect of the research, said people's
psychosocial wellbeing judged by simple measures was significant. "Collectively
these [measures] were responsible for about one third of the risk of the
population studies," she said.
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- "Persistent severe stress makes it two and a half
times more likely that an individual will have a heart attack compared
with someone who is not stressed." She said stress and depression
together increased the risk threefold.
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- "The public thinks stress is very important in their
heart attack. My patients often say they think it was due to stress, but
previous studies have shown contrary effects of stress. But the Interheart
study shows definitively that stress is one of the most important factors
in heart attack in all ethnic groups and in all countries."
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- Volunteers were asked a range of questions, including
if they had felt no stress in the previous year, if they had felt stress
on one or two occasions, if they had several periods of stress or if they
had experienced persistent stress.
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- They were asked about financial stress and stressful
life events such as divorce or close bereavement.
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- She said: "It would be most unusual to have no stress
at all. It's how you respond to it." Patients wanted to know what
had caused their heart attack if they were to blame for not handling stress
better.
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- Prof Sir Charles George, medical director of the British
Heart Foundation, said the results suggested stress might have more of
a role as a cause of heart attacks than many people had previously thought.
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- But he cautioned that the findings were the result of
"self-reported" stress that had not been confirmed by chemical
measures - of hormones in saliva, for example.
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- "We used to say stress could provoke an attack of
angina [chest pain], that it aggravated a previously existing condition.
The results suggest stress is likely to be partially causative."
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- Scandinavian researchers had thought stress was a cause
of heart attacks for about 20 years. "It is only in the last five
years that stress is starting to be seen more widely as a possible cause."
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- There was resistance to the idea in the medical profession.
"Doctors are not terribly comfortable with the touchy feely notion
of stress. Cardiologists feel more confident when they can deal with a
blockage in an artery which they see.
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- "Belief in this has waxed and waned, but I think
we can say with some confidence stress is going to be important."
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- The BHF has a booklet on stress which is in increasing
demand, particularly among people responsible for employees' wellbeing.
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