By T. Jared Bunch,
Jun 30, 2014
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A common question with heart disease is, did it develop from nature or nuture?
Unfortunately, most of us are personally acquainted with heart disease. Either we have experienced a form of heart disease ourselves or we know family members or close friends who have suffered from it. We ask, was the disease primarily from our genetics or from the environment we grew up in and the choices we made? Understanding the influence of environment provides insight into ways to prevent or minimize the disease risk.
Recognizing which life and social stressors are significant risks is important in understanding heart disease and stroke.
A new study in the Journal of the American Heart Association, from Kiarri Kershaw, PhD, MPH, at Northwestern University and others, tried to answer the question of nature versus nuture for the development of coronary artery disease or stroke in women. The study included 82,000 women studied over 16 years.
Traditional Heart Disease Risk FactorsThe study authors first collected information regarding traditional risk factors of coronary artery disease and stroke in women including these six:
- Cigarette smoking
- Excessive alcohol consumption
- Poor diet
- Low physical activity
- High blood pressure
- Abdominal obesity
Next, the authors tried to understand the role of life stressors and social strains on the development of heart and brain disease. They really wanted to isolated the daily environment in these women to examine the influence on disease. This is a difficult and challenging area to explore since stresses and strains can occur in so many ways in our lives.
Stressful Life EventsThe authors asked questions that they felt may correlate with significant stressful life events such as:
- Did the person have a spouse who had died?
- Did the person have a spouse with a serious illness?
- Did a close friend or relative die?
- Was the person or someone close to them having major problems with money?
- Was the person or someone close to them going through a divorce or a close personal breakup?
- Was the person experiencing a significant conflict with children, siblings, or grandchildren?
- Did the person, their spouse, or someone close to them lose a job?
- Was the person or someone close to them a victim of physical, verbal, or emotional abuse?
Each of these questions was scored with one point. Some of the questions could be counted more than once if the stress involved the person answering the question, their spouse, or a close friend. Women who had a score of five or more were considered to have a high level of stressful life events. Those with a score of zero or one were considered to have a low to low-medium level of stressful life events. Unfortunately, these type of stresses are often unavoidable and can occur in clusters.
Social StrainsIn addition, as discussed in one of my prior columns, how we respond to social and daily stressors can influence risk of heart events. In this regard, the authors asked the following questions to understand daily social strain and stress.
How many of the people who are important to you:
- Get on your nerves?
- Ask too much of you?
- Do not include you?
- Try to get you to do things you do not want to do?
Each of these questions was ranked from one (none) to five (all). If the composite score was seven or more, these women were identified as having a high level of social strain. A low level of social strain was a score of four or less.
Finally, the authors also looked at specific environmental variables such as education level, annual family income, and marital status to see if these factors help explain the social strain and stressors.
What the authors found is important in understanding the influence of our environment and our heart and brain disease risk.
- Women who experienced high levels of stressful life events were 12 times more likely to develop coronary artery disease.
- They were 14 times more likely to experience a stroke.
- These risks were independent of education level, marital status, or family income.
- Women who experienced high levels of stressful life events were five times more likely to develop coronary artery disease, even when accounting for all the traditional risk factors.
- And they were nine times more likely to have a stroke.
These findings show how powerfully the stresses in our environment can influence our health even in the absence of traditional risk factors.
Next, women who experienced high levels of social strain were:
- 12 times more likely to develop coronary artery disease
- 10 times more likely to experience a stroke
- These risks were independent of education level, marital status, or family income
Similar to the stressful life events analysis, when the authors accounted for all of the traditional risk factors, women who experienced high levels of social strain were still five times more likely to develop coronary artery disease and six times more likely to experience a stroke. These findings show how significant social stress can be on our health.
This study tells us something that you may have already expected. Our genetics, our environment and our choices influence our risk of heart disease and stroke. And it shows us how important both stressful life events and social strains can be.
When to Get Help for Your HeartIt is common for patients to come to me at the request of a friend, spouse, or child to prevent heart disease. Often, the visits were prompted when the patient’s loved ones recognized that the person had developed risk factors for heart disease such as high blood pressure or diabetes. I have never had a patient referred to me for heart disease prevention who had recently lost a spouse, was experiencing abuse, had difficulty coping with stress and the demands of those around them, or was fequently losing their temper.
I believe this study tells us if you are one of these people who are experiencing these stresses, or you know of a close friend or relative who experiences these stresses, you should know that if they persist, they are significant risk factors for heart disease. Consider seeking help to relieve the stressful situations, improve your coping mechanisms, or, if possible, improving the negative environment you’re in.