A new international study discovers psychosocial factors, including work and financial stress, significantly increase the risk of having a heart attack or myocardial infarction. Currently, few doctors ask about stress, depression, or anxiety during an annual examination.
Researchers believe inquires on stress, and suggestions on where to obtain information to improve coping skills and enhance resiliency, should become standard practice, just as current standards have physicians asking about smoking.
The INTERHEART study, presented at the 18th Annual Congress of the South African Heart Association, discovered the odds of myocardial infarction was 5.6 times higher in patients with moderate or severe work stress compared to those with minimal or no stress.
Individuals with significant financial stress had a 13-fold higher odds of having a myocardial infarction.
“The role of psychosocial factors in causing disease is a neglected area of study,” said lead author Dr. Denishan Govender, associate lecturer, University of the Witwatersrand, Johannesburg.
“The study showed that psychosocial factors are independently associated with acute myocardial infarction (heart attack) in Africa but as far as we are aware there are no other published local data,” said co-author Professor Pravin Manga, professor of cardiology, University of the Witwatersrand.
In other words, stress, even in the absence other cardiovascular conditions such as high blood pressure or elevated cholesterol, can significantly increases the risk of a heart attack.
This study included 106 patients with acute myocardial infarction who presented to a large public hospital in Johannesburg. A control group of 106 patients without cardiac disease was matched for age, sex, and race.
All participants completed a questionnaire about depression, anxiety, stress, work stress, and financial stress in the previous month. A Likert scale was used to grade the experience of each condition.
Investigators assigned four resiliency profiles to classify how well a person was coping with financial stress:
- individuals were assessed as having no financial stress if they were coping financially;
- mild financial stress if they were coping financially but needed added support;
- moderate financial stress if they had an income but were in financial distress;
- significant financial stress if they had no income and at times struggled to meet basic needs.
Levels of psychosocial conditions were compared between groups and used to calculate associations with having a heart attack.
Self-reported stress levels were common, with 96 percent of heart attack patients reporting any level of stress, and 40 percent reporting severe stress levels.
There was a three-fold increased risk of myocardial infarction if a patient had experienced any level of depression (from mild to extremely severe) in the previous month compared to those with no depression.
Govender said, “Our study suggests that psychosocial aspects are important risk factors for acute myocardial infarction. Often patients are counselled about stress after a heart attack but there needs to be more emphasis prior to an event.
“Few doctors ask about stress, depression, or anxiety during a general physical and this should become routine practice, like asking about smoking. Just as we provide advice on how to quit smoking, patients need information on how to fight stress.”
Source: European Society of Cardiology