Stress a significant risk factor in heart attacks among youth

KK Talwar

Former Director, PGIMER

RECENT times have seen a surge in sudden death/heart attacks among relatively young people, including celebrities. This has led to a debate about the possible causes and the preventive steps that can be initiated. One view is that such cases are possibly happening more frequently across the world after the Covid-19 pandemic.

Nearly 20 per cent of acute heart attacks in India occur in people in the under-40 age group as compared to only 5 per cent in the Western population. The most common cause of sudden death is acute myocardial infarction/acute heart attack. Smoking is considered to be the most important risk factor contributing to heart attacks in young people. Other risk factors include excessive consumption of alcohol, diabetes mellitus, hypertension, high cholesterol, substance abuse and the use of junk food and oral contraceptives (in case of young women).

There has been concern about whether Covid infection or its vaccine has something to do with this rise. There is no scientific data to blame the Covid vaccine. Some data was, however, published indicating higher risk of the cardiovascular complications, viz myocarditis, related to the mRNA vaccine. But this vaccine was not used in India. Recently, the Indian Council of Medical Research published a study stating that there was a high risk of heart attack/sudden death among those who had undergone symptomatic Covid-related hospitalisation.

Stress is another powerful risk factor. The New York Times once highlighted that stress may be your heart's worst enemy. It is possible that psychological stress associated with the aftermath of the Covid pandemic — job losses and financial problems — may also be a contributory cause. People who are worried about losing their job are nearly 20 per cent more likely to have heart attack, as per medical observations. At times, stress may also make a person indulge in unhealthy habits, like smoking and eating junk food; it can also lead to lack of sleep.

A hectic work schedule, target-driven jobs and job insecurity are major triggers for stress. It is a scientifically proven fact that stress takes a significant toll on the heart’s health. Stress produces neuroendocrine activation with the increased production of catecholamines and cortisol. There is also increased plasma proinflammatory/cytokines/prothrombotic and immune system activation. All this can increase the heart rate, blood pressure and myocardial oxygen requirement. The inflammatory process may induce the rupture of atherosclerotic plaque in the coronary arteries, resulting in acute heart attack. Mental stress may also result in coronary artery spasm and vasoconstriction and compromise blood flow in an already diseased vessel. Amygdala, the part of the brain that contributes to stress, has been seen to experience an increased activity under stress. It possibly activates the neuroendocrine system to release chemicals to either face stress or make you flee, depending on the kind of stress and the individual’s tolerance levels.

Stress is a part of the process of growing and achieving something substantial in life. A bit of stress is important as it makes you work harder to fare better in examinations or advance in career. But problems such as job losses and marital discord affect one’s mental stability and strength to face such situations and result in serious cardiac problems in the absence of strong family or social support. Thus, while advising preventive steps, like avoiding smoking, adopting a healthy diet and doing regular exercise, it is also important to talk of the stress levels and how to handle them.

The fact is that it is not easy to manage stress. There cannot be a one-size-fits-all approach. Reducing stress is not like flipping a switch. It requires persistent efforts and support from family, friends and the social system. Exercise is useful in raising the threshold levels of bearing stress and should be advised as a regular practice. When you exercise, you virtually burn some of your stress. Aerobic exercises, yoga and meditation are also useful in strengthening the mind. Sharing one's thoughts and feelings with friends/relatives helps in the adoption of a positive attitude. To stay connected with the people you love, reading motivational books, listening to music and undertaking some hobby help raise the threshold of bearing stress. Unfortunately, the trend of nuclear families is weakening traditional family support. In its absence, stress may induce in some people serious medical issues like depression and insomnia, which also make one susceptible to heart attack and sudden death. Most of the developed countries have a social system to financially support people when they lose jobs.

It is time for the corporate sector to create an environment to reduce stress and for the government to build some mechanism of social support in such stressful periods. To prevent heart diseases, there is also a need to work on the basic amenities — sanitation, a pollution-free environment and the availability of safe drinking water. Youngsters in schools and colleges should be educated about the importance of adopting a healthy lifestyle, including doing regular exercise, avoiding junk food and smoking and reducing the intake of alcohol. Medical advice must be taken in case of hypertension, diabetes mellitus or high cholesterol level.

Some young people may have hereditary arrhythmic or myocardial disorders, which may also result in sudden cardiac arrest. Thus, those with such a family background should have cardiac evaluations done and take preventive treatment.

Indeed, stress happens to be an enemy of the heart and we need to educate our youngsters on how to deal with it effectively.

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