Will Stress Cause Angina?

  • 1st Revision: Emma Soopramanien
  • 2nd Revision: Jasmine Yeh [Linkedin]
  • 3rd Revision: Shikha Javaharlal

Introduction

Stress is very much a part of everyday life. Whether it is caused by meeting deadlines or watching your favourite sports team, everyone experience stress on a daily basis.

Whilst research identifies that some stress can be good for us, overexposure to stress goes hand in hand with the development of several health conditions, including angina.1 The following article will explore how stress can increase our risk of angina, and the various ways we can help limit our stress levels.

Common Causes of Angina

Angina pectoris, more commonly known as angina, is the medical term used to define the chest pain we experience as a result of a reduction in oxygenated blood supply to our heart muscles. This condition affects approximately 6.2% of the global population and, whilst not considered life-threatening alone, it is a warning sign that more severe heart problems may occur without medication and/or lifestyle changes.2 

In most cases, angina occurs when plaque (made up of mainly cholesterol and fatty substances) builds up within the coronary arteries. As this process occurs, the affected arteries become narrower and less flexible, thus restricting blood flow through them. Consequently, our cardiac muscles receive a lower supply of oxygenated blood, causing us to experience angina pain. This process can occur due to the following reasons:

  • Coronary artery disease
  • Sedentary lifestyle
  • Poor diet
  • Smoking/drug use
  • Obesity
  • Ageing
  • Stress

Stress

What is Stress?

Stress is a feeling caused by emotional and physical pressures that can cause an individual to feel overwhelmed. Whilst some stress may be good for us, such as acute stress brought about by moderate physical activity, overexposure to stress can lead to several physical and psychological health conditions.

Signs of Stress

The NHS states that signs of stress can be both physical and psychological.3 The signs and symptoms of stress can vary from person to person. For example, those experiencing everyday stress may experience very different signs and symptoms than someone diagnosed with chronic stress. Some signs commonly associated with stress are:

  • Feeling of anxiousness
  • Increased heart rate
  • Increased breathing rate
  • Feeling nauseous
  • Shaking and lightheadedness
  • Difficulty making simple decisions or completing basic tasks

Those diagnosed with chronic stress may experience more severe symptoms alongside those listed above. These symptoms are usually experienced over a prolonged period of time, potentially lasting weeks or even months. Prolonged exposure to stress can lead to:

  • Chest pains
  • Regular illness
  • Difficulty sleeping
  • Decreased cognitive skills (e.g. memory and decision making)
  • Tiredness
  • Large increases/decreases in appetite

How can Stress Affect Angina?

Increased Blood Pressure

According to an article posted in the journal Hypertension, those with higher levels of stress are 22% more likely to suffer from hypertension (i.e. high blood pressure).4 When faced with a stressor, our body responds by increasing the production of cortisol and adrenaline. Whilst useful in “fight or flight” scenarios, cortisol and adrenaline raise blood pressure and heart rate. This process can therefore be dangerous for those who are regularly stressed. Research shows that prolonged high blood pressure damages our heart and arteries.5 Over time, this weakens our heart and can cause severe artery damage, increasing our risk of suffering from angina and many other cardiovascular-related conditions, including heart failure, coronary heart disease, and heart attacks.

Hormone Surge can Narrow Arteries and Worsen Angina

Research has found that surges of the hormones adrenaline, cortisol, and noradrenaline, are common in stressed individuals.6 Resultantly, prolonged bouts of stress can overexpose us to these hormones, contributing to the narrowing of our arteries and angina risk. Details of how these hormones increase the risk of angina are shown below:

  • Adrenaline – Overproduction of adrenaline leads to narrowing of our arteries, which reduces oxygenated blood flow to the heart, causing damage to our cardiac muscles, and thus, increasing angina risk.
  • Cortisol – Growing amounts of evidence shows us that cortisol raises blood pressure, blood sugar, cholesterol and plaque deposition on the walls of our arteries, all of which significantly increase angina risk.
  • Norepinephrine – Forces our blood vessels to narrow, raising blood pressure (i.e. vasoconstriction). Inconsistent high doses can increase an individual’s risk of hypertension, causing potential damage to the heart and arteries, and thus, raising the risk of angina.

Unhealthy Habits Linked to Stress

Studies have shown that stress can lead an individual to become more vulnerable to addictive behaviours, making them more likely to adopt unhealthy lifestyle habits.7 Some common unhealthy habits that those who are stressed may fall into are detailed below:

  • Comfort Eating – Research shows that 38% of stressed individuals comfort eat when dealing with stress.8 Most people’s comfort foods are high in saturated fat and sugars, thus leading to a higher risk of plaque build-up and hypertension, and increasing the risk of angina.9
  • Smoking – Smoking is a common occurrence in stressed individuals.10 Whilst many perceive smoking as a stress reliever, research has shown that smoking can increase anxiety levels, making our arteries narrower and more vulnerable to plaque build-up.11
  • Alcohol Consumption – Alcohol consumption is another common stress reliever. Whilst safe in moderation, excessive alcohol consumption has been shown to raise blood pressure, causing damage to our heart and arteries, therefore increasing angina risk.

Managing Stress

Lifestyle Changes

Leading a healthy lifestyle is strongly associated with a reduction in the amount of stress we experience.12 To help you assess some of the potential changes you could make, some of the most effective lifestyle changes for stress reduction are:

  • Partaking in 150 minutes of moderate physical activity weekly
  • Consuming a balanced, healthy diet
  • Having 6-8 glasses of water per day
  • Doing meditation and/or yoga
  • Sleeping between 7-9 hours each night
  • Practising stress relief techniques e.g. breathing exercises
  • Setting yourself achievable daily/weekly targets
  • Spreading your workload out if possible, and avoid leaving work until the last minute!

Mindfulness

Mindfulness is a type of meditation that requires the individual to focus on exactly how they feel at that exact moment. When practising mindfulness, research has identified activity levels within our amygdala (a region of the brain responsible for stress response) decrease, thus reducing the amount of stress the individual experiences.13 To help you practice mindfulness, use the STOP acronym:

  • S – Stop whatever you’re doing and put anything you’re holding down
  • T – Take deep breaths to help you regain focus and control over your emotions
  • O – Observe exactly how you’re feeling at that moment: what are you thinking? Why are you thinking those thoughts?
  • P – Proceed with the task calmly with the knowledge you have just developed regarding your thoughts and feelings

Social Support

The type of social support required for stressed individuals depends on their condition and what works best for them. In some cases, an individual may be better suited to simply discussing their stressors with their friends and family. In more severe cases of emotional distress, it may be more beneficial to visit a medical professional to discuss your condition. 

According to an article posted in the journal Frontiers in Behavioural Neuroscience, there are four main types of professional social support for those dealing with stress.14 These include:

  • Esteem Support – Helps the individual feel useful and understand their self-worth
  • Information Support – Provide the individual with advice or a chance to discuss the causes of their stress
  • Companionship Support – Individuals spend time together to help them recover from their stressors together
  • Instrumental Support – Providing the individual with some form of device they can use to help them deal with their stressors

Summary

It is evident that stress can directly influence your risk of an array of health conditions, as well as angina. If you experience constant stress, do not be afraid to talk to a friend or medical professional as talking always helps. Even if you do not currently feel overly stressed, making a few healthy lifestyle changes could help your overall health and reduce your risk of becoming stressed in the future.

References:

  1. Kirby, Elizabeth D., et al. ‘Acute Stress Enhances Adult Rat Hippocampal Neurogenesis and Activation of Newborn Neurons via Secreted Astrocytic FGF2’. ELife, vol. 2, Apr. 2013, p. e00362. PubMed, https://doi.org/10.7554/eLife.00362
  2.  Hemingway, Harry, et al. ‘Prevalence of Angina in Women Versus Men’. Circulation, vol. 117, no. 12, Mar. 2008, pp. 1526–36. ahajournals.org (Atypon), https://doi.org/10.1161/CIRCULATIONAHA.107.720953
  3. ‘Get Help with Stress’. Nhs.Uk, 2 Feb. 2021, https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/stress/
  4. Inoue, Kosuke, et al. ‘Urinary Stress Hormones, Hypertension, and Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis’. Hypertension, vol. 78, no. 5, Nov. 2021, pp. 1640–47. ahajournals.org (Atypon), https://doi.org/10.1161/HYPERTENSIONAHA.121.17618
  5. Tackling, Gary, and Mahesh B. Borhade. ‘Hypertensive Heart Disease’. StatPearls, StatPearls Publishing, 2022. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK539800/
  6. Chu, Brianna, et al. ‘Physiology, Stress Reaction’. StatPearls, StatPearls Publishing, 2022. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK541120/
  7. Sinha, Rajita. ‘Chronic Stress, Drug Use, and Vulnerability to Addiction’. Annals of the New York Academy of Sciences, vol. 1141, Oct. 2008, pp. 105–30. PubMed Central, https://doi.org/10.1196/annals.1441.030
  8. ‘Stress and Eating’. Https://Www.Apa.Org, https://www.apa.org/news/press/releases/stress/2013/eating. Accessed 7 Apr. 2022
  9. Yau, Yvonne H. C., and Marc N. Potenza. ‘Stress and Eating Behaviors’. Minerva Endocrinologica, vol. 38, no. 3, Sept. 2013, pp. 255–67. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214609/
  10. Slopen, Natalie, et al. ‘Psychosocial Stress and Cigarette Smoking Persistence, Cessation, and Relapse over 9–10 Years: A Prospective Study of Middle-Aged Adults in the United States’. Cancer Causes & Control : CCC, vol. 24, no. 10, Oct. 2013, pp. 1849–63. PubMed Central, https://doi.org/10.1007/s10552-013-0262-5
  11. ‘Smoking and Mental Health’. Mental Health Foundation, 7 Aug. 2015, https://www.mentalhealth.org.uk/a-to-z/s/smoking-and-mental-health
  12. Maruyama, Soichiro, and Kanehisa Morimoto. ‘The Effects of Lifestyle and Type a Behavior on the Life-Stress Process’. Environmental Health and Preventive Medicine, vol. 2, no. 1, Apr. 1997, pp. 28–34. PubMed Central, https://doi.org/10.1007/BF02931226
  13. Kral, Tammi RA, et al. ‘Impact of Short- and Long-Term Mindfulness Meditation Training on Amygdala Reactivity to Emotional Stimuli.’ NeuroImage, vol. 181, Nov. 2018, pp. 301–13. PubMed Central, https://doi.org/10.1016/j.neuroimage.2018.07.013
  14. Costa-Cordella, Stefanella, et al. ‘Social Support and Cognition: A Systematic Review’. Frontiers in Psychology, vol. 12, 2021. Frontiers, https://www.frontiersin.org/article/10.3389/fpsyg.2021.637060

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George Evans

Bachelor of Science - BS, Sport and Exercise Science, University of Chester, England

George is a freelance writer with three years of writing experience and first class honours in Sport Science (BSc).

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