Written by Dr. Susan Blum
For those of you who know me, either personally or professionally, you know that Mind-Body-Spirit self care strategies are at the core of what I practice and preach for preventing and treating chronic disease. I meditate every morning and spend lots of time in nature. But more than this, I teach others about how stress affects your health and offer tools to do something about it.
For this month, I offer a guest blog on this topic from my friend and colleague, Dr Alon Gitig, a gifted cardiologist who I work with to help my patients get the best care, including prevention and treatment of various conditions. Mind-Body Medicine for too long has been the step-sister to conventional medicine, but now you can see for yourself that it’s not any more!
Enjoy this perspective from a traditional cardiology practice!
Susan Blum, MD, MPH
Guest post by By Alon Gitig, MD, FACC
Health blogs talk a lot about “mindfulness” these days. Many of us have read claims that controlling our emotions can improve our health, and are left wondering whether there’s evidence to support this. Research into mind-body techniques is accumulating, as investigators look for ways to lower the risk of chronic diseases above and beyond the proven—yet incomplete–benefits offered by medications. In the field of cardiology in particular, despite major gains in the past 50 years, there is still an unacceptably high burden of heart disease, even when people are well-treated with evidence-based therapy. Let’s take a look at the evidence base behind whether stress management might help tackle this problem.
Psychological stress can have profound effects on our bodies.
Studies suggest that up to 60-80% of all primary care visits are related to manifestations of stress. A Mayo Clinic analysis identified stress as the most powerful predictor of cardiac events, while other studies indicate that mental stress predicts cardiac death more strongly than cigarette smoking. Depression roughly doubles the risk of heart attack. Both anxiety and anger have been linked to a 6-fold increased risk of cardiac events, including arrhythmias and sudden death.
Stress activates the sympathetic nervous system, with potential effects on blood pressure and heart rate. There is also evidence that elevation in cortisol levels, increased platelet clotting, and abnormal reactivity of artery walls might be triggered by psychological distress. What’s more, the brain may also directly affect the heart via descending nerve pathways. Amazingly, recent research reveals that subjects who intentionally generate positive emotions, such as gratitude, influence the heart’s beating into a pattern that is associated with healthy cardiovascular function and decreased risk of arrhythmic death.
These observations prompted studies attempting to improve health outcomes via stress-reduction techniques, such as meditation, yoga, and biofeedback. Results have been mixed, confounded by practical, methodological limitations inherent in conducting such trials. Not surprisingly, all of these modalities have generally led to significant improvements in psychological well-being, both in healthy volunteers and specifically in cardiac patients.
Some studies have demonstrated improved control of cardiac risk factors as well. Statistically significant reductions in blood pressure or resting heart rate have been achieved in patients with coronary disease, congestive heart failure, and atrial fibrillation. Interestingly, the magnitude of blood pressure lowering in some studies (i.e. 10 mmHg) mimics that seen in certain trials of hypertension drugs.
The data suggest that clinical symptoms and physical functioning can benefit from relaxation techniques as well. Patients with established coronary disease randomized to a 24-day intensive stress-management program experienced less angina episodes compared to baseline (versus no change in the control group). These patients also exercised longer on follow-up treadmill tests, and demonstrated improvements in blinded measurements of cardiac function.
Of note, a strict vegan diet was part of the experimental regimen, hence the impact attributable directly to the relaxation intervention is uncertain. Several studies of congestive heart failure patients treated with meditation or yoga demonstrated improvements in symptoms of breathlessness and fatigue, along with improved walking distance on standard 6-minute walk tests. Here too, the magnitude of the increase in distance walked was comparable to benefits seen in trials of drugs for angina and pulmonary hypertension. Three months of yoga therapy in atrial fibrillation patients resulted in less symptoms and fewer detected arrhythmia episodes on wearable heart rhythm monitors.
But do these techniques prevent heart attacks or prolong life? Believe it or not, there are two studies demonstrating reduced long-term risk of death following 3 months of meditation training. Since the magnitude of benefit observed was far greater than would be expected from the brief exposure to meditation, these results are intriguing, but far from definitive.
So what’s the bottom line on stress?
First, it’s clear that psychological stress, anxiety, and other adverse emotional states often cause or exacerbate a variety of symptoms, and that relaxation practices can offer symptomatic relief. Furthermore, evidence supports that emotional-regulation tools are very safe. For these reasons, two separate American Heart Association committees have endorsed their use as “reasonable to consider” in the care of cardiac patients.
For many people, the benefits of improved emotional equilibrium are motivation enough to try out these practices. If you’re hoping that your yoga class will control your palpitations, improve your exercise tolerance, or cut your risk of heart attack, there’s no guarantee. But if you are struggling with persistent symptoms despite your doctor treating you with the best available, evidence-based care, then there’s reason to be optimistic that mind-body practice may offer you the extra relief you’re looking for, with little to no downside to giving it a try.
By Alon Gitig, MD, FACC
Mount Sinai Riverside Medical Group
Read more from Dr. Susan Blum and other members of the Blum Center team on their blog!