A common question with heart disease is: Did it develop from nature or nurture?
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 our environment 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.
RELATED: The United States of Stress
A study published in 2014 in the Journal of the American Heart Association, from Kiarri Kershaw, PhD, MPH, at Northwestern University, and other researchers, tried to answer the question of nature versus nurture for the development of coronary heart disease and stroke in women. The study followed more than 82,000 women over 18 years.
Know Your Heart Disease Risk Factors
The study authors first collected information regarding traditional risk factors of coronary heart 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 disease. They really wanted to isolate the daily environment of 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 Events That May Hurt Your Heart
The authors asked questions that they felt may correlate with significant stressful life events such as:
- Did the person have a spouse who died?
- Did the person have a spouse with a serious illness?
- Did a close friend die?
- Was the person having major problems with money?
- Was the person or someone close to them going through a divorce?
- Was the person experiencing a significant conflict with children or grandchildren?
- Did the person lose a job?
- Was the person a victim of physical or verbal abuse?
Each of these questions was ranked by the respondents from one (not stressful) to three (very stressful). Women who had a composite score of five or more were considered to have a high level of stressful life events. Those with a composite 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 Strains That May Hurt Your Heart
In 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 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 disease risk:
- Women who experienced high levels of stressful life events developed coronary heart disease at a 12 percent higher rate than those with low levels.
- Women who reported high levels of stressful life events experienced stroke at a 14 percent higher rate than those with low levels.
- After accounting for traditional heart disease risk factors, women who experienced high levels of stressful life events were only 5 percent more likely to develop coronary heart disease.
- After accounting for traditional heart disease risk factors, women who experienced high levels of stressful life events were only 9 percent more likely to develop stroke.
These findings show how powerfully the stresses in our environment can influence our health even in the absence of traditional risk factors.
- 12 percent more likely to develop coronary heart disease
- 10 percent more likely to experience a stroke diagnosis
- These risks were independent of education level, marital status, or family income.
This study tells us something that you may have already expected. Our genetics, our environment, and our choices can influence our risk of heart disease and stroke. And it shows us how important both stressful life events and social strains can be.
Know When to Get Help for Your Heart
It 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 diabetes or high blood pressure.
I believe this study tells us that 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.