Medical memo: Stress and the heart: Treatment helps

Medical memo

Stress and the heart: Treatment helps

America's epidemic of coronary artery disease began to gather steam in the early part of the 20th century. By 1921, heart disease had become the nation's leading killer, but it took scientists awhile to catch on. By now, though, doctors have learned that smoking, abnormal cholesterol levels, high blood pressure, diabetes, obesity, and lack of exercise all contribute to cardiac risk. Even more important, they've learned that corrective measures can reduce risk. This important knowledge has contributed to a 56% decline in heart disease deaths and a 70% drop in stroke fatalities over the past 50 years.

Physicians have long suspected that psychological factors also contribute to cardiac risk. Because emotions are harder to measure than cholesterol, blood pressure, and body fat, it's been harder to prove. That started to change in 1959, when Dr. Meyer Friedman and Dr. Ray Rosenman reported that the "Type A" personality was a strong predictor of cardiac risk. There followed a flurry of research that didn't always agree with the original findings. Still, the new investigations put psychological influences firmly on the list of cardiac risk factors. Most studies agree that even if the Type A hypothesis has not lived up to its billing, its major components — anger, hostility, and stress — are each important. Research also suggests that social isolation and depression may be even stronger risk factors, particularly for men.

Identifying risk factors is always useful, but the proof is in the demonstration that treatment helps. Dr. Friedman argued that special Type A counseling could do just that, but many cardiologists remained skeptical. However, research from Duke University suggests that stress reduction really can reduce cardiac events in men.

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