Sources

Boyles, S. (2010). Stress hormone predicts heart death: high cortisol
     levels raise risk of heart disease. Journal of Clinical   
     Endocrinology & Metabolism, 16(2), 34-35. Retrieved from http://www.wedmd.com/heart-disease

Kumar, R., & Goel, N.K. (2008). Current status of cardiovascular disease
     due to stress. Internet Journal of Health, 7(1), 18. Retrieved 
     from http://ehis.ebscohost.com/eds/

 
Mahr, K. (2007, October 9). How stress harms the heart. Time
   Magazine. Retrieved November 10, 2010 from 

http://www.time.com/time/health/article/0,8599,1669766,00.html

http://www.tm.org/ 

Public Policy

Public Policy: laws, rules, regulations and mandates

It is rather difficult to create a law on minimizing and regulating stress, because it is different for each person and everyone responds to it differently.  There are ways, however, that doctors can help keep their patients from risk of developing cardiovascular problems due to stress. These methods still have yet to be put into action, yet if so, they may be useful for the public.

An article in Time Magazine talks about how we can use the medical community to create regulations in check ups.  Doctors and nurses need to find practical ways to help treat the kinds of stress, whether professional or personal. Currently, there isn’t a standard procedure for doctors, like cardiologists, to evaluate a person’s stress at work or struggling marriage. Right now, it isn't part of standardized practice for cardiologists, for instance, to evaluate their patients' feelings about a taxing job or a difficult marriage. Dr. Kristina Orth-Gomer, who has been studying cardiology for 25 years believes doctors should be asking these questions, and it is the responsibility of the medical community to make them  part of the routine.

One main reason why doctors don’t do this already is because they simply don’t have time. Dr. Daniel Brotman, director of the Hospitalist Program at Johns Hopkins Hospital believes this shouldn’t be required because it isn’t realistic for doctors to screen for stress in every patient.

What can be done, however, is the way doctors listen to the needs of the patients. For example, if a woman says she feels chest pains while she is “worked up,” the doctor should realize this as a sign for occurring only under stress, not physical activity, and should be treated accordingly. Again, this is something that is rather difficult to regulate or provide a law for, but it something that can be introduced to doctors and the medical community.

Community

Community: demographics, economics, geography, culture, transportation, water, financial services, medical system, recreation services and facilities, NGO's law and justice, military, built and natural environments 

WebMD discusses three different studies that were conducted in medical systems in order to determine if there is a relationship between the amount of stress and cardiovascular problems. 

Study One

Cortisol was testing in participants urine and years later showed an association between high levels and death in cardiovascular disease. Those with higher levels of cortisol were five times more likely to die from a heart attack, stroke, or other related cardiovascular issues. According to Nicole Vogelzangs, PhD of VU University Medical Center in the Netherlands, this is the first study to support the hypothesis between high stress levels and heart conditions.

Study Two

A study in Journal of Clinical Endocrinology & Metabolism measured cortisol levels over a 24-hour time period through urine as well, but in people aged 65 and over, for 6 years. Of the participants, 183 died in the 6 year time period. The cortisol levels strongly predicted death from heart attack and stroke.

Study Three

Researchers from the University of Western Ontario measured cortisol levels in hair samples for the course of 3 months. Even though the researchers found that the levels were predictors of people being at risk for heart attacks, high blood pressure and cholesterol, they believe more information is needed to determine if stress hormone measurement can over meaningful information. There are suggestions that cortisol levels may be lowered with exercise, weight loss, etc., it is uncertain if lowering cortisol levels can actually lower the risk for cardiovascular risk. Stan Vanuum, MD, PhD told WebMD "These studies reinforce the message that stress is bad for the heart, but we don't really know if we can reduce stress hormone levels or what impact this would have."

These studies show that the medical community is taken action to figure out whether or not there is a relationship between stress and cardiovascular problems. They are also looking at different demographics, such as age and gender. In addition, running tests such as these can be very expensive and labor intensive.

 

This graph shows the amount of deaths from cardiovascular disease among different ethnicity groups and genders.

Interpersonal/Groups & Institutional

Interpersonal/Groups: family, friends, co-workers, social groups, relationships, social support

According to Time Magazine, studies suggest that malfunctioning or bad relationships and chronic stress in work can lead to an increased risk for heart problems. Even sports, although a possible relief for stress, can sometimes increase a person's stress levels due to frustration and anger. 

Family members, friends and social groups, however, are also usually positive ways to relieve stress. 

Institutional: work, education, recreation, clubs, volunteer groups, faith

According to the article "How Stress Harms the Heart," it was found that patients who experienced heart attacks and returned to chronically stressful jobs were twice as likely to experience a second heart attack compared to those in occupations that were mostly free of stress. To help, doctors should be the ones educating patients properly. 

Schools and parents can also help teach adolescents at young ages how they can reduce their levels of stress, as well as how to manage their stress. By doing so, they develop early on methods to living less of a stressful life because they'll know how to reduce it before it gets out of hand.  

The Transcendental Mediation appears to be the best approach to educating people on stress. The Transcendental Mediation is described by Kulreet Chaudhary, M.D. neurologist at Scripps Memorial Hospital. She says, "The TM technique is an easy way to dissolve stress and promote a deeper, more fulfilling experience in our existing education system by nurturing the nervous systems of those giving and receiving knowledge- our teachers and students." 

According to the Transcendental Mediation website, http://www.tm.org, "Psychological stress has been shown to increase activation of the sympathetic nervous system.This increased activation releases stress hormones which lead to faster heart rate, increased cardiac output, and narrower arteries. These changes, in turn, create increased blood pressure. Activation of these systems also accelerates the progress of atherosclerosis and can lead to acute plaque rupture, which results in ischemia of the heart (angina) and coronary heart disease and stroke."

 Video: What is the Transcendental Method (First video: What is TM?)

 

This is an example of a meditating heart.

This is an example of a stressed heart

The TM helps to reduce activity in the sympathetic nervous system, which then dilates the blood vessels and reduces stress hormones. This reduction can be helpful to the body and heart. For example, if patients follow the TM model steps twice a day, it has shown that their blood pressure levels have dropped.

Intrapersonal

Intrapersonal: knowledge, attitudes, beliefs, and skills within an individual 

The individual is capable to remove stress from their everyday life. By doing so, they reduce the amount of chronic stress, which can lead to a decrease in the risk of cardiovascular disease. Ways people can individually reduce stress include:

• Meditation
• Breathing exercises
• Yoga
• Tai chi/qi gong
• Spending time in nature
• Spending time laughing/being with friends
• Writing a list of things to be grateful for
• Exercising daily
• Simplifying one's life
• Accepting the things one cannot change
• Enjoy free time

Video: Channel 7 News: 7 Tips to Reduce Stress 

Defining Stress and Cardiovascular Disease

Stress: Stress can either be a psychological or physical response of the body that occurs when a person must adapt to a change. Stress is subjective because it is different for every person. What makes a person stressed and to what extent is different for everyone, but the way the body responds is relatively similar. When a person feels psychologically stressed, the body increases the hormones of adrenaline and cortisol into the bloodstream. This causes the heart rate to rise, redirect blood flow, change the consistency of blood and heightens senses. While there are controversies over the issue, some believe that stress can lead to a higher risk for developing, and may cause cardiovascular disease.

Cardiovascular Disease (CVD): Cardiovascular Disease is defined as an abnormal function of the heart or blood vessels. Cardiovascular disease puts a person more at risk for heart attacks, heart failure, stroke, cardiac rhythm problems, and sudden death.