Previous Event: 11th April 2013

Eat your heart out by marie ll licensed Creative Commons

The impact of stress and other related unsatisfactory work lifestyles which adversely affect the heart

The Impact of Stress

Prof Jamie Vandenberg, B.Sc.(Med.), M.B.B.S., Ph.D. (Cantab)
Deputy Director of the Victor Chang Cardiac Research Institute,

Professor Vandenberg began his presentation with a brief rundown of the history of the Victor Chang Institute and research into coronary heart disease. While research covers all forms of heart disease, the focus is on those that affect the heart’s muscle tissue. These are the diseases that directly affect the heart’s ability to pump enough blood for the body’s needs, and can cause electrical disturbances (arrhythmias) that, in their severest form, can lead to sudden death.

In addition, programs address vital contemporary issues – including heart development and congenital heart disease, inherited heart diseases, the potential application of adult stem cell technologies in cardiovascular care, and how heart function is regulated in response to stresses like high blood pressure and aging.

Initially people believed that stress was the major course of heart disease. When Professor Vandenberg started his training the understanding of how stress related to heart disease was limited. Science and medical developments have been extremely significant in the past 50+ years.

Why did people believe that stress was the major cause of heart disease?

There is a need to examine 3 major questions in order to answer this question

1. What are the real risk factors?
2. What are the changing demographics of Heart Disease?
3. And is there an element of truth in the stress theory?

 Professor Vandenberg showed a graph that outlined the number deaths from Coronary Heart Disease over the time period from 1905 to present. The graph showed a dramatic increase in the post war period with 1960’s being the peak in the incidence of deaths.  

Professor Vandenberg then proceeded to examine several significant studies into Coronary Heart Disease and the impact of those events.

1. The Framingham Heart Study is a long-term, ongoing cardiovascular study on residents of the town of Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants. Prior to it almost nothing was known about the “epidemiology of hypertensive or arteriosclerotic cardiovascular disease”. Much of the now-common knowledge concerning heart disease, such as the effects of diet, exercise, and common medications is based on this longitudinal study. It is a project of the National Heart, Lung, and Blood Institute, in collaboration with (since 1971) Boston University.
2. Development of Beta blockers, also called beta-adrenergic blocking agents, which are still commonly used to treat a variety of conditions, such as high blood pressure, glaucoma and migraines.
3.  Desmond Julian- The concept of the Coronary Care Unit (CCU) had been pioneered by Dr Desmond Julian who set up the first CCU in Sydney in 1961.  Key parts of the CCU concept included continuous ECG monitoring, the availability of immediate CPR if required, having an IV drip in situ, and prevention of thromboembolism.
4.  Goldstein and Brown 1973 elucidated the role of LDL receptors in cholesterol metabolism. This work led to the development of Statins Recognizing risk factors and drugs development

 Professor Vandenberg then identified two groups of risk factors for Coronary Heart Disease and the significance of these to Coronary Heart Disease

Factors we can’t control

• Age  (85%> 60yrs old)- Men go up from 30 yrs- Women from menopause
• Male
• Family History

Factors we can control

• Overweight 60%
• not sufficiently  active 54%
• high Blood Cholesterol 51%
• High Blood pressure 30%
• Smoking 20%
• Diabetes 8%

  

What can you do about it?

Professor Vandenberg suggested we look at the factors we can change

1. Smoking is one of the most dramatic changes to the incident of Coronary Heart Disease
2. Exercise-The beneficial effects of exercise last for about 48 hours. Prof Vandenberg suggested that a brisk walk of about 20 to 30 minutes, 3 times a week was a good starting point. Better if you exercise every day.
3. Sedentary behaviour was discussed with figures showing that by standing rather than sitting you increased the metabolic rate by 100%. Reducing or breaking up sitting time important.

Victor Chang Institute has set up Heart Health Check booths with the support of HCF to tests

                                          i.    Blood pressure

                                        ii.    Serum Cholesterol

                                       iii.    Blood Sugar levels

 There is an element of truth in the stress theory of cardiovascular disease

a. Stress causes release of both adrenocorticoid (cortisol) and catecholamine hormones (adrenaline and nor-adrenaline).

b. Stress influences cardiovascular risk in four ways

1. Indirect effect on risk factors. People under stress tend to exercise less, have a less healthy diet etc,
2. Direct effect on vascular reactivity (facilitating development of atherosclerosis) – this effect however is relatively small
3. Trigger for cardiac events – especially increases the risk of cardiac arrhythmias and sudden cardiac death
4. Increases the risk of recurrent events and sudden death

ß-blockers, which reduce the response to catecholamine hormones, are one of the most effective drugs for reducing the risk of sudden death in patients who have had a previous myocardial infarct.

 Various questions were raised and discussed relating to specific medications, depression and Heart Disease, alcohol and weight.