17 April 2024
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Stress – The Great Precipitant

Dr Ross Walker
31 January 2022

I often state, “it is your genes that loads the gun but your environment that pulls the trigger.” Although the evidence is clear that all modern diseases have a strong genetic basis, it is also clear that environmental triggers can either precipitate, aggravate or progress underlying conditions.

I have been practising medicine for 40 years and have not seen one patient during that time who has suffered a heart attack, stroke, needed a coronary stent or bypass operation who wasn't under some form of stress at the time.

There are five categories of stress but, for the purposes of this article, I would like to focus on the first and, in many ways, most important form, which is emotional stress.

A number of studies over the past decade or so have highlighted the importance of relationship stress and its ability to precipitate illnesses, especially cardiovascular diseases.

Recently, a large study published in the Journal of Epidemiology and Community Health from Denmark followed just under 5000 participants aged 48 to 62, over a 26 year period. This was part of the Copenhagen Aging and midlife bio-bank study. The study ran from 1986 up to 2011 and clearly showed that relationship breakdowns, living alone, if you feel lonely, markedly increases inflammatory markers in the bloodstream, which are clearly related to the precipitation of cardiovascular events such as a heart attack or stroke.

Having two or more relationship breakdowns during the follow-up period led to a 17% increase in inflammatory markers and living alone for more than seven years was associated with a 12% increased level of inflammatory markers.

Strangely, this effect only appeared in males and was not seen in the female population. There are many reasons proposed for this sex difference and in my opinion, these are multifactorial. Men who are experiencing relationship stress, tend to eat poorly, not exercise and have an increased risk of substance abuse, both legal and illegal.

Women, on the other hand, in general, tend to take better care of themselves and would prefer to be by themselves rather than involved in a chronic, hostile relationship and thus experience less stress when the relationship finishes.

The chronic stress of poor relationships or relationship breakdown leads to an abnormal cortisol response which tends to increase inflammation and also weaken blood vessels.

Interestingly, the reverse also appears to be true. One of the longest epidemiologic studies in the world is the Grant trial performed at Harvard University which extended for 75 years and this clearly showed that the one key to health and happiness is to have someone else in your life who loves and cares for you, whom you love and care for.

In summary, the best thing you can do for your own health is to love your partner. Regularly talk and validate each other and do not hide issues that are causing you concern. Learn to listen and also enjoy all aspects of your physical relationship including hugging, holding hands and the more intimate forms of passion.

Rather topically, it has been shown that people involved in a satisfying relationship have an improved vaccination response.

We have been told for many years that the key to managing cardiovascular disease is to control your cholesterol, blood pressure and not to smoke, along with keeping your weight in the ideal range. Although I believe all of these goals are very laudable and should be part of every person’s health regimen, I have been saying for many years and will continue to say that the most important drug on the planet is happiness. Many aspects of happiness extend from having a long-term, healthy and enjoyable relationship.

The data shows that this is even more important than controlling standard risk factors for heart disease.

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