Stress levels associated with huet - Opito

4.5 IMPACT OF STRESS ON HEALTH STATUS
Stress due to exits
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As described earlier, stress generally means the mental and physical response of the
body to demands placed upon it. There is an optimal level of arousal that means that a
little stress will help the body to react to a challenge or threat, whereas an excessive
response to a stressor can have negative effects.
When considering the health impact of stress, the main concern for most people, and the
concern with the greatest potential impact is the risk of coronary heart disease. There are
now known to be many coronary risk factors. Action can be taken by the individual to
reduce some of the major factors that include smoking, high blood pressure, high blood
cholesterol and physical inactivity. The main risk factors particularly associated with
sudden cardiac death are reported to be an elevated resting heart rate (≥ 90 beats/min),
heavy drinking and arrhythmia/irregular heart beat (Shaper et al, 1993; Wannamethee et
al, 1995).
Most of the literature considering the effects of stress on coronary health focuses on
chronic psychosocial stressors such as work control, personal relationships and life
events such as bereavement. Effects of anxiety on the risk of coronary heart disease
have concentrated on trait anxiety, referring to how prone an individual may be to anxiety
and differences between people in their background tendency to respond to perceived
threatening situations. A number of large prospective studies have shown an association
between chronic anxiety and fatal coronary heart disease, in particular, sudden cardiac
death (Haines et al, 1987; Kawachi et al, 1994; Albert et al, 2005). There are a number of
possible causes. It has been suggested that acute stress, such as bereavement, may
trigger irregular heart rhythms and myocardial ischaemia (restricted blood flow to the
tissues of the heart) (Rozanski et al, 1999). Rozanski et al (1999) recognised that
psychosocial stresses tend to cluster together and when they do so, the resultant risk for
cardiac events is often substantially elevated. These authors also commented on the
impact of 'sudden' stressors (e.g. a high work-load exercise test without warm-up)
compared to 'graded stressors (e.g. graded exercise test with increasing work-loads). It is
significant that the severity of cardiac events found in the graded stressor was much less
than that found with the sudden stressor. It can therefore be supposed that 'graded'
training will benefit the health of trainees. It has also been recognised that psychological
factors usually have no acute deleterious effects in the normal heart, whereas in the
diseased heart, the consequences may be hazardous (Hartel, 1987). In many cases of
sudden death, there was a history of previous myocardial infarction or known
cardiovascular disease (Greene et al, 1972).
A lower level of risk was proposed by Bunker et al (2003). An Expert Working Group of
the National Heart Foundation of Australia undertook a systematic review of the evidence
relating to major psychosocial risk factors to determine whether there were any
independent associations between any of the risk factors and the development or
progression of coronary heart disease or the occurrence of acute cardiac events. The
group fond "no strong or consistent evidence for a causal association between chronic life
events, work-related stressors (job control, demands and strain), Type A behaviour
patterns, hostility, anxiety disorders or panic disorders and coronary heart disease". They
compared the increased risk contributed by these factors as being of similar order to
factors such as smoking and hypertension.
Whatever the true level of risk, it should be recognised that psychosocial support, regular
exercise, stress reduction training, a sense of humour and optimism have all been cited as
means of reducing the risks of stress on cardiovascular health (Das & O'Keefe, 2006).
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