Stress does bad things to the heart. New studies have found higher rates of cardiac problems in veterans with PTSD, New Orleans residents six years after Hurricane Katrina and Greeks struggling through that country's financial turmoil.

Disasters and prolonged stress can raise "fight or flight" hormones that affect blood pressure, blood sugar and other things in ways that make heart trouble more likely, doctors say. They also provoke anger and helplessness and spur heart-harming behaviors like eating or drinking too much.

"We're starting to connect emotions with cardiovascular risk markers" and the new research adds evidence of a link, said Dr. Nieca Goldberg, a cardiologist at NYU Langone Medical Center and an American Heart Association spokeswoman.

She had no role in the studies, which were discussed Sunday at an American College of Cardiology conference in San Francisco.

The largest, involving 207,954 veterans in California and Nevada ages 46 to 74, compared those with PTSD, or post-traumatic stress disorder, to those without it. They were free of major heart disease and diabetes when researchers checked their Veterans Administration medical records from 2009 and 2010.

Checked again about two years later, 35 percent of those with PTSD but only 19 percent of those without it had developed insulin resistance, which can lead to diabetes and hardening of the arteries.

Doctors also saw higher rates of metabolic syndrome — a collection of heart disease risk factors that include high body fat, cholesterol, blood pressure and blood sugar levels. About 53 percent of veterans with PTSD but only 37 percent of those without it had several of these symptoms.

The numbers are estimates and are not as important as the trend — more heart risk with more stress, said one study leader, Dr. Ramin Ebrahimi, a cardiologist at the Greater Los Angeles VA Medical Center and a professor at UCLA. It shows that PTSD can cause physical symptoms, not just the mental ones commonly associated with it.

"Twenty or 30 years ago PTSD was a term reserved for combat veterans. We have come to realize now that PTSD is actually a much more common disorder and it can happen in veterans who did not undergo combat but had a very traumatic experience" such as losing a friend, he said.

That goes for others who suffer trauma such as being raped, robbed at gunpoint or in a serious accident, he said. Nearly 8 million Americans have PTSD, the National Institute of Mental Health estimates.

They include survivors of Hurricane Katrina. Tulane Medical Center doctors led a study of their hospital's patients that suggests heart attack incidence is three times higher in New Orleans than it was in the two years before the 2005 storm.

Heart attacks made up 2.4 percent of admissions in the six years after the storm compared to just 0.7 percent before it. The post-storm patients were more likely to be unemployed or uninsured, to smoke, and to have depression, anxiety or high cholesterol, resarchers found.

 A third study found that heart attacks rose sharply in the Messinia area of southwestern Greece since January 2008, the start of that country's financial crisis. Researchers compared medical records of more than 22,000 patients admitted to the General Hospital of Kalamata — the only hospital with a cardiology department in the region.

There were 1,084 heart attacks in the four years after the crisis began compared to 841 in the four years before it, even though the population and its demographics remained the same.

Heart attack incidence rose 40 percent among women, who have higher unemployment rates than men and tend to be more responsible for child care — a double burden of stress, said the lead researcher, Dr. Emmanouil Makaris.

By Genevra Pittman
Reuters
The proportion of patients who have blocked arteries show up during a stress test has dropped "enormously" over the past two decades, according to a new study. 

However, researchers disagreed about why that might be the case - whether the tests are getting worse, people's heart problems are becoming less severe, or simply too many healthy people are being referred for testing they don't need.

On a stress test, doctors monitor a person's heart and blood vessels during exercise or after administering a combination of drugs that similarly stress the heart. The exams are used to make a more definitive diagnosis among patients who have some signs of a blockage but not enough to warrant treatment, such as with artery-opening stents.

For the new study, researchers tracked close to 40,000 people who underwent stress testing to look for blocked arteries at Cedars-Sinai Medical Center in Los Angeles between 1991 and 2009.

During that period, the proportion of referred patients with an abnormal test fell from about 41 percent to less than nine percent. Similarly, the proportion with moderate to severe blockage dropped from 21 percent to five percent, according to findings published Monday in the Journal of the American College of Cardiology.

In the study's later years, more patients undergoing testing were obese or had diabetes, the research team found, but fewer smoked.

The researchers, led by Dr. Alan Rozanski from St. Luke's Roosevelt Hospital in New York City, suggest the findings may mean fewer people with heart-related symptoms, such as chest pain, now have blockages. Or it could be that doctors need a better test to diagnose those patients.

Dr. Patrick O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, had a different interpretation.

"The fact that the results are changing over time can only mean one thing, and that's that we're overusing this test," O'Malley, who wasn't involved in the new research, told Reuters Health.

"I think it represents a culture of testing that has been sort of an epidemic in this country."

It could be that more people with mild or non-traditional heart disease symptoms - such as shortness of breath - are being sent to stress testing when it's unlikely to reveal any problems, O'Malley said.

The majority of tests performed in the most recent years used medication rather than exercise to stress a patient's heart, Rozanski's team found. Rozanski did not respond to requests for comment before deadline.

So-called pharmacologic stress tests are typically three to four times more expensive than an exercise stress test, according to O'Malley. He thinks they should largely be limited to people who aren't able to walk on a treadmill.

According to the Healthcare Blue Book, an exercise stress test costs about $200, depending on the hospital.

The use of more expensive tests - in likely less appropriate patients - reflects how "obsessed" heart doctors have become with finding and treating any small abnormalities, O'Malley said.

"If the prevalence of (positive test) results are going down, it just means we're doing too many, and we're doing them on people we shouldn't be doing them on," he said. 

By Andrew M. Seaman
Reuters
A man's ability to produce sperm may depend on his ability to handle stress, according to a new study from Italy.

Researchers found that men with higher levels of both short- and long-term stress and anxiety ejaculated less semen and had lower sperm concentration and counts. Men with the highest anxiety levels were also more likely to have sperm that were deformed or less mobile.

But one fertility researcher not involved in the new work said it's hard to know how the results apply to the general population because the research included men who were already seeking treatment at a fertility clinic.

"Do you become stressed from becoming infertile or is stress causing infertility?" asked Tina Jensen from Rigshospitalet in Copenhagen, who has studied the effects of environmental factors on sperm quality.

Previous research has found that men going through fertility treatment or evaluation have higher stress levels than the average person, and some studies have also shown links between stress and sperm quality, according to the Italian researchers, led by Elisa Vellani of the European Hospital in Rome.

But no one had looked at whether short increases in a man's stress and long-term anxiety had differing effects, Vellani and her colleagues write in the journal Fertility and Sterility.

For the new study, the team recruited 94 men who were visiting the hospital's fertility clinic for the first time, and 85 other men who were not seeking fertility treatments as a comparison group.

Each man provided a semen sample for analysis. The men then answered two surveys that measured their current stress and long-term anxiety on scales ranging from 20 to 80 points, with higher scores indicating greater stress or anxiety.

On average, men in both groups scored between 37 and 40 on the tests, which is not considered "pathological," the researchers note.

When Vellani's group compared the 28 men with the lowest stress and anxiety levels to the 40 men with the highest levels, however, they found the stressed men were more likely to have lower sperm concentration and counts. The most stressed men's sperm we also more likely to be immobile and slightly more prone to DNA breaks.

"Taken together, our observations strongly suggest that (stress and anxiety) may represent a significant factor involved in male fertility," wrote the researchers, who did not respond to requests for comment.

They note in their report, however, that the association between stress and sperm quality was weaker in men who were not seeking fertility treatment, and who also seemed to have better sperm quality anyway.

For example, men seeking fertility treatment produced about 29 million sperm per milliliter of semen, compared to approximately 52 million sperm per milliliter produced by the men in the comparison group.

By the World Health Organization's standards, anything above 15 million sperm per milliliter is considered normal.

Vellani and colleagues conclude that "social and psychological factors" should be considered when assessing possible causes of infertility and addressed as part of infertility treatment.

Jensen said that it's hard to tell how different the most and least stressed men were based on the study report, but agreed that the results are probably most relevant to men who are going through fertility treatment, which she said is itself very stressful.

"Generally, for normal men it's not important," Jensen said.

I’m stressed, you’re stressed, your partner is stressed, even our pets are stressed. But according a new survey from the American Psychological Association, the most stressed generation of adults in the nation is also the youngest.

So-called “Millennials,” defined here as American adults ages 18 to 34, reported higher stress levels than their parents’ and grandparents’ generations, and more Millennials said that their stress level had increased in the last year. And 52 percent of this age group even said stress had kept them up at night.

These new figures are from the APA’s annual report, Stress in America, which surveyed 2,020 American adults in a questionnaire conducted online by Harris Interactive in August 2012. The APA has commissioned the survey every year since 2007.

Generation Xers’ stress level was tied with Millennials, both reporting an average level of 5.4 on a 10-point scale, but slightly fewer Gen Xers, those aged 34 to 47, said their stress increased in the past year or was causing them to lose sleep.

It doesn’t take much imagination to figure out what young people might be stressing over: For one, the U.S. unemployment rate continues to creep higher, last week edging up to 7.9 percent. Some recent figures from the non-partisan group Generation Opportunity suggest the unemployment rate is even higher among 18- to 29-year-olds, at 11.5 percent, and only half of this age group believe they’ll be getting Social Security.

“Most of these young people have come out of college or graduate school with horrendous student debt into a job market where there are not very many jobs,” Katherine Nordal , executive director for professional practice of the APA, told “NBC Nightly News with Brian Williams.” “This has put their life plans probably on hiatus; they may be postponing marriage, postponing having a family.”

The APA survey found that 76 percent of Millennials surveyed by the APA say that work is a somewhat or significant stressor, compared to 65 percent of Gen Xers and 62 percent of Boomers. That’s a number that has been ticking upwards -- in the APA’s 2009 survey, for example, less than half of Millennials reported work as a somewhat or significant stressor.

And, as it turns out, young adults are not great at handling all this self-reported stress they’re under: Forty-four percent of both Millenials and Gen Xers say they’d experienced irritability or anger due to stress, compared to 36 percent of Boomers and 15 percent of what the APA deemed “Matures,” or Americans older than 67.

“Stress is a huge factor when we look at medical problems such as obesity, hypertension, diabetes, cardiac disease,” says NBC’s chief medical editor, Dr. Nancy Snyderman. That’s more bad news for younger Americans, who say they more likely than older generations to try to manage their stress by eating junk, drinking alcohol and smoking.

It's tempting to raise an eyebrow at the findings because the stress is self-reported: How are we sure that young people are really under as much stress as they say? To a certain extent, that doesn't really matter. If you perceive yourself to be under an incredible amount of stress, then that stress is real to you, says Gail Saltz, an New York City psychiatrist and frequent TODAY contributor. 

"I think that does have something to do about the acquisition of coping skills," Saltz says. "As you manage to get past things, your ability to look back as something else comes along and say, 'Well, I got through that' -- that goes a long way." 

We do seem to get better at managing stress as we age, according to the APA’s self-reported figures. While 29 percent of Millennials, 35 percent of Gen Xers and 38 percent of Boomers (adults aged 48 to 66) said they are doing an excellent or very good job at managing stress, half of those older than 67 thought they were doing a bang-up job of keeping their stress manageable. 

"There really is something to 'what doesn't kill you makes you stronger,'" Saltz says. 

Shelley Metcalf

Carlo Joyce, right, and Thomas Joyce share a moment on their wedding day on July 10, 2010.

As a teenager, Carlo Joyce’s relationship with his parents was strained. He’s gay, but hid that fact from family and most of his friends. So he usually found himself lying when his folks asked where he was going and with whom.

“After I came out at 19, things got better with my family,” he recalled. But then he joined the Marines and had to hide his sexuality all over again.

He had to go to strip bars to fit in, and when the other guys talked about sex, or dating, he had to be sure he changed the gender in his stories. “It was very stressful to live that double life,” he explained. “I always had to watch what I said.”

Now, in a study released today in the journal Psychosomatic Medicine, a team of psychologists and neurologists from McGill University and the University of Montreal has found that leading that double life affects physical and mental health. Gays, bisexuals and lesbians who disclosed their sexuality to family, friends and co-workers were psychologically healthier and had lower levels of a key stress-related hormone than those who were still “in the closet.”

That finding could help explain a remarkable study published last year by a group of researchers from Columbia University in the American Journal of Public Health. They found that after Massachusetts enacted its same-sex marriage law in 2003, there was a significant drop in medical and mental health care visits -- and therefore costs – incurred by gay men.

Lead author of the Montreal study, Robert-Paul Juster, a PhD student at the Centre for Studies on Human Stress at the University of Montreal, said “it seems to be that if you’re using more avoidance coping, and wishful thinking, then you get poorer health. If you aren’t dealing with the problem, it affects health in a negative way.”

On the other hand, dealing with the problem by transitioning from “in” to “out” can instill a great sense of accomplishment. “A rebirth happens that makes them feel much more empowered and conscientious” for having taken what many see as a risky action. That sense of empowerment can have ripple effects benefitting overall health and well-being.

Juster’s study was complex. It included 87 people with a mean age of about 25, 46 of whom were lesbian, gay, or bisexual, and 41 of whom were heterosexual. There were slightly more men than women.

All the participants completed a battery of psychological testing to gauge traits like depressive symptoms, chronic stress, burnout, anxiety and conscientiousness. Blood samples were taken by the researchers, and the participants collected their own urine and saliva at five time points each day for two consecutive days. These were tested for a series of 21 biomarkers related to immune function, metabolism, inflammation, the cardiovascular system, and the endocrine system.

When all the numbers were sifted, and differences like social and economic status were controlled for, it turned out that disclosed sexual minorities had fewer symptoms of depression.

They also had lower cortisol levels 30 minutes after waking. That’s important because cortisol, a key stress hormone, spikes about half an hour after we wake up, like an ignition spark getting us ready to face the day. But you don’t want too much or too little. Disclosed gay men and lesbians were just right. In fact, dislcosed gay men also had lower cortsone levels than straight men.     

Juster isn’t sure why, exactly. It could be because the gay men were in better physical shape. It could also be that because heterosexual men have never had to go through the stress of living life undercover, they’re less practiced at coping and so less resilient to life’s stress.

Joyce, now 33, and living in San Diego, has had a lot of practice. He’s an engineer at a large corporation. When he first started that job, he again hid his sexual orientation, from co-workers and bosses.

“It was like I was back in the closet,” he said. The hiding was self-imposed, but stressful all the same. “Once I did come out, it was much less stressful and I found great acceptance and support.” When he married his partner, many of his co-workers attended. (To clarify, the July 10, 2010, wedding was not a legal marriage as recognized by the state.)  “Life’s much easier,” he said.

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

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Each morning, 48-year-old Troy Prater starts his day by getting breakfast for his teenage triplets. On weekdays he checks homework and then hurries them off to school. Then it’s back home to take care of his mom, Ella, who suffers from Alzheimer’s disease. Life, Prater says, “is organized chaos.” 

Prater is among the millions of Americans who have stepped up to do the right thing and take care of family members who can’t take care of themselves. Unfortunately, most caregivers are spread so thin that they don’t have time to take care of their own needs, NBC's Dr. Nancy Snyderman reports.

“Caregivers don’t go to the dentist; they don’t get mammograms or annual checkups,” says Melissa Gartenberg Livney, a clinical
psychologist with the PENN Memory Center at the Perelman School of Medicine at the University of Pennsylvania. “So they get sick.”

Even worse, Livney says, “there’s some evidence that this kind of stress can contribute to the onset of dementia" which is why she and others are trying to encourage caregivers to get help, to find ways to take breaks, and to make and keep their own doctors’ appointments.

How many people have stepped up to take care of a family member?  

One survey found that nearly one third of American households had someone serving as an unpaid family caregiver. That adds up to almost 40 million households with a caregiver present, according to the 2009 survey conducted by the National Alliance for Caregiving in conjunction with the AARP.

Many of those caregivers are dealing with Alzheimer’s, which Livney says can be incredibly stressful.

"Alzheimer's disease is 10 or 15 years of slow and steady loss of the person you once knew," she says. "Caregivers often suffer in silence and feel guilty when they don't feel up to the work."

Currently, there are 5 million Americans who have been diagnosed with the disease, says Beth Kallmyer, vice president of constituent services at the Alzheimer’s Association. “And we estimate that there are 15 million people caring for them.”

Unfortunately, the number of Alzheimer's patients is growing. The Alzheimer’s Association estimates that there will be 16 million Americans with the disease by mid-century if nothing changes. And that means there will be even more of us taking care of spouses and parents suffering from dementia.

Prater, who juggles caregiving along with his normal responsibilities as a dad, acknowledges the dual roles can be very taxing.

“I’m running on adrenaline,” he says. “I’ve lost quite a few pounds.”

What's the answer to getting caregivers to care for themselves?

People like Prater need to ask for help, Kallmyer says. But most seem to feel that caregiving is something they need to do on their own. And that's a setup for disaster, she says.

“When you’re taking care of someone over a period of time, you can’t just soldier on,” Kallmyer says. “At some point your health will be impacted and that will keep you from being the best caregiver you can be. We often ask people, ‘If you get sick and land in the hospital then what is going to happen?’”

Kallmyer suspects that the urge to go it alone is part of the American character. She’d like to see that change.

So would Livney.

"[Caregivers] need to allow themselves to not be perfect," she says.  

They also need to learn to look after their own needs.

“People need to give themselves permission to take care of themselves,” says Livney. “That’s what we focus on. We don’t spend much time talking about the disease and functional aspects of caring for someone with dementia. We try to help people understand how to take care of themselves."

Rachael Rettner
MyHealthNewsDaily

Although stress is common among people with health problems, few primary care doctors take time to discuss ways to reduce stress with their patients, a new study suggests.

The results show just 3 percent of visits to primary care doctors include discussions of stress reduction, the researchers said.

That's much lower than the 60 to 80 percent of doctor's visits thought to involve stress-related health problems, the researchers said.

Stress counseling was also less common in the study than nutrition counseling, which occurred in about 17 percent of visits, physical activity counseling, which occurred in 12 percent of visits, and weight counseling, which occurred in about 6 percent of visits.

"The low rate of [stress] counseling points to potential missed opportunities, suggesting that physician counseling about stress has not been incorporated into primary care to the extent of other types of counseling," the researchers write today (Nov. 19) in the journal Archives of Internal Medicine.

Primary care doctors, already crunched for time during office visits, may feel they simply can't fit in a discussion about stress management, the researchers said. Indeed, office visits in the study that did involve such discussions were longer.

Changing primary care so that patients are treated by teams of doctors could address this issue, said study researcher Dr. Aditi Nerurkar, a primary care physician at Beth Israel Deaconess Medical Center in Boston. Physicians could partner with nurses and other health care providers who could counsel patients on stress, Nerurkar said.

Stress and disease
Studies have linked stress to high blood pressure levels, heart disease and heart attacks. In fact, another study published today in the same journal found a link between unemployment — a stressful circumstance — and an increased risk of heart attacks.

While stress does not necessarily cause these conditions, it may exacerbate them, Nerurkar said. Stress may also make diabetes harder to control, and affect how people perceive chronic pain.

Nerurkar and colleagues analyzed information from more than 34,000 visits to 1,263 physicians between 2006 and 2009. They looked to see whether the office visits included information on ways to reduce stress, such as through exercise or yoga, or if doctors referred their patients to a specialist to discuss stress reduction.

A little more than 1,000 of the visits included stress management counseling. Patients were more likely to be counseled for stress if they were experiencing a flare-up of a chronic condition, or if they had depression.

This suggests doctors are not preventing stress-related complications, but rather, counseling patients after the fact, the researchers said.

Does stress management work?
Offering stress counseling earlier could lead to better outcomes for patients, but more research is needed to study this, Nerurkar said.

Dr. Doug Campos-Outcalt, chairman of Family, Community and Preventive Medicine at the University of Arizona College of Medicine, said the results should be interpreted with caution, because the study only looked at whether stress counseling was being offered, not whether patients actually needed this counseling.

In addition, it would be important to know how often patients are helped by stress counseling, said Campos-Outcalt, who was not involved in the study.

Nerurkar said that because stress is a culprit in so many medical conditions, "we could all benefit in managing our stress better."

One recent study found that patients with heart disease who practiced meditation — a possible way to reduce stress — had a reduced risk of death during the study period compared with those who did not practice mediation, Nerurkar said.

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By MyHealthNewsDaily Staff

If you're stressed at work, a little yoga on your lunch break might just help.

A new study from the United Kingdom suggests yoga done at work can reduce stress levels and lower back pain.

The study involved 74 British government workers ages 25 to 64 who said they experienced stress and back pain that was somewhat bothersome. Participants were randomly assigned to practice either eight weeks of yoga, or no yoga.

People in the yoga group took part in a 50-minute yoga class once a week, either at lunchtime or after work. They could also practice yoga at home twice a week for 20 minutes using a DVD.

All participants completed questionnaires designed to assess back pain, stress levels and overall well-being.

At the beginning of the study, 10 people in the yoga group and eight in the control group said they had back pain. At the end of the study, just four participants in the yoga group reported back pain, compared to 13 in the control group.

In addition, participants in the yoga group had reported lower levels of stress and less sadness at the study's end, compared with those in the control group.

The findings agree with previous research showing that yoga can reduce stress levels and back pain.

The researchers, from the Bangor University in North Wales, noted that the majority of participants were women, so the findings may not apply to men. Also, the benefits in the yoga group may have been influenced by the placebo effect — the idea that a treatment is beneficial simply because patients believe it will work.

Future studies should examine whether yoga at work can reduce the number of sick days workers take, the researchers said.

"Integrating yoga into the workplace, at lunchtime or after work, may provide a time-effective, convenient and practical method for reducing the costly effects of stress and back pain," the researchers wrote in the Sept. 25 issue of the journal Occupational Medicine.

• 7 Ways to Reduce Job Stress
• 11 Tips to Lower Stress
• The Science of Yoga and Why It Works

Everyone knows stress can cause headaches and sleepless nights. But a new study suggests it can actually shrink your brain.

We’re not talking run-of-the-mill stressors here, like a looming deadline or a missed bus.

“These are bad things happening, like a relationship breakup, loss of a loved one, being held at gunpoint,” says Yale neurobiologist Rajita Sinha, senior author of the new report.

Simply feeling stressed-out was not linked to gray matter shrinkage. But feeling stressed-out combined with a history of stressful life events was.  In particular, stress was linked to markedly less gray matter than expected in a part of the prefrontal cortex that regulates emotion and self-control, not to mention blood pressure and blood sugar.

That shrinkage might serve as a red flag about a greater risk of chronic diseases such as high blood pressure as well as psychiatric disorders, according to the researchers. And maybe it’s already affecting brain function in the healthy individuals she studied, Sinha says.

In other words, the stresses of modern life are far more complicated than what our ancestors experienced. “You can say stresses are a part of life, so what’s the big deal?” Sinha says. But it is a big deal, she adds, because there’s extensive evidence that stress has contributed to the rise in chronic diseases.

Most human research about the impact of stress on brain structure has focused on patients with stress-related psychiatric disorders such as addiction and anxiety, according to the authors. Those studies have found decreased volume in the frontal lobe, considered the center of emotion control and personality.

But studies of the cumulative effects of stress on the brains of healthy people are rare, Sinha’s team writes in a paper published online this week in Biological Psychiatry.

The study enrolled 103 health adults ages 18 to 48. Researchers conducted structured interviews with the volunteers to collect information about stressful life events and subjective feelings of chronic stress.

The scientists then used MRI to scan the volunteers’ brains.

Whose brains shrunk more, men’s or women’s? You might think you know the answer, but the researchers don’t, because they didn’t have enough women to compare the sexes.

The take-home message, Sinha says, is that the better you cope with stress -- take a walk, call a friend -- the better off your brain will be.

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