The Stress and Heart Attack Connection

Michelle Routhenstein, MS, RD, CDE


July 17, 2023

Can stress cause a heart attack? Not on its own, but it can certainly play a role in how healthy your heart is and your risk of a heart attack. Stress is powerful, but so are you. Understanding the connection between stress and your heart health can help you implement preventive lifestyle habits. 

How Stress Impacts Your Body

Stress is all around us and we’re all impacted by it uniquely. There’s a difference between short and long-term stress, including the symptoms we might experience. Your body is poised and ready to respond to stressors to keep you safe from perceived danger.

Acute vs. Chronic Stress

Acute stress is short-term and might even be described as exhilarating or helpful. This might be something like preparing yourself to go on a rollercoaster ride or give a public speech. Acute stress comes and goes without significantly impacting your health.

Chronic stress is long-term and ongoing. For example, working a job or in an environment you really dislike, or being in a toxic relationship, can induce chronic stress. This stress can take a toll on your physical and mental wellness, including the health of your heart. 

The Stress Response

A physiological response takes place in your body every time you’re up against a stressor. This happens to protect you from harm.

The stress response is regulated by the hypothalamic–pituitary–adrenal (HPA) axis. It’s connected to the endocrine and central nervous systems, which work together to adjust the balance of hormones. 

One stress hormone is cortisol, which is released when the HPA axis is activated. Cortisol sends more blood to your muscles, increases your blood sugar, and raises your blood pressure as part of your “fight or flight” preparation. There’s a negative feedback loop in which high cortisol levels tell the HPA axis to stop producing it when the stressful event has passed.

Symptoms of Stress

Most of us describe stress as feeling overwhelmed or struggling to cope with mental pressures. It may also have physical manifestations. 

Symptoms of stress can include: 

  • Trouble falling asleep and/or disrupted sleep
  • Fatigue or low energy
  • Irritability and little patience
  • Reduced libido
  • Low mood

Long-Term Health Effects of Stress

Prolonged stress doesn’t feel good, nor does it have any health benefits. While cortisol is helpful in the short term, it’s not meant to remain elevated. When it’s triggered over and over again, this can adversely affect heart health.

Chronic stress can raise blood sugar levels as well as the release of insulin. Over time, this can promote insulin resistance. Notably, 70% of people who have heart attacks are insulin resistant. 

Other long-term effects of stress can include inflammation, increased blood pressure, and reduced blood flow to your heart. This mix of factors can become a perfect storm for a heart attack. 

Can Stress Cause a Heart Attack?

The idea of having a stress heart attack is misleading, as many factors are involved. Still, stress can be a trigger. Many people are living with heart attack risk factors. I often see that a stressful event or unmanaged chronic stress is ultimately what triggers a heart attack.

Other common heart attack risk factors include: 

So can stress cause a heart attack? Not directly, but research supports the notion that chronic stress can increase your risk. 

In a 2021 analysis in JAMA, researchers examined over 900 patients with underlying heart disease. The goal was to understand how blood flow to the heart responds to mental and emotional stressors. 

The participants underwent standardized stress tests and the researchers measured the blood flow to their heart. Mental stress took a large toll on the heart during stress tests. Those faced with mental stress had a higher likelihood of having a heart attack. They were also more likely to die of cardiovascular disease for years following the stressful experience. 

In other words, unmanaged stress can put you at risk of having a heart attack in both the short and long term. Having stress management practices in place is key. 

Putting it into Practice

A 50-year-old woman came to see me two weeks after she had a massive heart attack. Her heart attack was complicated with pericarditis and she was having a hard time catching her breath. She was overwhelmed with all of the diet information out there and was scared to eat in fear that she would have another heart attack and it would exacerbate her pain. 

She joined my VIP program and we worked closely together to optimize her lifestyle and diet through science-based nutrition. She had no recent blood work since she hadn’t gone for a physical in several years. She was on vacation when the heart attack happened, but had mentioned that she had prolonged personal stress before then. The stress likely contributed to her other risk factors that led to her heart attack, even if it wasn’t solely a stress heart attack.

There was clear underlying inflammation that was a proponent of her cardiac event given her increased waist circumference of 44 inches, pericarditis, and the complete blockage in the LAD artery. 

We worked on reducing inflammation, oxidative stress, insulin resistance, and optimizing all potential risk factors to reduce her risk of future cardiac complications. She decreased her waist circumference by 4.5 inches in 1 month which was a clear indication of a reduction in inflammation. 

Her shortness of breath resolved. She texted me right after her 2-month post-heart attack appointment with her cardiologist saying that he is beyond thrilled with how her heart looked, the strength she gained, her recovery process, and her laboratory results (LDL was 67mg/dL (target post-heart attack <70mg/dL), non-HDL cholesterol which assesses more for atherogenic plaque potential was 81mg/dL (target post heart attack <80-100mg/dL).

Stress Management for Better Heart Health

We can’t get rid of stress. However, you can work to identify when stress is present, become aware of what’s triggering it, and find management tools to bring down your cortisol levels. 

The most success will be had when you can adopt everyday habits, like: 

  • Improve your sleep. Not getting enough quality sleep — the recommended 7-9 hours — can promote increased cortisol. Consider creating a more sleep-promoting space, adhering to a regular sleep-wake schedule, and avoiding screens near bedtime. Blue light emitted from technology can interrupt the circadian rhythm. 
  • Rest. We live in an on-the-go moment that’s easy to get caught up in. Instead, try to schedule rest as part of your regular routine. Perhaps this looks like taking space to meditate first thing in the morning or sitting outside on your patio in the evening. Rest is healing and can help your body relax. 
  • Design a heart healthy diet pattern. Eating mostly minimally-processed foods, including fruits, vegetables, nuts, seeds, legumes, whole grains, and lean proteins in a balanced way that meets your nutrients needs can help reduce inflammation and support your immunity, healthy arteries, blood pressure, blood sugar, and blood lipids.  If you need help with this, work with a registered dietitian who specializes in heart disease.
  • Stay active. Aim for at least 150 minutes of moderate-intensity exercise per week, which might include a combination of jogging, playing tennis, swimming, or dancing. Resistance training is particularly beneficial for heart health, as studies show it can help increase exercise tolerance and reduce high LDL, lowering cardiovascular mortality by 40%.
  • Find your people. It’s okay to have time alone, but we were never meant to do life in isolation. Research shows that the support of a community is critical to our longevity
  • Don’t smoke or consume alcohol excessively. Vapors from smoking can contribute to lower HDL, higher HDL, a higher risk of blood clots, and damage to blood vessels and arteries. Excessive alcohol can damage the structure and function of the heart. 
  • Seek mental health support. Most of us have something we could benefit from speaking to a therapist about. Carrying around wounds and burdens can negatively impact your long-term wellness. Furthermore, struggling with a medical diagnosis can be overwhelming and trigger health anxiety. Counseling can be effective for addressing stress from this as well. 


Can stress cause a heart attack? It’s not the only piece of the puzzle but can be a significant one, especially when other risk factors are at play. Understanding your stressors and how they impact you, and then adopting effective management tools, are crucial. 

If you want to take a proactive approach to reduce your risk of a heart attack and optimize your heart function, consider my Heart Optimization Group Program. I’d love to help you!


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