Family Stress Linked to Angina Pain

Study Shows Demanding Relationship With a Partner May Have an Impact on Heart Health

By Salynn Boyles
WebMD Health News

Reviewed by Laura J. Martin, MD

Dec. 23, 2010 -- Just in time for those holiday family gatherings comes news that family stress -- especially stress involving spouses and children -- may hurt the heart.

People in a Danish study who reported having a worrisome or demanding relationship with a partner had a more than threefold increased risk for developing the severe chest pain condition known as angina.

Angina is both a warning sign and symptom of heart disease.

Researchers followed more than 4,500 men and women in their 40s and 50s with no known heart problems for six years. Those with the most stressful close family relationships had the highest risk of developing angina.

Study researcher Rikke Lund, MD, PhD, says it has long been known that positive social relationships are good for the heart. "We wanted to look at it another way and examine the impact of difficult social relationships on cardiovascular risk," she tells WebMD.

Family Stress and the Heart

The randomly selected study participants were followed from 1999 to 2006, when they were asked about both their heart health and the quality of their relationships with the people in their lives, including partners, children, other relatives, friends, and neighbors.

Participants were specifically asked about the level of demand placed on them by family members and friends, the degree of worry associated with each relationship, and the degree and frequency of conflict.

During the six years of follow-up, roughly one in 10 study participants developed chest pains associated with angina.

Not surprisingly, older participants were more likely to report the condition than younger ones.

Having a worrisome or demanding relationship with a spouse or partner was associated with a more than 3.5-fold increase in angina risk, while a similar relationship with a child was associated with a twofold increase in risk.

The association was not quite as strong for other family members, and the impact of worries and demands involving non-family members was negligible.

Surprisingly, conflict with family members was much less strongly linked to angina risk than being in a worrisome or demanding relationship. People who reported having frequent arguments with a partner had a 44% increase in angina risk.

Second Opinion

Psychologist William R. Lovallo, PhD, who wrote the 2004 book Stress and Health: Biological and Psychological Interactions, says the study provides more evidence linking social relationships with health.

But he adds that it is not clear if the quality of these relationships has a direct impact on conditions like angina.

Lovallo is with the Veterans Affairs Medical Center in Oklahoma City and the department of psychiatry and behavioral sciences at the University of Oklahoma Health Science Center.

"It is tempting to assume that bad social relationships cause medical symptoms, but we have to be careful about making this association," he tells WebMD.

Lovallo cites earlier research by the same investigators suggesting a link between hostility and poor health.

"It would come as no surprise that people who are hostile by nature would have more difficulties in social relationships," he says. "So it may not be the social relationships that lead to symptoms like angina."

But cardiologist Nieca Goldberg, MD, says stress clearly has a negative impact on the heart. She says it is increasingly clear that interventions to relieve stress, such as meditation and cognitive behavioral therapy, can benefit the heart.

"The biggest challenge for me is getting patients to accept that they need to take steps to lower stress," says Goldberg, who is a spokeswoman for the American Heart Association. "I live and work in New York City where most people view stress as a fact of life. But worry and stress are not good for the heart, no matter where you live."

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SOURCES: Journal of Epidemiology and Community Health, 2010.Rikke Lund, MD, PhD, Section of Social Medicine, Institute of Public Health, University of Copenhagen, Denmark.William R. Lovallo, PhD, Veterans Affairs Medical Center; department of psychiatry and behavioral sciences, University of Oklahoma Health Science Center, Oklahoma City.Nieca Goldberg, MD, cardiologist, Total Heart Care, New York.News release, BMJ Journals.Ulla, C. and Lund, R. Psychosomatic Medicine, 2004; vol 66: pp 572-577.

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