IS STRESS THE NEW CHOLESTEROL?
It’s time cardiologists began to address emotions to treat heart disease, says expert
It can go dark during despair, feel heavy under stress, beat like a drum when angry, sink like a stone in grief and nearly stop under shock. In fact, sometimes, it does stop due to shock. And the person dies. The heart, an astonishing feat of nature’s engineering, can just as suddenly give up its beat due to grief, stress, loneliness or shock as it would to scaled-up levels of cholesterol, LDL, and triglycerides. And yet, there is an overwhelming emphasis on gearing up the entire heart disease management apparatus to address the physiological markers, to the near exclusion of the role of emotions in the field of cardiology.
One cardiologist, however, is pushing for a change in outlook.
Dr Sandeep Jauhar, a US-based cardiologist and author of Heart:
A History, believes it is time cardiologists devoted more attention to the emotional make-up of patients. What does the map of their feelings look like? Are they in an unhappy relationship? Are they lonely? Are they stressed by work, finances, a divorce, the loss of a spouse?
Dr Jauhar’s book overlaps emotional health and heart health, delving into the history of cardiovascular medicine and its remarkable technological advances, from open-heart surgery to the artificial heart. The mechanistic approach to treating heart diseases, Dr Jauhar believes, has helped CVD (Cardiovascular diseases) mortality drop significantly over the last century. “There have been great success stories,” said Dr Jauhar, speaking to Gulf News from New York.
But we must look beyond the mechanistic progress, he says.
“If we are to continue with that kind of progress, we have to view the heart not just as a machine but also as an organ [that needs] a more nuanced approach,” he says. “The heart was transferred medically into [being viewed as a] machine and we need to return to the emotional [mode].”
The heart, says Dr Jauhar, has been considered an emotional organ for most of history.
The reason cardiologists shy away from tackling the emotional aspect, he believes, is because it is difficult to handle. “There is no one prescription [to treat] emotional response to stress. Each individual is different.” But the point is to at least raise the issue of emotional stress with heart patients, he says. “Patients listen to their cardiologist.” He’s found significant merit in spending time talking to his patients.
The history of heart disease management and treatment, he says, would have been a markedly different story had the landmark US Framingham Heart Study, started in 1948, also taken into account the emotional factors.
The Framingham investigators initially considered looking at psychosocial determinants of heart disease as well, but decided to focus only on measurables.
“What came out of it were the risk factors that we now know and treat,” Dr Jauhar says. “What was eliminated were things like emotional dysfunction and marital health.” That, according to him, was a mistake.
Has his book raised awareness on the issue? “Definitely,” he says. There has been “tremendous appreciation and it has opened a new door.”
But it’s hard to say if things will move in this direction soon enough. “Everything moves very slowly,” he says.
The heart was transferred medically into [being viewed as a] machine; we need to return to the emotional [mode].” Dr Sandeep Jauhar | US-based cardiologist and author, Heart: A History