Heart-to-Heart Talk--New Studies on the Subject

Carson McCullers told us that the heart is a lonely hunter, but three recent studies have taken a more clinical look at the vulnerabilities and strengths of the poets' and lyricists' favorite subject.

Caregivers' Risk of Heart Disease
More than half of American women will care for a sick or disabled family member at some point in their adult lives. Women are also 1 1/2 times more likely than men to perform labor-intensive and intimate care tasks.

The first study, published in the February 2003 American Journal of Preventive Medicine, found that women who spend nine or more hours a week caring for an ill or disabled spouse have an increased risk of coronary heart disease. "Although many caregivers describe their work in rewarding terms, an increasing number of studies have begun to suggest health risks," says Ichiro Kawachi, M.D., Ph. D., of the Harvard School of Public Health.

Kawachi and his colleagues collected data on caregiving and coronary heart disease for nearly 55,000 women enrolled in a long-term nurses' study. Questionnaires filled out by the nurses tracked how many hours each woman spent in caregiving activities each week and asked them to rate how stressful or rewarding their caregiving experiences were. Interestingly, the researchers found no association between how much stress or reward from caregiving the nurses reported and their risk of coronary heart disease. Despite this, according to the researchers, "The mental distress from seeing loved ones suffer, added to the stress from financial burdens and the pressures of juggling work with caregiving, may have contributed to the risk of disease in caregivers."

Caregivers may also have less time to look after their own health and fewer opportunities to seek social support outside their homes. According to the researchers, both these factors might contribute to an increased risk of heart disease.

The Role of Social Support in Protecting the Heart
Social support and its effects on heart health was the topic of a study of New York City traffic enforcement agents that was reported in the March/April 2003 Psychosomatic Medicine. According to researchers, social support at work is associated with lower blood pressure during the workday and smaller blood pressure increases during Work-related stressful moments.

Previous studies have identified emotional support from a network of family and friends as protective against cardiovascular disease, but the exact mechanism has long remained poorly understood. One of two predominant lines of thinking--called the buffer-effect model--suggests that social support protects against blood pressure and heart rate increases only under high-stress conditions. Study authors Elizabeth Brondolo, Ph.D., and William Karlin, Ph.D., of the department of psychology at St. John's University in Jamaica, N.Y., found evidence for this model, rather than the model that suggests social isolation has a negative effect on heart health in both stressful and nonstressful times.

You may wonder whether there are differences between men and women in this regard. Fact is, the researchers noted that males and females had different preferred sources of social support. Lower blood pressure among females tended to be linked with immediate supervisor support, and males tended to benefit from coworker support.

"Men may benefit more than women from coworker support because close social relationships may sometimes be a source of stress or demand for women," says Brondolo. Overall, though, she concludes, "The relations of workplace social support to workday blood pressure measurements may be complex in that they may depend on the source of workplace support, the gender of the participant, the level of stress in a given situation and the measure of cardiovascular response." Future research should take these moderating factors into account.

"Letting It All Out" May Help, Too
Men who outwardly express anger at least some of the time may be doing their health a favor: A new study, published in the January/February 2003 issue of Psychosomatic Medicine, suggests that occasional anger expression is associated with decreased risk of stroke and coronary heart disease.

Previous research has found that chronic anger is related to the development of coronary disease, but few studies have examined how different styles of expressing anger might impact the disease, according to the researchers. In this study, the more than 23,000 participants completed surveys that asked them to rate how often they behaved in certain ways when they were angry. They could choose from options such as "I argue with others" and "I do things like slam doors."

Men with moderate levels of anger expression had nearly half the risk of nonfatal heart attacks and a significant reduction in the risk of stroke, compared with men with low levels of anger expression. In the case of stroke, the researchers found that the risk decreased in proportion to increasing levels of anger expression.

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