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Stress and Cardiovascular Disease

Recognizing and Lessening the Impacts of Stress on Heart Disease Risk

Heart Disease affects the lives of over 125 million Americans


We’ve all heard about cholesterol increasing our risk, but what about stress?


What kind of “stress” will increase our risk?


What if there were ways to reduce the impacts of stress and lower your heart disease risk?


Chances are you or someone you know suffers from cardiovascular disease. Unfortunately, it affects millions of us. It can be scary to think about or even talk about. You’ve most likely heard of improving your diet, exercising, and taking any prescribed medications to lower your risk. But, what about stress?

It turns out that stress has a significant impact on cardiovascular disease risk. The good news is that we have some control over our response to the inevitable stress that we will encounter throughout life. By working on our stress response, we can lower the impacts it has on our health and reduce our risk of heart disease.


In addition to continuing to work on a whole foods diet low in processed foods and exercising modulating our stress response can give us one more tool to lower our risk and improve our quality of life.


  • Cardiovascular disease affect the lives of over 125 million Americans

  • Chronic stress is associated with an increased risk of cardiovascular disease

  • Stress reduction strategies like exercise, social connection, enough sleep and relaxation techniques can all improve our response to stress

  • By changing our response to stress, we can improve our cardiovascular health


Cardiovascular Disease, what is it and just how common is it?


Cardiovascular diseases involve the heart and blood vessels, and include heart disease, heart failure, stroke and high blood pressure. According to the latest statistics from the American Heart Association, over 125 million Americans have some form of cardiovascular disease, and costs to our healthcare system and individuals totaled over $350 billion. Unfortunately, cardiovascular disease takes more lives each year than all forms of cancer and chronic lung disease combined.


What does Lifestyle and Stress Have to Do with Heart Disease?


There are several lifestyle factors such as exercise and nutrition that can have an impact on an individual’s risk for cardiovascular disease. Another often under recognized factor is stress. According to the American Heart Association, chronic stress can be associated with an increased risk of high blood pressure, heart disease and stroke.

Stress does have an impact on the cardiovascular system. The physiologic changes from stress can cause constriction of blood vessels as well as elevation of heart rate, stress hormones (like cortisol and adrenaline) and blood pressure. These effects over time can contribute to a higher risk of hypertension and cardiac disease. Chronic stress from diverse causes including external stressors as well as internal worries can have an effect. A few of these long-term stressors include work situations, family discord, ongoing noise exposure, living in urban environments and stress from social isolation. In addition to these long-term stressors, we are finding that “daily hassles” or day-to-day “micro-stressors” like sitting in traffic, waiting on hold, etc. can also play a role.

Research Examining the Association between Chronic Stress and Cardiovascular Disease:

The Interheart Study published in 2004 looked at potentially modifiable risk factors associated with heart disease in about 25,000 people from 52 different countries. One of the modifiable risk factor categories they examined was psychosocial stress. Stress was assessed by asking about financial stress, stress at work and stress at home. They found that those who reported “permanent stress” at work or home had more than two times the risk of developing heart disease.

Another study looking more closely at job related stress in particular found that those with higher work demands and a lower sense of control at work had higher stress levels, potentially contributing to a higher risk of cardiovascular disease. Other studies have looked more closely at marital stress/family stress and found this type of chronic stress was also associated with a higher risk of recurrent cardiovascular disease

Lifestyle Tips to Reduce your Risk for Cardiovascular Disease: A Focus on Stress Modulation:

For some general tips on nutrition and exercise, please see our blog.

Improving our Resilience to Stress:

For all of the unavoidable stressors in life, it’s become essential that we build our toolkit for resilience for our overall health and specifically for cardiovascular disease. There are many choices when it comes to working with our stress response that can help immensely. The American Heart Association recommends several strategies to help manage stress including: exercising regularly, meditation, yoga, social connection, getting enough sleep, and other relaxation techniques. This CDC website has some useful links to try out for some of these breathing and relaxation techniques. 

Here’s a summary of some resources to consider to modulate the stress response, let’s start with some that you can do on your own and implement at home:

  • Physiological Sighs explained by Dr. Huberman

  • Heart Rate Variability Biofeedback [link to our resources on HRV biofeedback/app when available]

  • Belly breathing

  • Meditation: there are a LOT of options here, Tara Brach has many resources available including meditations and a body scan

Here’s some other options that are more involved and may involve finding a practitioner:


While stress does not cause cardiovascular disease, it is important to recognize it as one potentially modifiable risk factor. Chronic stress and “daily hassles” are unavoidable for all of us, but there are many interventions that can help reduce their impact on our health.

Cardiovascular Disease and Heart Rate Variability: How self-directed HRVB can have positive effects on Cardiovascular Disease Outcomes

The Research Behind HRV, HRVB and Cardiovascular disease:

Low heart rate variability (HRV) has been associated with worse outcomes and increased inflammatory markers such as interleukin-6 (IL-6) and C-reactive peptide (CRP) in those who have cardiovascular disease. It has also been associated with increased


( In conclusion%2C low HRV,fatal or non-fatal CVD.)

Fortunately there are several ways to improve HRV. Some of the standard lifestyle recommendations for heart disease such as smoking and alcohol cessation, exercise, consuming more fruits and vegetables, and weight loss are all associated with increased HRV. Reducing stress and worry is also an important part of addressing the effects of stress on HRV. So, how do you reduce stress and worry?

One method is via heart rate variability biofeedback (HRVB). HRVB is an easy to implement intervention that uses breathing exercises to help modulate the nervous system. This results in a shift towards a more parasympathetic relaxation state, which can modulate the impact of stress on the cardiovascular system.

We know that the stress response and the resulting changes in the autonomic nervous system can have negative effects on blood glucose regulation and blood pressure. HRVB has been shown to reduce blood pressure, a common risk factor for cardiovascular disease.  Another study showed that a stress reduction program including HRVB resulted in improvements in some of the most common risk factors for heart disease: cholesterol, blood pressure and glucose levels.

Conclusions HRVB and Cardiovascular Disease:

Overall, low HRV has been associated with both an increased risk of cardiovascular disease events in those who are already are affected by this condition, and with the onset of new cardiovascular disease. While there are many strategies to improve HRV, HRVB is one easy to implement method to modulate the effects of stress on the cardiovascular system and improve health outcomes.

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