When Heartbreak Causes Heart Attacks
Data is beginning to show the link between prolonged emotional distress and heart disease
In the late 20th century, medical focus shifted from treating cardiovascular disease to preventing it in those at risk. In 1998, while I was still in medical school, researchers published a formula, based on the major independent cardiac risk factors that had been identified — family history, smoking, diabetes, high serum cholesterol, and hypertension — to calculate a patient’s risk of getting heart disease within 10 years. Today, we know that programs targeting such risk factors improve public health. For example, a recent 12-year study of 20,000 Swedish men showed that almost four out of five heart attacks could be prevented through lifestyle changes, such as a healthy diet, moderate alcohol consumption, no smoking, increased physical activity, and maintaining a normal body weight. Men who adopted all five changes were 86 percent less likely to have a heart attack than those who did not.
Much of this science first came to be understood through the famous Framingham Heart Study, in which investigators monitored about 5,000 residents of Framingham, Massachusetts, for 20 years, beginning in 1948. Its findings were massively influential in identifying risk factors—indeed, Framingham researchers introduced the term “risk factor” in 1961. But even then, the researchers recognized the lack of diversity in the study population as a major limitation. The results for the mostly white subjects do not seem to apply equally to nonwhite ethnic groups. In 1959, for instance, the first study showing an increased risk of premature heart disease in Indian males was published in the American Heart Journal. These men had four times the rate of heart disease compared with men living in Framingham, despite having lower rates of hypertension, smoking, and high cholesterol and more often consuming a vegetarian diet. Over the past half-century, the average age at which a first heart attack occurs has increased by 10 years in the United States but decreased by about 10 years in India. South Asians will soon make up over half of the world’s cardiac patients. What is it about South Asian genetics or environments that leads to so much heart disease? We need a Framingham-type study to answer this question.