The stress response is a complicated hormonal cascade of events that was designed to save your life in an emergency. But when you’re under stress 24/7, nothing good happens.

The stress response is a kind of metabolic “first gear,” which can be a lifesaver if you’re trying to drive up a steep hill. But if you’re cruising down the highway doing 80 mph, it’s death to your transmission.

When you’re under stress, hormones (cortisol and adrenaline) are released which cause blood pressure and heart rate to rise. Blood pounds against the artery walls, ultimately contributing to micro-injuries in the vascular system that soon become inflamed.

Those inflamed areas attract oxidized particles of LDL cholesterol called LDL-b, as well as inflammatory chemicals called cytokines and all sorts of other metabolic riff-raff — all of which causes the buildup of plaque.

And if the plaque is unstable, it can lead to a heart attack.

A cardiovascular system that’s already been weakened by a bad diet with too many trans fats, too much sugar, and by too much inflammation in the vascular walls can easily be overwhelmed by a sudden overload of cortisol and adrenaline.

This is probably why more heart attacks happen on Monday morning than on any other time or day.


There’s now a medical field devoted to the effects of stress on the heart. It’s called stress cardiomyopathy.

Martin A. Samuels, M.D., chairman of the neurology department at Brigham and Women’s Hospital in Boston, has collected hundreds of reports detailing how people died suddenly in scary situations. The reports include stories of children who died while on amusement park rides, people who were victims of muggings (even though there was no physical attack or injury), and car accident victims whose injuries were negligible.

The only thing they all had in common was that their hearts literally failed — not because of cholesterol, not even because of physical injury, but because they were unable to survive the aftermath of a massive overload of stress hormones.

So why are we chasing cholesterol and not paying attention to stress?

One reason might be money. There’s more than $31 billion a year made on cholesterol-lowering drugs. There’s not a whole lot of money to be made teaching people how to manage stress.

One of the biggest casualties of the war on cholesterol is that it’s caused us to take our focus off the things that really cause heart disease — things we can actually do something about cheaply, which don’t require prescription drugs.

Cholesterol is not your enemy.

But stress — except in small, infrequent doses — definitely is.