That stress can affect health and well-being has been understood by people for millennia. However, there are very few studies in this era of 'scientific medicine', that confirm the profound impact that our emotional life and social relationships have on us. At the Lown Centre we have had a longstanding interest in this topic. Indeed, our founder and my mentor, Dr Bernard Lown, is one of those who made seminal contributions to this field in the 20th century, particularly by showing that psychological stress increases the risk of fatal arrhythmia, a disorder of heart rate. More recently, the large international INTERHEART study found that all over the world, answers to four simple questions correlated to increased risk of a heart attack. These covered stress at work, stress at home, depression and locus of control (one's sense of control over job factors and life situations). The result was comparable to that from hypertension and abdominal obesity.

Many factors are responsible for this phenomenon. Changes in nervous system traffic to the heart and alterations in various protective cardiac reflexes, is one aspect.

Sources of Stress
The biggest source of stress comes from our social life and jobs. In India now, the fraying of family ties across and between generations, and the sense of isolation of the nuclear family are likely contributors. Job stress, coupled with a car culture, not only reduces the opportunity for exercise but also generates serious frustration from driving and traffic, raising stress further. And of course, the pain of recurring economic cycles and the stress of financial losses or insecurity seem inevitable with unregulated capitalism.

Effect of Stress on the Heart
In our clinic, we have found that persistent anxiety is a big risk factor. A strong, confident relationship with the doctor is a key element in reducing anxiety in case of a heart condition.

Tips to Reduce Stress
While stress, challenges and bereavement are a part of human life, staying connected provides natural protection. India is blessed with a highly networked society and culture, but the challenge is to maintain this while adopting some benefits from the western model.

1. Always set aside some time for quiet meditation.



2. Take time out for exercise too, this improves resilience and reduces mental tension



3. Yoga can improve both mental and physical well-being



4. Having someone to talk to about problems and tensions, is extremely important



5. Get regular sleep



6. Take vacations away from a difficult job



7. Fostering an ethic that the 'pursuit of material wealth is not worthwhile at the cost of health' can help in dealing with financial crises.

How Reducing Stress Works
In Sweden, a randomised trial of women coronary patients for a stress reduction programme of 1 year, resulted in 7% mortality after nine years compared with 20% in the control group. Another study showed that meditation reduced the risk of death, heart attack and stroke by 40% over five years in patients with proven coronary heart disease. These small studies are among the first to show that stress reduction can make a big difference. More research will need to be done before most cardiologists accept these findings.

There is growing evidence that inflammation, which increases cardiac risk, is also increased by stress reactions and the risk further increases with age. Indeed, remarkable new data suggests that the nervous system directly signals immune cells and so alters immune function and inflammation. However, this is a woefully under-researched area.