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Here's the problem with stress: your body thinks you're a caveman. There hasn't been time for us to evolve physiologically from the high-threat, short-duration stress situations that primitive man faced to the relatively low-threat, long-duration stresses of modern society.

So when your body receives a message that you are under stress, it thinks you are going to do one of two things -- fight or run away. It doesn't know how to temper its response to deal with a frustrating 45-minute commute or the week-long pressure of a looming deadline. This overkill response, in time, takes a physical toll -- especially on your cardiovascular system.

"Nonsense!" the macho types among you are saying. "I thrive on stress. It's exhilarating!"

No, it's not. The people who truly thrive in very busy, demanding environments do so because they don't find that sort of situation stressful, or because they have good stress-reduction skills. If you are really under stress, you are not thriving. Your blood pressure is elevated, your blood clotting mechanism is working at full force, your heart is beating faster than normal and your metabolic rate is up. Keep it up for hours and you'll be exhausted. Keep it up for years and you may hasten a heart attack. And I used the word "hasten" advisedly. Stress is a secondary risk factor for heart disease.

If you have one or more of the primary risk factors -- obesity, diabetes, smoking, lack of exercise, chronic hypertension or a genetic predisposition to coronary artery disease, that will probably be the root cause of your heart attack. But stress may bring it on sooner. If you suffer from arrhythmia -- malfunctioning of the bioelectrical system that controls the heartbeat -- the effect is much more direct. Stress can trigger arrhythmias, some forms of which can be fatal.

There have also been some recent studies, using nuclear imaging techniques, that showed the blood supply to the heart in a stressful situation is actually diminished, even though more work is being demanded from it.

The ways in which you cope with stress may actually be more dangerous to your heart than the stress itself, if (as is frequently the case) they include smoking, overeating, too much alcohol, too little rest and failing to take time to exercise.

And don't take too much comfort from the debate over whether statistical evidence really supports the contention that hard-working, competitive Type A personalities are particularly heart disease prone. I suspect that the debate really revolves around a failure to distinguish between hard-driving, energetic self-confident achievers and neurotic, insecurity-driven overachievers.



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