, Newburyport, MA

November 15, 2013

Health and Well-Being: Reflections on heart disease

Health and Well-Being
Dr. Jim Manganiello

---- — Health experts have estimated that nearly 44 million Americans have some form of cardiovascular disease. About 1.5 million Americans will have a heart attack this year, and more than 500,000 Americans will die because of their cardiovascular problems. For half of them, the first sign of heart disease is death. By age 56, heart disease will be the principal cause of death in 30 percent of American women and 50 percent of men.

What is remarkable about these figures is not only that they are so high — but that they do not have to exist. Cardiovascular illness is a mindbody problem that can be prevented.

Among the leading cause of heart ailments is coronary artery disease. This involves atherosclerosis and fatty plaque formation that cause a narrowing in the blood vessels. Because the heart is a pump that circulates blood, when blood vessels are narrowed, the heart becomes strained because it has to work harder to get its job done. Constricted arteries and vessels also reduce blood flow back to the heart and to other organs, including the brain.

The process that causes constricted blood flow, because it is silent and hard to identify, often goes unnoticed by routine physical exams, until it is too late. As a consequence, it is critically important that we develop an active approach to our cardiovascular health that includes an awareness of our personality functioning, stress levels, heredity, and other lifestyle risk factors such as smoking, exercise and nutrition. We can then make changes, if necessary, that can greatly reduce our chances of heart disease.

A phenomenon called “free radical” pathology has been identified as a contributing factor to atherosclerosis. A free radical is a kind of unstable molecule formed by oxidation. Free radicals seek each other out and “cross-link,” which is similar to the coming together of cells in a scar when a wound heals. Cross-linking leads to a process like scarring on the arterial walls that restricts blood flow and puts strain on the heart. Free radicals are generated naturally with age, but stress biochemistry can significantly increase their numbers.

Antioxidant vitamins have been shown to stabilize free radical pathology and thereby reduce their risk to the cardiovascular system. Antioxidant vitamins include A, C, E, selenium and beta carotene. It is a good idea to get a daily supply of these vitamins either in a carefully planned nutritional program and/or with an excellent-quality nutritional supplement.

These vitamins can also be very helpful in moderating the destructive effects of stress biochemistry. When we are chronically stressed, our body has a hard time adjusting to the powerful hormones, such as adrenaline and cortisol, that are generated by the stress response. For many people, these hormones lead to a constriction of the smooth muscle fibers that line our arterioles and blood vessels.

As with atherosclerosis, what results is that the heart has to work very hard to pump blood throughout the system. Some symptoms of stress-induced vascular constriction include frequently cold hands and feet, as well as high blood pressure.

Learning how to pull the plug on stress can help us avoid the harmful biochemical consequences of stress. Deep relaxation and mindfulness training can enable us to keep our arterioles and blood vessels dilated, so that our blood vessels do not constrict and put our heart at risk.

Counseling and psychotherapy are very useful for dismantling stress provoking personality patterns characterized by impatience, anger, hostility, and a sense of urgency and pressure about time. These are some of the features of the coronary-prone personality. We have three coronary arteries that the heart relies upon for its supply of blood. Blockage or spasm in just one of them can cause a heart attack.

A Harvard Medical School study has recently shown that, under stress, people with coronary artery disease experience a 27 percent decrease in blood flow. According to the New England Journal of Medicine, this study indicates how badly stress biochemistry can constrict damaged arteries. Other studies have shown that feelings of anger can send diseased coronary arteries into spasm. This cuts off oxygen that the left ventricle of our heart needs for pumping.

Studies continue to show that stress can elevate cholesterol levels and interfere with the electrical functions that control our heart. This is especially the case for men. Some researchers, such as those from the American Institute of Stress, have suggested that stress plays as much a role in heart disease as does diet.

It is important to remember that our cardiovascular health is not a matter of luck, fate or chance. We can have a good deal of control over whether or not we develop heart problems. It all depends on our willingness to be active caretakers of our own health and well-being.


Dr. Jim Manganiello is a clinical psychologist and diplomate-level medical psychotherapist based in Groveland and West Boxford. He is also an author and teacher focusing on stress, personal growth, meditation and “inner fitness.” His book “Unshakable Certainty” is available on Amazon. Email him at or visit