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Some stress at work is normal but too much can be dangerous for your heart. 

Long hours, punishing deadlines and the need to perform at a consistently high standard means lawyers are often burdened by high stress levels. The negative impacts of work-related stress – like sleeping difficulties, irritability, aggression and poor performance – are well documented, as are the effects on mental health conditions like anxiety and depression. But can this stress be so great that it causes a heart attack?

High pressure

A heart attack happens when a coronary artery, which supplies blood to your heart, becomes blocked. This stops the blood flow and affects the amount of oxygen that can get to your heart. On average, 21 Australians die every day from a heart attack.

The most common cause of heart attack is coronary heart disease, which occurs when the coronary artery narrows because of a build-up of fat, cholesterol and other materials. The condition is so serious that it’s the leading single cause of death in Australia.

What causes coronary heart disease? It’s complicated. Family history, ethnic background and other factors you can’t control, like complications during pregnancy, can play a part. Lifestyle factors like smoking, an unhealthy diet and being inactive and overweight, may also increase your risk, and they’re cumulative. Many of these issues are themselves drivers of high blood pressure – one of the main risk factors for heart disease.

According to experts, high blood pressure is often exacerbated by – you guessed it – persistent stress. “Chronic stress can be linked to increasing blood pressure, which can in turn increase your risk of cardiovascular disease including heart attacks,” says Brooke Atkins from the Heart Foundation.

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“Chronic stress can be linked to increasing blood pressure, which can in turn increase your risk of cardiovascular disease including heart attacks”

In the mind

There’s also evidence of more indirect, emotion-focused pathways. Work-related stress can trigger mental health conditions like anxiety and depression, which affect a disproportionately high number of legal professionals. Research shows these conditions can then increase your risk of heart disease and, in turn, heart attack.

“There’s this little collection of psychosocial factors – anxiety, depression, social isolation and loneliness – that are now recognised as being as important to the creation of risk as the traditional factors like smoking and obesity,” says Professor Alun Jackson, director of the Australian Centre for Heart Health.

Atkins agrees heart disease and mental health are “closely linked” and “can be viewed similarly to other established risk factors, such as high cholesterol and high blood pressure­­”.

Jackson explains that stress may cause an inflammatory response that disrupts the functioning of the heart.

“Your body is in a state of constant arousal and that systemic inflammation can lead to the creation of atherosclerosis [where arteries become clogged with fatty substances],” he says.

“It can also affect your blood … so you’re not getting good oxygen circulation. There’s a very direct physiological impact that is dangerous for your body.”

Indeed, a recent study published in The Lancet found heightened activity in the amygdala – a region of the brain involved in stress – is associated with a greater risk of heart disease and stroke. The researchers reported the heightened activity was linked to increased bone marrow activity and inflammation in the arteries and suggested this may lead to the increased risk.

That said, how we respond to stress varies, and Professor Robert Graham from the Victor Chang Cardiac Research Institute cautions this sort of research is “very difficult to do and get definitive data on”. But he says stress has a much more obvious emotional impact on our risk of heart attack: it can make it hard to maintain heart healthy habits.

“When you’re stressed you might not be doing any exercise and be eating bad food and sitting down in one place all the time,” Graham says.

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Being heart healthy

Thankfully, your heart attack risk can be managed – even if you’re under a lot of stress at work. Getting your blood pressure checked regularly is one of the easiest ways to identify any problems with your heart before they become too serious.

“High blood pressure is not something that’s going to give you a sign – it’s not like a pain in the chest,” Jackson says.

Atkins recommends regular check-ups even if you’re feeling well. “The most important thing is to know your risk factors, and the best person to speak to is your GP. They can check your blood pressure and help you make positive lifestyle changes to lower your risk.”

For those aged over 45, when the risk of heart problems increases, she suggests a regular heart health check with your GP.

Seeking professional help for mental health issues also offers long-term benefits for heart health. “If you’re in a situation of stress that you’re not quite sure how to resolve, and you’re concerned about the possible physical consequences, go and talk to somebody,” Jackson says. Quitting smoking, eating healthily and drinking in moderation can also help to improve heart health and stave off any issues. Then there’s exercise, which is arguably the best lifestyle intervention for stressed-out legal folks.

“Being physically active is one of the most effective ways to improve not only heart health, but also mental health,” Atkins says. “It can improve your mood and decrease your risk of heart attack, and it can also help with high blood pressure.”

Graham agrees, explaining that your “blood vessels dilate, and everything comes back down to where it should be” during exercise. “Take some time out to go to a gym or out running in the street or play squash. When you return to work, you’ve cleared your head. You’ve destressed and can keep going.”