Young woman covering her face because of stress while wondering how it might be related to heart disease

Understanding the intersection of stress and heart disease

Written on March 29, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Heart disease statistics

Heart disease is the leading cause of death in the United States among men and women [1]. In 2020, approximately 697,000 adults in the US died from heart disease, translating to 1 in every 5 deaths. Between 2017 and 2018, heart disease expenses in the US are estimated to be up to $229 billion yearly in healthcare services, medicines, and loss of productivity.

Types of heart diseases

Heart disease encompasses several types of heart conditions, such as coronary artery disease or coronary heart disease, heart attack, arrhythmias, and heart failure [2].

Coronary artery disease (CAD) is the most common heart disease and impacts the blood flow to the heart [1,2]. In 2020, over 380,000 people died because of CAD. Approximately 20 million adults 20 years and older have CAD.

A heart attack can occur when blood to the heart is decreased [2]. Every year, around 805,000 adults in the US have a heart attack [1]. Of these, 605,000 experienced their first heart attack.

Signs and symptoms of heart disease

Heart disease may not have any symptoms until a person has a diagnosis of heart attack, arrhythmias, or heart failure [2]. When symptoms are present, they can include:

  • Heart attack: Chest pain or discomfort, pain in the upper back or neck, indigestion, heartburn, nausea or vomiting, extreme fatigue, dizziness, and shortness of breath.
  • Arrhythmias: Chest palpitations or chest fluttering.
  • Heart failure: Fatigue, shortness of breath, swelling of the feet, ankles, legs, abdomen, or neck veins.

Risk factors for heart disease

There are several risk factors for heart disease. Key risks for heart disease are high blood pressure, elevated cholesterol, and smoking [2]. An estimated 47% of people in the US have at least one of these factors. Other chronic conditions and lifestyles also increase risks for heart disease, including diabetes, obesity, an unbalanced diet, physical inactivity, and excessive alcohol use. Also, increasing age, male gender, family history, irregular sleep, and stress can all contribute to an increased risk for heart disease [3].

Stress and heart disease

Stress impacts everyone differently. Stress is defined as “the result of pressures or tensions and how our body responds” and “a physical and emotional reaction that people experience as they encounter challenges in life” [4,5]. Examples of common stressors are work issues, marital discord, social isolation, financial crises, socioeconomic status, the burden of caring for a family member, or the death of a loved one [6].

Under immediate stress, your body will release hormones that increase your heart rate, breathing, and blood pressure [4-6]. When stress becomes long-term, it may lead to health issues such as digestive disorders, headaches, or sleep disorders. Chronic stress may also worsen conditions such as asthma, anxiety, depression, and mental illnesses, and contribute to heart disease.

Stress is a contributing risk factor for heart disease [3,6-9]. Data has shown that chronic stress can predict coronary heart disease (CHD) incidence and increase the risk of recurrent CHD events and death [8]. Another study found that various degrees of stress were significant risk factors in patients with CHD [9]. Psychological stress has been estimated to be connected with approximately 40% to 60% of additional risk for CHD [6].

In acute stress, the body responds with increased blood flow to the brain and a heightened sympathetic nervous system, also known as the “fight or flight” response [6]. The “fight or flight” response starts the release of chemicals, hormones, and pro-inflammatory mediators, leading to increased heart rate, elevated blood pressure, and increased blood vessel constriction, or ischemia. The effects on the heart contribute to increasing the risk of heart disease. In chronic stress, potential mechanisms that, over time, might contribute to heart disease are the development and progression of plaque buildup in blood vessels (atherosclerosis), activation of pro-inflammatory proteins and cells, and increases in stress hormones, mainly cortisol [6].

Preventing heart disease

Some ways you can reduce your risk factors and prevent heart disease include [3,10]:

  • Selecting a healthy and balanced diet
  • Maintaining a healthy weight
  • Avoiding smoking and alcohol use
  • Getting regular physical activity
  • Managing your chronic conditions, such as elevated cholesterol, high blood pressure, and diabetes
  • Getting an adequate quality amount of sleep
  • Finding ways to manage and address causes of stress and make time for things you enjoy

At Everlywell, you can consult a healthcare provider through a Virtual Care Visit if you have questions about your heart disease risk factors or stress. You can speak with the licensed clinician to address your health needs and devise a care plan with the next steps.

You can also consider a Heart Health at-home lab test. The Heart Health test is for you if you are interested in a more comprehensive look at heart health and preventing heart disease.

Heart disease and stroke: what you need to know

8 different types of heart disease

93 Heart Disease Facts and Statistics to Know for 2022


  1. Heart disease facts. Centers for Disease Control and Prevention. URL. Published October 14, 2022. Accessed March 22, 2023.
  2. About heart disease. Centers for Disease Control and Prevention. URL. Published March 21, 2023. Accessed March 22, 2023.
  3. Understand your risks to prevent a heart attack. American Heart Association. URL. Published January 24, 2023. Accessed March 22, 2023.
  4. Stress. Centers for Disease Control and Prevention. URL. Accessed March 22, 2023.
  5. Stress. National Center for Complementary and Integrative Health. URL. Accessed March 22, 2023.
  6. Levine GN. Psychological stress and heart disease: fact or folklore? Am J Med. 2022;135(6):688-696. doi: 10.1016/j.amjmed.2022.01.053. URL.
  7. Dar T, Radfar A, Abohashem S, Pitman RK, Tawakol A, Osborne MT. Psychosocial stress and cardiovascular disease. Curr Treat Options Cardiovasc Med. 2019;21(5):23. doi:10.1007/s11936-019-0724-5. URL.
  8. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012 Apr;9(6):360-70. doi: 10.1038/nrcardio.2012.45. URL.
  9. Kurd BJ, Dar MI, Shoaib M, Malik L, Aijaz Z, Asif I. Relationship between stress and coronary heart disease. Asian Cardiovasc Thorac Ann. 2014;22(2):142-7. doi: 10.1177/0218492312469803. URL.
  10. Prevent heart disease. Centers for Disease Control and Prevention. URL. Published March 21, 2023. Accessed March 22, 2023.
Everlywell makes lab testing easy and convenient with at-home collection and digital results in days. Learn More