For a Happy Heart; Depression, loneliness and anger take a toll on cardiac health. New research shows how to help.(Cover Story)

Byline: Anne Underwood

The Japanese have a word for it--karoshi, or "death by overwork." But can stress on the job really do you in? Finnish researchers decided to find out. The years 1991 to 1993 in Finland were as bad as it generally gets economically, with unemployment nearly tripling. Those who survived the downsizing had to assume greater work loads. During this period and for seven years afterward, Dr. Jussi Vahtera and psychologist Mika Kivimaki at the Finnish Institute of Occupational Health in Helsinki followed municipal workers who survived the cutbacks in four towns. Their sobering conclusion appeared this February in the British Medical Journal. Kivimaki puts it bluntly: "Those in work units with the most downsizing suffered twice the death rate from heart attack and stroke."

It should come as no surprise that emotions affect the heart--and not only in metaphorical terms. Suffer a fright, and your heart begins to pound. Get angry, and your blood pressure rises. Thirty years ago scientists told us that men with type A personalities--hard-charging, competitive and hostile--were more likely to suffer heart attacks. That turned out to be only partly true. Upon further investigation, anger and hostility were a problem, but not simple ambition or competitive drive. Today scientists are using high-tech instruments to elucidate the mind-body connections that damage the heart. And they are pointing the way to nonsurgical treatments that may benefit all of us.

If belligerence puts people at risk, science increasingly shows that a life of quiet desperation does, too. Patients who are depressed at the time of bypass surgery are more than twice as likely to die in the next five years as patients without clinical depression. Heart-attack survivors who live by themselves die at twice the rate of those who live with others. In a major study in the Lancet this month, researchers surveyed more than 11,000 heart-attack sufferers from 52 countries and found that in the year before their heart attacks, the patients had been under significantly more stress than some 13,000 healthy control subjects. "Severe stress didn't pose as great a risk as smoking," admits senior investigator Dr. Salim Yusuf of McMaster University. "But it was comparable to risk factors like hypertension and abdominal obesity. That's much greater than we thought before."