Authors Philip Strike and Andrew Steptoe of University College London point out that the triggers for heart attacks may be quite different from the factors that lead to development of coronary heart disease over the long term, such as cigarette smoking, lack of exercise, work stress, social isolation, anxiety and depression.

The review notes that "physical exertion has an apparently paradoxic association with triggering" severe chest pain, heart attack or sudden death. Physically fit people enjoy a reduced risk of heart attacks, while inactive cardiac patients who suddenly engage in vigorous activity may do so at their peril.

The findings come from a review published in the current issue of Psychosomatic Medicine of dozens of studies done between 1970 and 2004.

In one study, people who exercised rarely were nearly seven times more likely to suffer a heart attack after strenuous exertion than those who exercised more than three times a week. Nevertheless, point out the authors, the absolute risk of cardiac events after any single bout of activity remains less than one in a million, including sexual activity, where there is also a slightly elevated risk for heart patients.

Because strong social support and marital relationships promote physical well-being, "My view is that it is much more important for people to maintain good personal and sexual relationships than it is to worry about this small increase in risk," Steptoe says."

Emotional distress, along with natural disasters, war and sporting events may also trigger heart attacks in vulnerable individuals, according to the review.

"The evidence of triggering by physical exertion and emotional stress is compelling," the authors observe. Furthermore, they note, "It is likely that triggers are more
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Contact: Andrew Steptoe
a.steptoe@ucl.ac.uk
Center for the Advancement of Health
22-Mar-2005