People under significant financial stress are 13 times more likely to have a heart attack than those with no or minimal financial stress, according to research presented Nov. 9 at the Annual Congress of the South African Heart Association.

The study included 106 patients from a public hospital in Johannesburg who presented with acute MI. They were matched for age, sex and race to a control group of 106 patients without a history of cardiac disease. All participants completed a questionnaire about depression, anxiety, stress, work stress and financial stress in the previous month.

Patients were considered to have no financial stress if they were coping financially, mild stress if they were coping but needed support, moderate stress if they had an income but were in financial distress and significant stress if they had no income and struggled at times to meet basic needs.

Among heart attack patients, 96 percent reported some level of stress and 40 percent reported severe stress levels. Moderate or severe work stress was associated with a 5.6-fold greater risk of having a heart attack, while significant financial stress was associated with 13-fold risk. Any level of depression was associated with a threefold risk increase for MI.

“Our study suggests that psychosocial aspects are important risk factors for acute myocardial infarction,” lead author Denishan Govender, MB, BCh, said in a press release. “Often patients are counselled about stress after a heart attack but there needs to be more emphasis prior to an event. Few doctors ask about stress, depression or anxiety during a general physical and this should become routine practice, like asking about smoking. Just as we provide advice on how to quit smoking, patients need information on how to fight stress.”