You can't eliminate stress, but you can manage it with techniques like yoga.(VEER)

The cardiologist in urgent care at Scripps Green Hospital in La Jolla, Calif., was puzzled. Sandy Levin had had a heart attack, yet she didn't show any of the classic risk factors. "I looked like the perfect picture of health," she said. "But I was under excessive stress, and that's what did it."

Levin, 56, of San Diego, wasn't overweight and didn't have high blood pressure or high cholesterol. But she'd recently started taking care of her mother, who had Alzheimer's disease.

"While people know stress plays a role in how they feel physically, they're often unaware that it is a risk factor for heart disease," says Suzanne Steinbaum, MD, an attending cardiologist at Lenox Hill Hospital in New York City.

Stress creates inflammation
Several studies have linked stress, job strain, and general demoralization to a greater risk for heart disease, though the relationship is less causal than other lifestyle factors, like smoking.

Stress triggers an increase of cortisol, a "stress hormone," which can raise blood-sugar levels and blood pressure. The overproduction of cortisol can lead to a constant state of chemical arousal, which can eventually cause a heart attack.

One study of Belgian workers found that those who reported feeling they had little control of their work life had increased levels of markers of inflammation such as C-reactive protein and fibrinogen, which are linked to heart disease.

Like the Belgian workers, Levin felt she had little control over her circumstances. But protecting your heart doesn't always require stress reduction, says Dr. Steinbaum. Rather, you need a plan of action when the stressful situation presents itself.

Learning to change your response to stress

"You can't always change circumstances," she says. "If you get in a taxi cab and there's tons of traffic you can hyperventilate and your heart rate increases and your blood pressure increases. Or you can reframe the situation and take the time to relax and breathe. That's taking a stressful situation and making it less stressful. Everyone has stress," she adds. "Don't react by internalizing it."

Levin made that mistake. "When I was stressed, I'd get angry at everything and everybody," she says. "I'd hold that anger inside and I wouldn't show it, and by holding it in, it would hurt my heart more."

After her heart attack, she took an eight-week stress management class. She now does yoga almost every day and credits that with protecting her heart.

"Before, my head was going a mile a minute," says Levin. "It was only after I learned how to meditate and relax my mind that I was able to control my stress."