It's impossible to be human and not to experience frustration, anger, or sadness at times. Negative emotions are a part of life and cannot be avoided. What matters to your health is not that you feel these things, but how you deal with your feelings. The way you handle your emotions is connected to your ability to resist stress, and stress plays a role in disease. Heart disease is the leading cause of death in the United States. There is growing scientific evidence that emotions and stress directly and indirectly affects the health of your heart.

Scientists have observed that negative emotions, such as tension, sadness, and frustration, can reduce the amount of blood flowing to the heart. Strong emotions are also linked to increased blood pressure levels. Depression is another condition that stems from emotions and affects your heart. The National Institute of Mental Health estimates that 40 to 65 percent of heart attack victims also suffer from depression. People who have had a heart attack who are depressed are more likely to have a second heart attack. Depressed heart patients are also less likely to follow medical advice. They are more likely to abuse alcohol, eat poorly, and not get enough sleep. On the other hand, people with heart disease who are positive, have high self-esteem, and feel in control are three times less likely to have continued heart problems.

Unfortunately, about half the time the first sign of heart disease is a heart attack or sudden death. The symptoms of stress, however, can be recognized early on. They include fatigue, headaches, diarrhea, migraine, acne outbreaks, asthma attacks, and sleeping problems. Recognizing and learning to handle stress may be vital for the health of your heart.

Since most of the stress in our lives is associated with day-to-day events, it's important to learn how to incorporate stress management into our lives. (While a vacation in Bora Bora may seem to be the perfect solution to stress, it won't help when you're home again and in the middle of another hectic day.) Stress reduction techniques, when practiced regularly, will help you to feel better and stay healthier. For people with heart disease, these can reduce the possibility of future heart problems, from bypass surgeries to heart attacks. Stress management therapies include:

• relaxation techniques
• biofeedback
• deep breathing
• meditation
• yoga
• visualization/imagery
• journal writing
• massage
• practicing religious beliefs
• getting enough sleep
• getting regular exercise
• avoiding being overworked
• talking to friends or family about problems
• building a positive mental attitude

No one technique works for everyone; try different ones to see which one you respond to best. Note: It's most important to determine if your stress is from larger issues than day-to-day ins and outs. While stress management techniques are helpful, they do not solve things like broken relationships or financial difficulties. Talk to your doctor about how to resolve any persistent problems that are causing you stress in your life.

American Medical Association's Web site. "Long-Term Lifestyle Changes Increase Regression of Coronary Heart Disease." Synopsis of article in The Journal of the American Medical Association, December 16, 1998. Available at: http://www.ama-assn.org.

American Medical Association's Web site. "Stress Management Works in Cardiac Rehab." Synopsis of article in Archives of Internal Medicine, October 27, 1997. Available at: http://www.ama-assn.org.

Blumenthal JA, Jiang W, Babyak MA, et al. Stress management and exercise training in cardiac patients with myocardial ischemia. Arch Intern Med. 1997;157:2213-2223.

Carels RA, Sherwood A, Babyak M, et al. Emotional responsivity and transient myocardial ischemia. J Consult Clin Psychol. 1999;67(4):605-610.

Gullette ECD, Blumenthal JA, Babyak M, et al. Effects of mental stress on myocardial ischemia during daily life. JAMA. 1997;277:1521-1526.

Helgeson VS, Fritz HL. Cognitive adaptation as a predictor of new coronary events after percutaneous transluminal coronary angioplasty. Psychosom Med. 1999;61;488-495.

Spiegel, D. JAMA Web site. "Healing Words: Emotional Expression and Disease Outcome." Available at: http://jama.ama-assn.org.