Building resilience to reduce heart disease risk

On Nutrition

If I asked you what factors help reduce your risk of heart disease, what would you say? Diet, exercise, not smoking … maybe red wine in moderation? Correct on all counts, of course, but here’s one you probably didn’t consider: psychological resilience, or the ability to bounce back from stress.

Everyone can benefit from being resilient, but analysis of data from the Women’s Health Initiative suggests that when it comes to heart health in older women, resilience really matters. That’s significant, because heart disease — especially coronary artery disease — is the top cause of death among women, and risk goes up after menopause as the protective effects of estrogen fade.

This research, published in 2020 in the journal Nutrients, found that among 77,395 women — average age 77 years — from diverse racial and ethnic backgrounds, high resilience was associated with higher engagement in heart-protective health behaviors. Specifically, highly resilient women tended to eat a better quality diet, be physically active for at least 150 minutes, get seven to nine hours of sleep per night, and keep alcohol intake moderate.

The authors noted that the women who reported higher resilience levels had generally experienced fewer stressful life events, such as death of a spouse or close friend, divorce or separation, major family conflict, physical or verbal abuse, or loss of a job. They also tended to have higher income, education and social status, and were less likely to struggle with depression.

Earlier Women’s Health Initiative research published in 2016 found that highly resilient women felt they were better able to manage both stress and life challenges associated with aging. That’s important, because research published in the journal Circulation in 2019 found that women with lower levels of cumulative stress — stress that arises from a combination of a variety of psychological, social, physical and environmental conditions — were more likely to exercise and have a healthy diet, and less likely to smoke or have high blood pressure, cholesterol or glucose levels. This is consistent with a larger body of research showing that experiencing more stress than we can cope with and adapt to isn’t good for cardiovascular health — or our ability to develop heart-healthy habits. That’s true for both men and women.

While there are varying definitions of resilience, generally speaking, resilient people tend to recover quickly after hard times or stressful events and come through these challenges with little lasting negative effects. People who have low levels of resilience have a hard time snapping back when something bad happens and find that it takes them a long time to get over setbacks in their life.

It’s worth noting that resilience is not the same as sucking it up and soldiering on, or pretending that a stressful or traumatic event didn’t happen. The authors of the 2020 study noted that succumbing to pressure to function normally at work and at home in the face of excessive and daily stressors — a “superwoman” phenomenon that’s especially common among Black women — may lead to lack of emotional support, depression and unhealthy behaviors.

Some researchers argue that resilience is a personal trait — you either have it or you don’t. Others say that resilience involves behaviors, thoughts and actions that anyone can learn and develop. This means we have the potential to learn to adapt in positive ways in the face of significant adversity, high levels of stress, and even traumatic or threats. It’s also possible that resilience is something that we experience more of or less of depending on the strength of our social connections.

Like building a muscle, increasing resilience takes time and intentional effort. These four strategies can help increase your capacity for resilience so you can withstand and even learn from challenging and stressful experiences.

Build connections

Social isolation lowers resilience. Grow your ability to rebound from hardships by genuinely connecting with individuals in your life — friends, family members, mentors — who will show you compassion and validate your feelings when you’re grappling with one of life’s curveballs. Helping others by joining a charitable organization or being there for a friend who is having their own struggles can build connection and provide social support while also fostering self-worth and a feeling of purpose. The books I mentioned in my recent column about stress all emphasize the importance of connection.

Take action

Allowing yourself to feel your feelings with self-compassion is important when times are tough. It’s also important to ask yourself what you can do about the current situation, then set some realistic goals for moving in a positive direction, whether that’s working on your résumé, joining a grief support group or looking for a therapist.

Take care of yourself

The research on women, resilience and heart-healthy habits raised an interesting question: Does resilience help us adopt health-supporting behaviors, or does adopting health-supporting behaviors help us be more resilient in the face of tremendous stress? Eating well, moving our bodies in ways that feel good and getting enough sleep can help our bodies handle both the physical and emotional aspects of stress.

Be mindful

Mindfulness practices such as meditation or journaling can help you be aware of what you are feeling — so you can then ask yourself what you need in order to cope with those feelings — and accept that the present situation is what it is for now, making it easier to take meaningful action rather than sticking your head in the sand. Mindfulness also helps you be aware of your thoughts, helping you avoid getting caught up in rumination or catastrophic thinking. This can also help you keep things in perspective and accept that change is a part of life. If you struggle with this, one book I regularly recommend is “The Happiness Trap” by Russ Harris.

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