It's heart month - but this isn't about valentines - it's about raising awareness of heart health and the importance of loving, supportive relationships.

Heart disease is the leading killer of North Americans. Risk factors include smoking, lack of exercise, obesity, high cholesterol, high blood pressure, stress, and diabetes, plus your family history, age, and gender. But did you know that love is a vital part of your heart health?

Your emotions can have powerful effects on your physical health. Psychological factors are now recognized as contributing to the development of heart disease. Being involved in a supportive, and loving relationship is good for your heart.

All you need is love?

Studies in men revealed similar findings - coronary artery blockage is eased in those who feel loved. As far back as in 1965, an Alameda County, CA, study found that men and women who did not have love, support, and community ties were 1.9 to 3.1 times more likely to die prematurely.

Valentine's Day is celebrated on February 14 throughout the world. People express love by sending cards, flowers, or chocolates. Where does the tradition come from? One theory speculates the holiday originated from the story of Saint Valentine, who was so heartbroken when his mistress rejected him that he took a knife to his chest and sent her his still-beating heart as a token of his undying love. Heart-shaped cards are sent as a tribute to his overwhelming passion and suffering. The US Greeting Card Association estimates approximately one billion valentines are sent each year worldwide. Women purchase approximately 85 percent of all valentines.

More recently scientists at Yale University looked at the degree of blockages in coronary arteries of 119 men and women and found that those who felt the most loved had substantially less blockages. Researchers discovered the quality of the relationships (in the sense of feeling loved and emotionally supported) was a more important predictor of the severity of coronary artery blockages than was the number of relationships a person had. This finding was also independent of diet, smoking, exercise, cholesterol, genetics, and other risk factors.

A study of 1400 heart patients at Duke University Medical Center in 1992 demonstrated the importance of having a close confidant with whom you talk regularly. All 1400 patients had blocked coronary arteries. After five years, those who were unmarried and without a confidant were three times more likely to have died than those who were married or who had a close confidant.

We all need someone we can lean on

A new study by researchers in Canada shows having a close relationship with a friend, lover, or relative, lowers the risk of further heart attacks by 50 percent. This was true even after taking into account the severity of the first heart attack and other risk factors. Researchers suggest those people who do not have a close confidant may delay seeking treatment or be less likely to adhere to treatment after a heart event..This research involved 600 patients, average age 60. They were screened three to four days after having a heart attack and were monitored for 12 months to assess their risk of a later heart attack. The study revealed that having a shoulder to lean on carries significant potential to help prevent a second heart attack, and maybe even a first heart attack.

Most of the theories regarding why loving relationships are positive for heart health seem to indicate that people who are married or in close, healthy relationships tend to be less likely to smoke, are more physically active, and are more likely to have a well-developed social structure. And, they are more likely to have lower levels of stress and anxiety. As well, people who are in loving relationships may experience neuro-hormonal changes that have positive effects on the body, including the cardiovascular system.

Experiencing a positive relationship may have beneficial effects on your cardiovascular system over long periods of time. Conversely, studies have shown that relationships that are negative or that involve conflict are associated with an increased risk for heart disease.

"Those in a negative relationship were 34 percent more likely to have a coronary event in 12 years of follow-up," says Roberto De Vogli, PhD, a researcher for a study published in the Archives of Internal Medicine in October 2007.

De Vogli's team asked 9,011 British civil servants, on average in their mid-40s, to complete a questionnaire either between 1989 and 1990 or 1985 and 1988. They answered questions about up to four of their close personal relationships, but mostly about their primary relationship. More than 64 percent listed their spouse as their primary relationship. Others were close personal friends.

During the follow-up period, heart disease was reported by 589 men and women of the 8,499 respondents who finished the questionnaires. None of the 8,499 respondents had any history of heart disease at the start of the study.Those who had high negativity in their close relationships, such as saying that talking to the partner or friend about problems made things seem worse, were 34 percent more likely to have a heart problem compared with those with more positive interactions and low level of negativity. The increased risk dropped to 25 percent after taking into account other variables that could contribute to heart disease.

What's behind the bad relationship, bad heart link?

"It can activate emotional responses, including depression or hostility," De Vogli said, in turn boosting heart disease risk. De Vogli found the association between relationships and heart health was true for both men and women and for those in higher and lower socio-economic positions.

Another study, published in September 2007 in the Journal of Behavioral Medicine, showed that negative discussions between a couple increase systolic blood pressure, heart rate, and cardiac output. Researchers think that relationship stress may increase the risk of cardiovascular disease through "cardiovascular reactivity" - the way your heart responds to stress and emotions.

"Anxiety and emotional stress are associated with an increase in adrenaline levels in the blood, which can increase blood pressure and possibly cause vessel spasm," says Erica Jones, MD, a cardiologist at the Iris Cantor Women's Health Center at Weill Cornell Medical College. Dr. Jones says that chronic anxiety and stress in a relationship will lead to depression and lack of motivation, including not taking the proper medication, exercising, eating healthfully, and sleeping well. All these factors can lead to weight gain and increase cardiovascular risk.

Can improving our relationships help keep our hearts healthy?

We know that lifestyle changes such as quitting smoking, losing weight, changing your diet, and exercising can help reduce stress and the risk factors for cardiac disease. While a bad relationship may increase your risk of cardiovascular problems, a good relationship may actually decrease your risk. Previous studies have shown that married people, in general, are less likely to develop heart disease.And if you are already living with heart disease, support from loved ones is a vital part of your heart recovery - not just in the immediate days and weeks after a heart event, but ongoing in the months and years to follow.

"As a cardiologist, I have been convinced for years that a bad relationship is associated with cardiac risk," says Dr. Jones. Perhaps marriage counseling will eventually be added to the list of heart-healthy advice!

Some things you can do

To have close, nurturing relationships and supportive communities, we all need to take time to slow down enough to connect with ourselves and other people.

Accept your friends' and loved one's flaws (and your own!) and learn to cooperate and compromise. The first thing to remember is that no one is perfect. If you are experiencing difficulty communicating in your relationships you might want to speak to a therapist or counselor about how you can improve your communication skills. Check out Love Is Never Enough by Aaron T. Beck, MD.

Ease stress in your life - Significant stress is associated with an increase in cardiovascular risk and puts added tension into your relationships.

Exercise with loved ones. Exercise allows you to spend quality time with your partner or friends while also taking care of your heart. Try walking or riding bikes together.

Go out on dates with your significant other. You may have been together for years but that doesn't mean that romantic time together is any less important than it was in the beginning.

Remain intimate with your mate for both the physical and emotional benefits. If you're experiencing sexual problems, don't be afraid to consult your doctor because treatment options are available.

It's the power of love

The more you give, the more you get. As The Beatles said in the song The End, "And in the end, the love you take is equal to the love you make." Fill your life with love and not only will you enrich your life, but you'll help your heart too.

PS. Happy Valentines Day

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