We all know that our emotions affect our hearts. You can feel your heart “flutter” with anxiety and “pound” with anger.But can emotional stress actually hurt your heart or even cause heart disease? And, if stress does jeopardize heart health, are there strategies to alleviate stress and protect your heart?QUIZ: Find Your Stress LevelsScientists debate these questions endlessly. Some argue that doctors should focus on “real” medicine—if you can’t see it on a CT scan or x-ray, it’s not there. Others agree with William Shakespeare, poet John Donne and a host of other writers and artists who recognized the truth—emotional stress can be bad for the heart.Does Stress Cause Heart Disease?Dozens of scientific studies confirm that people who experience the most stress, whether job-related, marital or economic, face an increased risk of developing coronary heart disease and suffering heart attacks. The question is whether chronic and repeated stress actually causes damage to the heart’s arteries.Acute stress certainly causes changes in the body’s physiology. Release of adrenaline, cortisol and other hormones activates our “fight-or-flight response.” This includes increases in heart rate, blood pressure, inflammation, blood clotting and blood glucose (sugar). Over time, it is certainly possible that chronic exposure to these physiologic changes could damage the insides of arteries and set the stage for formation of obstructing plaques.COLUMN: Can Sex Cause a Heart Attack?But there is another factor at work.When stressed, people tend to embrace unhealthy behaviors. Stressed at work or at home, people eat too much of the wrong foods, smoke cigarettes, abandon exercise and sometimes forget to take prescribed medications. These behaviors certainly increase the risk of developing heart disease.Which hurts heart health more, the changes in physiology or the stress-induced behaviors?Doctors argue quite a bit about this question, but the answer is irrelevant. When it comes to devising a plan to manage emotional stress, they are a package deal. The best strategy is to reduce emotional stress and avoid the unfavorable behaviors that accompany it. We’ll tell you how to do this—right after we answer one more important question.MORE: Tips to Quell AnxietyCan Stress Trigger a Heart Attack?This question pertains to people who already have coronary heart disease and blockages in the heart’s arteries. The short answer is this: Emotional stress can trigger a heart attack in a person who has coronary heart disease. A variety of “accidental” experiments confirm this finding.On January 17, 1994, the Northridge earthquake devastated parts of southern California. That day, the number of deaths from coronary heart disease in Los Angeles County nearly doubled. The greatest death toll was recorded closest to the epicenter of the earthquake, with the number of patients dying from heart attacks decreasing in proportion to distance from the epicenter. Interestingly, in the weeks following the earthquake, the number of people dying from heart attacks was unusually low, in part because many of the most vulnerable people had already died.MORE: Earthquakes, Stress & BeautyMore recently, Hurricane Katrina endangered the heart health of New Orleans residents. This natural disaster has had a long-term impact. Years after the storm, New Orleans residents still face an increased risk in heart attack.Man-made disasters also endanger heart patients. At the beginning of the first Gulf War, Israeli citizens were under constant and enormous stress, wearing gas masks and continually running for safety as Scud missiles rained down on Tel Aviv. The first days of the war saw a dramatic increase in heart attack admissions to local hospitals. As in the case of the Northridge earthquake, this rate decreased after a few days—the war continued, but the most vulnerable patients had had their heart attacks in the initial days of the fighting. In addition, people eventually became somewhat accustomed to the constant sounds of sirens and the stresses of war.COLUMN: Women, Men and Matters of the HeartFor Americans, the stress associated with the terrorist attacks of September 11, 2001, was qualitatively different from the stress experienced by communities during earthquakes and rocket attacks. As a result of widespread media coverage, the entire country was affected. Heart attacks and abnormal heart rhythms spanned the country and were recorded from New York to Miami to Los Angeles.What about “everyday stresses?” The effects are similar. Three percent of heart attacks are triggered by anger. Divorced and single people are more likely to succumb to heart disease than are the happily married. And a recent study from Duke University shows that heart health tracks the stock market; when the market goes down, heart attack risk goes up.What Can You Do?Fortunately, major disasters like earthquakes and terrorist attacks are relatively uncommon. But life’s “regular” stresses—money, marriage and relationships, work—are daily occurrences. How can you manage these everyday stressors to help yourself feel better and, at the same time, protect your heart?MORE: How Stress Busts BeautyThe National Institutes of Health and other funding agencies have become increasingly involved in supporting studies designed to answer this important question.Preliminary results support the notion that a variety of strategies can reduce stress and improve heart health. Scientists have achieved positive results with yoga, biofeedback, guided imagery, cognitive behavioral therapy and even transcendental meditation.But our favorite stress reliever is exercise.Exercise is an extremely effective tool for stress management. A good workout requires focus and concentration, freeing your mind from turmoil. As you concentrate on your running stride or your tennis backhand, thoughts of that problem at work or dip in your finances leave your mind.Meanwhile, your heart “enjoys” the proven cardiovascular benefits of exercise, including reduced blood pressure, improved fitness, weight control and reduced risk of diabetes.It is impossible to avoid all of the stresses of modern life. But you can manage your stress. Don’t succumb to temptation and reach for the Haagen-Dazs when you feel frustrated, angry or stressed.Instead, lace up your running shoes or dig that racket out of the closet. You’ll feel better and you’ll do your heart a favor.