The Biology of Adversity – 2022 AHA Presidential Session

Adversity is defined as a state of continued difficulty or misfortune. Everyone has experienced some form of adversity or stressful obstacles, but how can scientists quantify it to fully understand the biological connections between stressors and overall health? Dr. Michelle Albert discussed this during her address at the Presidential Session on day 2 of the AHA’s Scientific Sessions in Chicago and explained how adversity translates into clinical medicine and how researchers and healthcare professionals can better understand and evaluate patient outcomes.

The first part of understanding the complicated relationship the human body has with adversity is that not all stress is created equal, and the three types of stress have varying effects on an individual’s overall health. Positive stress is temporary, and usually has a satisfying outcome – when a problem is resolved and the individual can move on from the obstacles or situations they were facing. The second type is tolerable stress, which is more serious and longer-term, but can be overcome with emotional and social support. The third and most serious type of stress is known as toxic stress, which is often caused by unrelenting and virtually unchanging factors. Toxic stress can persist from childhood, referred to as Adverse Childhood Experiences (ACE’s), or can be experienced during adulthood, such as discrimination, structural racism, or economic adversity. Toxic stress can even have intergenerational results, causing health disparities for the children of those suffering from it.

Dr. Albert stated that healthcare professionals need to acknowledge a patient’s overt and covert stressors before they can understand their full effects on cardiovascular health. To integrate this into a care plan, providers must follow the 5 A’s: Awareness, Adjustment, Alignment, Assistance and Advocacy. For example, 12% of patients have trouble paying their medical bills – which can be a major cause of constant stress, especially when facing serious health concerns on top of economic instability. Healthcare providers must ask the right questions, adjust their communication and treatment, and go beyond the traditional course of care to assist and advocate for their patients. The future of medicine is viewing every patient as an iceberg, with the presenting symptoms above water, and the potential causes and exacerbating factors hidden beneath.