For people living in rural and regional NSW, stress is often accepted as part of everyday life, shaped by cost-of-living pressure, distance from services, workforce shortages and the quiet expectation to “just get on with it”.

But health experts warn that this constant pressure may be doing more than wearing people down mentally, it could be putting extra strain on their hearts.

This February, Heart Research Australia is raising awareness of stress as a major, and often overlooked, risk factor for heart disease, at a time when rural Australians already face poorer health outcomes than their city counterparts.

National data shows the burden of disease rises sharply with remoteness.

Disease burden linked to remote living

According to the National Rural Health Alliance 2025 Rural Health in Australia Snapshot, total disease burden in Remote areas is 1.4 times higher than in Major Cities.

Coronary heart disease is the leading cause of disease burden across all remoteness categories, with its impact in Remote and Very Remote Australia 2.2 times higher than in Major Cities.

While the data does not isolate stress as a single cause, health experts say it is a significant contributor, particularly in communities where access to preventative care and specialist services is limited.

“Stress is a key risk factor for heart disease and knowing when to adjust your lifestyle and situation is an important part of living a healthy lifestyle,” Heart Research Australia says.

“Understanding stress, stress management and relaxation are vital in ensuring good mental health, and in adjusting to the pressures and strains of everyday life.”

Stress is a major, and often overlooked risk factor for heart disease.

Heart Research Australia CEO Nicci Dent said stress is often misunderstood as purely emotional.

“Most people think of stress as emotional or mental, but the heart feels it too,” Ms Dent said.

“We’ve normalised being wired and tired, but living in stress mode is like leaving your car engine running all night.

“The cost-of-living squeeze means many Australians feel like every day is a crisis, and our hearts are paying the price.”

Cardiologist Avedis Ekmejian said stress can damage the heart both suddenly and gradually.

“A sudden surge of stress hormones, like an angry outburst or a major shock, can trigger a serious cardiac event,” Dr Ekmejian said.

“Sometimes that can be a heart attack, or stress cardiomyopathy, often called ‘broken heart syndrome’, where the heart muscle temporarily weakens.”

He said the long-term effects of chronic stress are just as concerning.

“If we are constantly exposed to stress without recovery periods, this results in blood pressure issues and changes to metabolism, increasing cholesterol and sugar levels,” he said.

“That can increase the incidence of coronary disease among other cardiac conditions.”

Clinical neuropsychologist Miranda Say said chronic stress changes how the brain functions, particularly when the body never returns to baseline.

Stress Management is vital

“Stress itself is not a bad thing, it’s critical for our safety,” Dr Say said.

“The real danger is when stress never switches off.

"When this is chronic, people wake groggy, feel restless at night and remain stuck in a constant state of tension.

“Many people have become so used to being stressed that it feels normal.”

She said recognising warning signs, poor sleep, constant tension, headaches or snapping at small things, is the first step toward resetting the body’s stress response.

Simple actions, she said, can help bring stress hormones back into balance, including mindful breathing, spending time with others, and connecting with nature.

“A hug, a laugh, or a walk in the park aren’t luxuries, they’re medicine for the heart,” Dr Say said.

As part of its February campaign, Heart Research Australia is encouraging Australians to take part in the REDFEB Bingo Challenge, focused on small, achievable actions across meals, movement, measurement and mental attitude.

“Your heart listens to your lifestyle,” Ms Dent said.

“This REDFEB is about small, joyful habits to help your body return to baseline.”

For communities across the Western Plains of NSW, the message carries particular weight.

Residents often live hours from specialist cardiac care, face long GP wait times and shoulder higher out-of-pocket health costs, adding another layer of pressure to already stressful lives.

Health advocates say that combination - higher baseline disease burden, reduced access to services and chronic stress - makes prevention and early intervention critical.

With coronary heart disease already the leading cause of disease burden in remote Australia, experts say recognising stress as a genuine heart health issue, not just a mental health concern, is an important step in protecting regional communities.

To learn more and support Heart Research Australia’s critical research, please visit www.heartresearch.com.au