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Psychosocial stress and cardiovascular disease: pathophysiological links
C Noel Bairey Merz1, James Dwyer, Cheryl K Nordstrom
1Cedars-Sinai Medical Center, University of California Los Angeles, School of Medicine, USA. noel.baireyMerz@cshs.org
Insights
Cardiovascular disease (CVD) decline has stalled. Psychosocial stress emerges as a key factor, impacting cardiac events through multiple pathways, necessitating new interventions.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) decline has plateaued in developed nations.
- Many CVD patients experience cardiac events despite optimal management of traditional risk factors.
- This suggests a need to explore nontraditional risk factors for effective intervention.
Purpose of the Study:
- To highlight psychosocial stress as a significant nontraditional risk factor for CVD.
- To explore the mechanisms through which psychosocial stress contributes to cardiac events.
- To emphasize the importance of understanding stress-CVD associations for future research and clinical practice.
Main Methods:
- This study is a review of existing literature and evidence.
- It synthesizes current understanding of psychosocial stress and its impact on cardiovascular health.
- It identifies key pathways linking stress to CVD mechanisms.
Main Results:
- Psychosocial stress is implicated in multiple CVD mechanisms, including risk factor clustering, endothelial dysfunction, and plaque instability.
- It contributes to myocardial ischemia, thrombosis, and malignant arrhythmias.
- Understanding these links is crucial for developing novel therapeutic strategies.
Conclusions:
- Psychosocial stress is a critical, under-addressed factor in cardiovascular disease.
- Further research into the behavioral and physiological links between stress and CVD is essential.
- Targeting psychosocial stress may offer a new avenue for reducing CVD morbidity and mortality.
Abstract:
The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality.