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"Stress" and coronary heart disease: psychosocial risk factors
Stephen J Bunker1, David M Colquhoun, Murray D Esler
1National Heart Foundation, 411 King Street, West Melbourne, VIC 3003, Australia. steve.bunker@heartfoundation.com.au
Insights
Depression, social isolation, and poor social support are strongly linked to coronary heart disease (CHD) risk and outcomes. Other psychosocial factors show no consistent association with CHD development or progression.
Area of Science:
- Cardiology
- Psychosocial Medicine
- Public Health
Background:
- Psychosocial factors are increasingly recognized as potential contributors to cardiovascular disease.
- Existing evidence on the association between various psychosocial factors and coronary heart disease (CHD) requires comprehensive evaluation.
Purpose of the Study:
- To systematically review evidence on major psychosocial risk factors and their independent association with CHD development, progression, and acute cardiac events.
- To inform clinical risk assessment, public health policy, and future research directions.
Main Methods:
- An Expert Working Group conducted a review of existing systematic reviews.
- Evidence was assessed for independent associations between psychosocial factors and coronary heart disease (CHD).
Main Results:
- Strong evidence confirms an independent causal link between depression, social isolation, and lack of quality social support with CHD causes and prognosis.
- No strong or consistent evidence was found for a causal association between chronic life events, work stressors, Type A behavior, hostility, or anxiety/panic disorders and CHD.
Conclusions:
- Depression, social isolation, and poor social support are significant psychosocial risk factors for coronary heart disease (CHD), comparable to conventional risk factors.
- Certain other psychosocial factors lack consistent evidence of a causal link to CHD.
- These findings have implications for CHD risk assessment, management, public health policy, and research priorities.
Abstract:
An Expert Working Group of the National Heart Foundation of Australia undertook a review of systematic reviews of the evidence relating to major psychosocial risk factors to assess whether there are independent associations between any of the factors and the development and progression of coronary heart disease (CHD), or the occurrence of acute cardiac events. The expert group concluded that (i) there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and (ii) there is no strong or consistent evidence for a causal association between chronic life events, work-related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD. The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking, dyslipidaemia and hypertension. The identified psychosocial risk factors should be taken into account during individual CHD risk assessment and management, and have implications for public health policy and research.