[Epidemiological studies on the relationship between psychosocial factors and cardiovascular disease]

Psychosocial factors contribute significantly to the pathogenesis and expressions of cardiovascular disease(CVD). Recent studies have demonstrated that 5 specific psychosocial entities are most relevant: (1) depression, (2) anxiety; (3) personality factors and character traits; (4) social isolation, and (5) chronic life stress. Epidemiological studies consistently demonstrate a significant prospective relationship between the occurrence of major depression and the cardiac events. Increasing evidence now links anxiety disorders to the development of CVD events in general populations. Although type A behavior is continuously found to be positively related with increased risk of CVD, a series of studies have reported no correlation between type A behavior and CVD risk. However, hostility, a major attribute of the type A behavior pattern, is considered to be more pathogenic. Social isolation characterized mainly by a relatively small social network has been shown to be associated with increase in the incidence of CVD over time. Finally, chronic life stress, particularly the work-related stress, proved to be closely related to CVD risk. The pathophysiological mechanisms of psychosocial factors on the pathogenesis of CVD are: (1) excessive sympathetic nervous system activation, (2) triggering of myocardial ischemia; (3) promotion of arrhythmogenesis, (4) stimulation of platelet function, and (5) deterioration of endothelial function.