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Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms
Mark Hamer1, Gerard J Molloy, Emmanuel Stamatakis
1Department of Epidemiology and Public Health, University College, London, United Kingdom. m.hamer@ucl.ac.uk
Insights
Psychological distress increases cardiovascular disease (CVD) risk, primarily through behavioral factors like smoking and inactivity. Interventions targeting health behaviors are key to reducing CVD risk in distressed individuals.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Psychological distress is linked to cardiovascular disease (CVD) risk, but the mechanisms are not fully understood.
- Understanding these pathways is crucial for developing interventions to mitigate CVD risk through psychological distress management.
Purpose of the Study:
- To quantify the contribution of behavioral and pathophysiological factors to the association between psychological distress and incident CVD events.
- To identify key mediating factors in the relationship between psychological distress and cardiovascular outcomes.
Main Methods:
- A prospective study of 6,576 healthy adults (mean age 50.9 years) assessed psychological distress, behavioral risk factors (smoking, alcohol, physical activity), and pathophysiological markers (CRP, fibrinogen, lipids, obesity, hypertension).
- Cardiovascular events, including myocardial infarction, stroke, and CVD-related mortality, were tracked over an average of 7.2 years.
Main Results:
- Psychological distress was independently associated with smoking, physical activity levels, alcohol intake, C-reactive protein, and hypertension.
- Individuals with psychological distress had a 1.54-fold increased risk of CVD events.
- Behavioral factors explained approximately 65% of the variance in the distress-CVD association, while pathophysiological factors explained a smaller proportion (e.g., hypertension ~13%, CRP ~5.5%).
Conclusions:
- The link between psychological distress and cardiovascular disease risk is predominantly mediated by behavioral factors.
- Interventions aimed at reducing CVD risk in individuals experiencing psychological distress should prioritize promoting healthy behavior changes.
Objectives:
This study sought to estimate the extent to which behavioral and pathophysiological risk factors account for the association between psychological distress and incident cardiovascular events.
Background:
The intermediate processes through which psychological distress increases the risk of cardiovascular disease (CVD) are incompletely understood. An understanding of these processes is important for treating psychological distress in an attempt to reduce CVD risk.
Methods:
In a prospective study of 6,576 healthy men and women (ages 50.9 +/- 13.1 years), we measured psychological distress (using the 12-item version of the General Health Questionnaire >or=4) and behavioral (smoking, alcohol, physical activity) and pathophysiological (C-reactive protein, fibrinogen, total and high-density lipoprotein cholesterol, obesity, hypertension) risk factors at baseline. The main outcome was CVD events (hospitalization for nonfatal myocardial infarction, coronary artery bypass, angioplasty, stroke, heart failure, and CVD-related mortality).
Results:
Cigarette smoking, physical activity, alcohol intake, C-reactive protein, and hypertension were independently associated with psychological distress. There were 223 incident CVD events (63 fatal) over an average follow-up of 7.2 years. The risk of CVD increased in relation to presence of psychological distress in age- and sex-adjusted models (hazard ratio: 1.54, 95% confidence interval: 1.09 to 2.18, p = 0.013). In models that were adjusted for potential mediators, behavioral factors explained the largest proportion of variance ( approximately 65%), whereas pathophysiological factors accounted for a modest amount (C-reactive protein approximately 5.5%, hypertension, approximately 13%).
Conclusions:
The association between psychological distress and CVD risk is largely explained by behavioral processes. Therefore, treatment of psychological distress that aims to reduce CVD risk should primarily focus on health behavior change.
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