Role of stress management for cardiovascular disease prevention

Despite the significant decline in cardiovascular disease (CVD) rates owing to recognition of risk factors, timely and appropriate therapy for acute events, and improved medical therapy, it remains the leading cause of death globally. Novel risk factors and modifications must be considered in the development and progression of CVD. The purpose of this review is to delineate the association between psychological and mental stress and CVD.

Stress has been implicated as a significant risk factor in both the acceleration of atherosclerosis and a trigger for acute CVD events. In the last decade, a growing body of evidence has been accumulated on the biological, neuroanatomical, and neurophysiological effects of stress and the benefits of cultivating resilience. The pathophysiology of stress is complex and involves the brain, autonomic nervous system, and the endocrine system, with associated metabolic, inflammatory, and hemostatic abnormalities.

Most practice guidelines do not recognize the importance of screening for stress in primary and secondary CVD prevention. There is a paucity of large, scalable, and cost-effective approaches for stress intervention. Two potential strategies are required for reducing stress: strategies that are population-based, and narrower targeted strategies for clinical practice.