Mental stress as a trigger of cardiovascular events: A narrative review

Several mental disorders has been associated with cardiovascular disease (CVD), although stress may have the strongest correlation. In this narrative review, we examine how stress is linked to CVD.

Stress can be secondary to multiple factors and it can be imposed on an individual in more or less manifest ways. Psychosocial stress can result from adverse social circumstances such as poverty, racial, gender, religious disparities or discrimination, violence and environmental pollution. Large segments of the population are forced to endure poor working conditions, low food quality, physical and verbal abuse not only in the developing world but also in more flourishing societies as well. Wars that have ignited widely of late are inherently stressful events with potential enduring effects after the conflicts. Isolation and loneliness are growing issues in modern societies and impose a heavy burden of stress. Epidemiological studies have shown that stress is linked to CVD through an increased incidence of traditional risk factors (smoking, hypertension, insulin resistance and obesity). Experimental and laboratory evidence has shown a link between stress and CVD via neuro-endocrine, inflammatory and immune pathways. Patients with prior CV events affected by stress are at higher risk of recurrent events compared to similar patients without stressful conditions.

The close association between stress and CVD suggests that interventions to limit the effect of stress may result in a reduced incidence of de novo and recurrent CV events. Physicians should be aware of the importance of screening for stress in patients with CVD. Future efforts should be directed to the development of easily implementable screening tools and targeted interventions within healthcare frameworks.