Stress response physiology in the cardiac patient: from the laboratory to real life

Recognition of a "brain-heart axis" has grown substantially, highlighting the contribution of psychological stress on cardiovascular physiology and the development and progression of cardiovascular disease (CVD). This connection appears particularly consequential for individuals with established CVD. Laboratory-based mental stress paradigms have been central to uncovering the mechanisms linking psychological stress with cardiovascular outcomes, implicating autonomic dysregulation and its downstream effects on immune function, vascular reactivity, and myocardial ischemia. Dynamic alterations in autonomic and molecular pathways during stress or negative emotional states may serve not only as critical determinants of cardiovascular risk but also as potential markers of heightened vulnerability. Certain patient groups-women, individuals with mental health conditions, and those facing adverse psychosocial exposures such as racial minorities-are especially susceptible to these stress-related effects. Recent advances extend these insights beyond controlled laboratory settings, demonstrating that ambulatory assessments of autonomic physiology are related to momentary psychological states in everyday life. This updated review synthesizes emerging knowledge on mind-body interactions in CVD and outlines promising avenues for future intervention. Collectively, the evidence underscores the importance of an integrative framework that considers psychological and biological processes jointly to fully understand the pathophysiology and outcome of CVD.