J Korean Med Assoc.  2013 Jun;56(6):462-470.

Stress and cardiovascular disease

• Cho JJ

Abstract

As we have summarized, a confluence of pathophysiological and epidemiological studies establish that both acute and chronic forms of psychosocial stress contribute to the pathogenesis of atherosclerosis. Clinical consequences of acute stress include the development of myocardial ischemia, cardiac arrhythmias, and fostering of more vulnerable coronary plaques and hemostatic changes. Chronic stress and affective disorders, such as depression, appear to promote atherosclerosis via hypothalamic-pituitary-adrenal (HPA) axis overstimulation. Chronic stress can contribute to the occurrence of cardiovascular disease (CVD) by direct and indirect pathways. These results establish that, in addition to traditional CVD risk factors, psychosocial factors contribute to CVD. Physicians should never neglect to assess psychosocial risk factors, for example depression, hostility, social isolation, and chronic life stress and job stress, by clinical interview or standardized questionnaires. Management approaches include directly treating patients with mild forms of psychological distress by applying multifactorial lifestyle interventions and treating patients with clinical depression and anxiety. However, patients with severe psychological distress should be referred to specialists. Additional attention and research related to stress and CVD will be needed in the future.

Keyword

Stress, psychological; Cardiovascular diseases; Affective disorders, psychotic; Life style

MeSH Terms

Affective Disorders, Psychotic
Anxiety
Arrhythmias, Cardiac
Atherosclerosis
Axis, Cervical Vertebra
Cardiovascular Diseases
Depression
Foster Home Care
Hostility
Humans
Life Style
Mood Disorders
Myocardial Ischemia
Surveys and Questionnaires
Risk Factors
Social Isolation
Specialization
Stress, Psychological

Figure

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  Figure 1 Pathophysiologic mechanisms by which chronic stress and affective disorders promote atherosclerosis (From Rozanski A, et al. J Am Coll Cardiol 2005;45:637-651, with permission from Elsevier) [5]. ANS, autonomic nervous system; HPA, hypothalamic-pituitary-adrenal; SNS, sympathetic nervous system; Endo, endothelial.

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