Psychosocial Stress and Cardiovascular Disease: Pathophysiological Links

Abstract

The remarkable decline in cardiovascular disease (CVD) experienced in developed countries over the last 40 years appears to have abated. Currently, many CVD patients continue to show cardiac events despite optimal treatment of traditional risk factors. This evidence suggests that additional interventions, particularly those aimed at nontraditional factors, might be useful for continuing the decline. Psychosocial stress is a newly recognized (nontraditional) risk factor that appears to contribute to all recognized mechanisms underlying cardiac events, specifically, (a) clustering of traditional cardiovascular risk factors, (b) endothelial dysfunction, (c) myocardial ischemia, (d) plaque rupture, (e) thrombosis, and (f) malignant arrhythmias. A better understanding of the behavioral and physiologic associations between psychosocial stress and CVD will assist researchers in identifying effective approaches for reducing or reversing the damaging effects of stress and may lead to further reductions of CVD morbidity and mortality.

Key Words:

• cardiovascular disease
• psychosocial interventions
• psychosocial stress
• review

Additional information

Notes on contributors

Robert H. Schneider

Dr Bairey Merz is director, Preventive and Rehabilitative Cardiac Center, attending cardiologist, Cedars-Sinai Medical Center, Los Angeles and an associate professor of clinical medicine at the University of California Los Angeles, School of Medicine. Dr Dwyer is an associate professor, Department of Preventive Medicine, the Atherosclerosis Research Institute and Institute for Health Promotion and Disease Prevention Research, University of Southern California School of Medicine, Los Angeles, where Ms Nordstrom is with the Department of Preventive Medicine. Dr Walton is a senior research fellow, Center for Natural Medicine and Prevention, and an associate professor, Departments of Chemistry and Physiology, Center for Natural Medicine and Prevention, College of Maharishi Vedic Medicine, Maharishi University of Management, Fairfield, Iowa, where Dr Salerno is an assistant professor and assistant director of the Center for Natural Medicine and Prevention, and Dr Schneider is a professor, dean, and director of the Center for Natural Medicine and Prevention.