Abstract
Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.
Key points
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Psychological stress has long been associated with negative health consequences, particularly cardiovascular disease, but the mechanisms and potential causal links have remained speculative.
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Physiological responses to stress are emerging as key pathways for the risk of cardiovascular disease, especially haemodynamic, vascular and immune perturbations triggered by stress.
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More data are needed from prospective studies and from assessments in real-life situations.
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Mobile health technologies and wearable devices might be helpful in the prospective assessment of stressful exposures and stress responses in everyday life.
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Psychological assessment should be integrated with clinical care and prevention.
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Stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, although more data from large, randomized trials are needed.
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Acknowledgements
Part of the authors’ work reported in this article was supported by National Institutes of Health grants P01 HL101398, R01 HL109413, R01 HL125246, R01 HL136205, R01 HL088726, R01 MH120262, UG3 DA048502, T32 HL130025, KL2TR000455, K23 HL127251, K24 HL077506 and K24 MH076955.
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Vaccarino, V., Bremner, J.D. Stress and cardiovascular disease: an update. Nat Rev Cardiol (2024). https://doi.org/10.1038/s41569-024-01024-y
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DOI: https://doi.org/10.1038/s41569-024-01024-y
