Stress and cardiovascular disease: an update

• Published in: Nature reviews cardiology Vol. 21; no. 9; pp. 603 - 616
• Main Authors: Vaccarino, Viola, Bremner, J. Douglas
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-09-2024; Nature Publishing Group
• Subjects: 692/308/174; 692/420; 692/699/75; Autonomic Nervous System - physiopathology; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiovascular disease; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - psychology; Heart Disease Risk Factors; Hemodynamics; Humans; Medicine; Medicine & Public Health; Physiology; Review Article; Risk Factors; Stress; Stress, Psychological - complications; Stress, Psychological - physiopathology
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/s41569-024-01024-y

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.
Physiological responses to stress are thought to increase the risk of cardiovascular disease via haemodynamic, vascular and immune perturbations. In this Review, Vaccarino and Bremner focus on issues with the measurement of psychological stress and the underlying pathobiology connecting stress to the risk of cardiovascular disease.
Key points
Psychological stress has long been associated with negative health consequences, particularly cardiovascular disease, but the mechanisms and potential causal links have remained speculative.
Physiological responses to stress are emerging as key pathways for the risk of cardiovascular disease, especially haemodynamic, vascular and immune perturbations triggered by stress.
More data are needed from prospective studies and from assessments in real-life situations.
Mobile health technologies and wearable devices might be helpful in the prospective assessment of stressful exposures and stress responses in everyday life.
Psychological assessment should be integrated with clinical care and prevention.
Stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, although more data from large, randomized trials are needed.