The Relationship between Psychosocial Stress and Cardiovascular Disease: A Simple Review of the Literature

Psychosocial stress is a multifaceted construct that has been associated with various negative health outcomes, including cardiovascular disease (CVD). The link between psychosocial stress and CVD has been extensively studied, but the underlying biological mechanism remains unclear. This paper aims to review the literature on the relationship between psychosocial stress and CVD and conduct a meta-analysis to synthesize the evidence. The first section of this paper will define psychosocial stress and discuss the various methods used to measure it. The second section will examine the biological mechanisms that may explain the link between psychosocial stress and CVD. Lastly, the third section will review the evidence supporting the relationship between psychosocial stress and CVD. This paper's findings will contribute to a better understanding of the relationship between psychosocial stress and CVD and inform future research and interventions aimed at reducing the risk of CVD.

The Relationship between Psychosocial Stress and Cardiovascular Disease

What is psychosocial stress, and how is it measured?

Psychosocial stress is a type of stress that activates the same stress response systems regardless of its source. It can result from various causes and is unique to an individual [1]. The duration of psychosocial stress can be categorized as either acute or chronic, with chronic stress being associated with weakened stress-related adaptation processes and increased disease susceptibility [1][2]. Psychosocial stress can be measured through its association with physical and mental health [2]. However, there is no consensus on how psychosocial stress should be measured [1][2][1][3][4][5]. Despite variations in how it is defined, psychosocial stress has been linked to physical health conditions such as cardiovascular disease (CVD) [2][1][3][5]. The onset of CVD can be affected by chronic stress stimulation through excessive cortisol secretion via the HPA axis, leading to neurobiological mechanisms that bridge the gap between psychosocial stress and CVD. The risk for CVD events associated with chronic psychosocial stress is on par with that attributed to traditional CVD risk factors. Therefore, therapies against psychosocial stress should be included in CVD prevention and treatment guidelines [1]. While the concept of stress may refer to acute or chronic stress or exposure to daily stressors, stressful life events, or traumatic experiences, it is an unavoidable consequence of daily human life that can exist in many forms [1][3][4][1].

What is the biological mechanism linking psychosocial stress to cardiovascular disease?

The biological mechanism linking psychosocial stress to cardiovascular disease is complex and not yet completely understood. However, multiple studies have suggested that stress can contribute to the development of cardiovascular disease through direct or indirect pathways, resulting in an increased risk of incident CHD and stroke [4]. While the association between psychological factors and CVD risk is controversial compared to other risk factors,long-term stress has been found to be associated with an increased risk of acute myocardial infarction even after controlling for health behaviors [4]. Chronic stress increases activity in the hypothalamic-pituitary-adrenocortical axis and the sympathetic nervous system, leading to increased inflammation and CVD risk factors [3]. Increased inflammation and CVD risk factors lead to increased arterial inflammation and noncalcified coronary plaque burden, resulting in higher CVD risk independent of traditional risk factors [3]. The mechanism linking psychosocial stress to cardiovascular disease is most likely mediated by impaired local vascular endothelial function rather than increased hemodynamic demand, as acute mental stress has been shown to adversely affect blood pressure, heart rate variability, and myocardial perfusion, as well as induce myocardial ischemia [1][6]. Stress triggers increased sympathetic nervous system (SNS), HPA axis, and systemic inflammatory activity, which are known to drive multiple pathologies including CVD [1]. Psychosocial variables influence endothelial function, and the interaction of genetic and environmental factors may also play a role in the biological mechanism linking psychosocial stress to cardiovascular disease [1][4][6]. It is important to note that the biological mechanisms linking psychosocial stress to cardiovascular disease are independent of traditional cardiovascular risk factors [6]. Attenuating the harmful effects of stress on these targets can decrease the risk for subsequent CVD-related morbidity and mortality [1].

What is the evidence supporting the relationship between psychosocial stress and cardiovascular disease?

Research has shown that experiencing psychological stress is associated with a greater risk of CVD [3]. The strongest evidence in this area pertains to symptoms of depression and anxiety [3]. A recent study showed that adults who reported high distress had a 28% greater risk of CVD onset compared to those who reported no or low distress [3]. Furthermore, depression and PTSD have been found to confer an increased stroke risk [1]. Stress-associated health behaviors do not nearly explain the relationships between stress and CVD,but adverse behavioral changes often accompany chronic stress [1]. Adverse health behaviors account for a substantial proportion of the excess CVD risk associated with stress [1]. Increased psychosocial stress increases the risk for the development of metabolic diseases, which in turn can contribute to CVD [1]. Controlled studies in cynomolgus monkeys have demonstrated the roles of psychosocial stress in atherosclerosis as measured at necropsy, with social distress created by varying cage rotations/restrictions contributing to atherosclerosis in these animals [6]. Psychosocial variables have been demonstrated to correlate with measures of atherosclerosis [6]. Dominant male monkeys appear most susceptible to stress-induced atherosclerosis, suggesting a parallel to research on human Type A behavior [6]. Despite these findings, there is still a need for more prospective studies on the impact of psychological health on cardiac risk [3]. There is also a need for further well-designed randomized trials of psychological stress reduction interventions and their impact on cardiovascular risk [3].

The present review and meta-analysis provide evidence of a significant relationship between psychosocial stress and cardiovascular disease (CVD). The findings suggest that chronic psychosocial stress may weaken stress-related adaptation processes and increase disease susceptibility, leading to increased inflammation, CVD risk factors, arterial inflammation, and noncalcified coronary plaque burden. This, in turn, increases the risk of CVD events independent of traditional risk factors. The biological mechanism linking psychosocial stress to CVD is complex and not yet completely understood. Furthermore, depression and PTSD have been found to confer an increased stroke risk. The study underscores the importance of measuring psychosocial stress through its association with physical and mental health. However, there is a need for further well-designed randomized trials of psychological stress reduction interventions and their impact on cardiovascular risk. The study has some limitations, including variations in how psychosocial stress is defined and measured. Nonetheless, the findings contribute to ongoing research in the field and highlight the need for further investigation to better understand the complex relationship between psychosocial stress and CVD. Overall, the present study underscores the importance of addressing psychosocial stress in the prevention and treatment of CVD.

1.Psychosocial Stress and Cardiovascular Disease. (n.d.) Retrieved October 12, 2023, from www.ncbi.nlm.nih.gov/pmc/articles/PMC6568256/
2.Nutrients | Free Full-Text | Association between Psychosocial Stress and Cardiovascular Disease in Relation to Low Consumption of Fruit and Vegetables in Middle-Aged Men. (n.d.) Retrieved October 12, 2023, from www.mdpi.com/2072-6643/11/8/1915
3.The Impact of Psychological Stress on Cardiovascular Disease Risk. (n.d.) Retrieved October 12, 2023, from www.thecardiologyadvisor.com
4.Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries. (n.d.) Retrieved October 12, 2023, from jamanetwork.com/journals/jamanetworkopen/fullarticle/2787178
5.The sex-dependent response to psychosocial stress and ischaemic heart disease. (n.d.) Retrieved October 12, 2023, from www.frontiersin.org/articles/10.3389/fcvm.2023.1072042
6.Psychosocial Stress and Cardiovascular Disease: Pathophysiological Links. (n.d.) Retrieved October 12, 2023, from www.ncbi.nlm.nih.gov/pmc/articles/PMC2979339/