The impact of stress on physical health has been fairly well documented, with emerging research detailing possible pathways or mechanisms of action. Such research has a tremendous impact on disease prevention strategies and best practices in healthcare. One of the areas revealing the strongest connection between stress and physical health is cardiology, with a strong correlation between environmental, psychological, and psychosocial stress and the etiology or exacerbation of heart disease. The following five articles provide an overview of recent research into the link between stress and cardiovascular disease. Cohen, B.E., Edmondson, D. & Kronish, I.M. (2015). State of the art review. American Journal of Hypertension 28(11): 1295-1302.

Stress contributes to the etiology of cardiovascular disease, even in patients who had previously shown no other risk factors. Chronic stress—whether exposure to daily life stressors over time or the chronic stress associated with posttraumatic stress disorder—may be particularly damaging to heart health. Stress increases risk for heart disease and also results in poorer patient prognosis. Possible mechanisms whereby psychological health impacts physiological health include autonomic nervous system and immune system activity, hemodynamics, and the hypothalamic-pituitary-adrenal axis: providing insight into the physiological links between mental states and cardiovascular health.

In a systematic review of literature published in the American Journal of Hypertension, Cohen, Edmondson & Kornish (2015) showcase recent research on the connection between mental health in general and cardiovascular disease. Both epidemiological studies and smaller-scale empirical research have “firmly established a connection” between cardiovascular health and specific mental health states linked to stress including depression, anxiety, and post-traumatic stress disorder. The authors summarize the findings from epidemiological and clinical studies detailing the specific physiological factors and biological mechanisms underlying the stress responses, detailing them for each of the relevant mental health conditions. The authors also provide details related to study methodology and research design to offer suggestions for future research on the relationship between stress and heart disease. Generally, issues like blood pressure and inflammatory responses are particularly indicated as stress-related causal factors in heart disease. In fact, research shows that exposure to systematic daily stressors also increases the mortality rate from heart disease. Daily stressors have been shown to be causes of cardiovascular disease in general, and also associated with the risk factors that may lead to cardiovascular disease. According to the authors, there is an even stronger correlation between posttraumatic stress disorder and cardiovascular disease. The development of acute myocardial ischemia is of particular note.

Dimsdale, J.E. (2008). Psychological stress and cardiovascular disease. Journal of the American College of Cardiology 51(13): DOI: 10.1016/j.jacc.2007.12.024

The relationships between stress, heart health and cardiovascular disease are complex. Research can reveal the different impacts of acute versus chronic stress, with potentially different physiological responses to both of these types of stress. Some research also elucidates the connection between experiencing a stressful life event and specific heart-related issues....

There may in fact be different pathophysiological responses involved in acute stressors such as living through a sudden disaster versus chronic exposure to stress such as work-related stress. How stress directly affects the heart is an important area of research, too, shedding light on things like how stress adversely affects homeostasis or the central nervous system, which then in turn leads to cardiovascular disease. Effective stress management is therefore considered a critical component of heart health, with implications for healthcare practice.
In “Psychological Stress and Cardiovascular Disease,” Dimsdale (2008) provides a systematic review of literature on the relationship between stress and cardiovascular disease. According to Dimsdale (2008), there have been over forty thousand individual studies focusing on stress and heart disease: a strong indicator of the relevance of the issue for healthcare in general. Some of the studies point to direct correlations between heart health and “myocardial infarction, myocardial ischemia, and wall motion abnormalities,” according to Dimsdale (2008, p. 1237). As research becomes more sophisticated in terms of isolating or pinpointing specific pathophysiological responses and mechanisms, it will become more possible for future researchers to identify either the best pharmacological or psychological treatment interventions that can improve coping mechanisms or reduce the impact that stress has on physiological pathways. The author also differentiates between acute and chronic stress. As Dimsdale (2008) points out, effective coping strategies, genetics, and individual differences can all be mitigating factors that build resilience in persons who have been exposed to stressful events or who experience regular stressors. The author also points out research design and methodological issues that helps to clarify the causal relationships, and to suggest improvements to research reliability and validity.

Johnson, J.V. & Hall, E.M. (2011). Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. American Journal of Public Health 78(10): 1336-1342.

Some studies on the connection between heart disease and stress use experimental designs to show how specific types of stress impact physiological changes correlated with heart disease. Stress is a relatively generic term that should be qualified better in good research designs. For example, not all people react to the same situations in the same way. Some people perceive a situation as being stressful, a situation that others would not find stressful and vice-versa. It is important to classify the types of stressors and individual responses to those stressors. Locus of control has been implicated as a stressor in the workplace, with social support systems being identified as a mitigating factor.

In “Job Strain, Work Place Social Support, and Cardiovascular Disease,” Johnson & Hall (2011) use a cross-sectional research design to demonstrate the relationships between workplace environmental factors and cardiovascular disease prevalence. The authors randomly selected over thirteen thousand subjects in Sweden, and used self-report measures to determine the workplace factors such as psychosocial support, psychosocial work-related demands, locus of control in the workplace, status or power, and perceived supervisory support. Prevalence ratios were assessed…