Stress and Cardiovascular Disease: A Literature Review

Introduction: Stress and Heart Disease

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 cardiovascular disease, 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, Edmondson & Kronish (2015): Mental Health and Cardiovascular Disease

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 post-traumatic 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 & Kronish (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 findings from epidemiological and clinical studies detailing the specific physiological factors and biological mechanisms underlying the stress responses, examining each of the relevant mental health conditions in turn. The authors also provide details related to study methodology and research design in order 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. 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 are also associated with risk factors that may lead to cardiovascular disease. According to the authors, there is an even stronger correlation between post-traumatic stress disorder and cardiovascular disease, with the development of acute myocardial ischemia being of particular note.

Dimsdale (2008): Acute vs. Chronic Stress Responses

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 each type. 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, shedding light on how stress adversely affects homeostasis or the central nervous system, which in turn leads to cardiovascular disease. Effective stress management is therefore considered a critical component of heart health, with significant 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 this 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" (Dimsdale, 2008, p. 1237). As research becomes more sophisticated in isolating specific pathophysiological responses and mechanisms, it will become increasingly possible for future researchers to identify the most effective 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, noting that effective coping strategies, genetics, and individual differences can all serve as mitigating factors that build resilience in persons who have been exposed to stressful events or who experience regular stressors. The author additionally addresses research design and methodological issues that help clarify causal relationships and suggest improvements to research reliability and validity.