Psychological Stress and Cardiovascular Disease

Psychological Stress and Cardiovascular Disease

Joel E. Dimsdale

Stressors have enormous impacts on cardiovascular functioning. This review summarizes approaches taken in the waning years of the 20th century to study cardiovascular responses to acute and chronic stressors. The task for 21st century researchers is to better understand individuals’ vulnerability and resilience in the face of stressors.

There is an enormous amount of literature on psychological stress and cardiovascular disease. This report reviews conceptual issues in defining stress and then explores the ramifications of stress in terms of the effects of acute versus long-term stressors on cardiac functioning. Examples of acute stressor studies are discussed in terms of disasters (earthquakes) and in the context of experimental stress physiology studies, which offer a more detailed perspective on underlying physiology. Studies of chronic stressors are discussed in terms of job stress, marital unhappiness, and burden of caregiving. From all of these studies there are extensive data concerning stressors’ contributions to diverse pathophysiological changes including sudden death, myocardial infarction, myocardial ischemia, and wall motion abnormalities, as well as to alterations in cardiac regulation as indexed by changes in sympathetic nervous system activity and hemostasis. Although stressors trigger events, it is less clear that stress “causes” the events. There is nonetheless overwhelming evidence both for the deleterious effects of stress on the heart and for the fact that vulnerability and resilience factors play a role in amplifying or dampening those effects. Numerous approaches are available for stress management that can decrease patients’ suffering and enhance their quality of life.

Abbreviations and Acronyms: BP, blood pressure, CAD, coronary artery disease, EF, ejection fraction, HR, heart rate, MI, myocardial infarction, SNS, sympathetic nervous system