Psychological Stress and the Development of Heart Disease

Until recently it was thought that no more than 50% of clinical coronary heart disease was explicable in terms of classical cardiac risk factors such as dyslipidemia, cigarette smoking, high blood pressure and diabetes. Recent large scale epidemiological studies have increased our understanding of the mechanisms generating cardiac risk and have provided evidence indicating that psychosocial factors, including stress at work and at home, financial stress, recent major life events and the presence of depressive illness are involved here, “triggering” clinical cardiovascular events, and possibly also contributing to hypertension and atherosclerosis development. The underlying mechanisms in play are most likely multi factorial in origin, involving the autonomic nervous system, platelet activation, thrombogenesis and endothelial dysfunction. Given that strategies for preventive therapy remain largely unformulated, future research should focus on generating a better understanding of the neurobiology of psychogenic heart disease as a basis for rational and effective therapy.