Mental Stress and Cardiovascular Health—Part I

Abstract

Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.

Mental stress, meditation, and yoga in cardiovascular and cerebrovascular diseases

“…[ 2 ] The sympathetic response, more commonly known as the fight or flight response, may potentially play a role in the development of myocardial ischemia. [ 3 ] A similar mechanism has also been suggested to increase ischemic stroke. [ 4 ] There is also a unique difference in myocardial ischemia caused by mental stress as compared with physical exercise.…”

The Impact of Mental Stress on Cardiovascular Health—Part II

“…Treatment of major depression even in individuals without baseline CAD substantially reduced the development of coronary events [ 156 ]. In a small-size study of patients with stable CAD and MSIMI (see Part I [ 5 ]), treatment with escitalopram reduced the rate of MSIMI demonstrated on echocardiography and/or ECG, probably due to a beneficial effect on platelets aggregation [ 157 ]. However, other studies showed little or no evidence that treating depression in such patients improves CV outcomes [ 158 , 159 ].…”

“…Epidemiological studies suggest that acute and chronic mental stress, such as anger, fear, job strain, depression or exposure to natural disasters, may contribute to the pathogenesis and development of coronary artery disease (CAD) [ 1 , 2 , 3 , 4 ]. The first part of the review on the relationship between psychological stress and cardiovascular (CV) disease focused on the brain response to negative emotions and autonomic nervous system imbalance, leading to hemodynamic and coronary artery responses to mental stress [ 5 ]. The aim of Part II is to review the evidence for the clinical association between mental stress and systemic CV effects, including endothelial dysfunction, inflammation, hypertension, arrhythmia, and stress cardiomyopathy, based on most recent literature findings.…”

The Ketogenic Diet and Cardiovascular Diseases

“…High blood pressure is observed in as many as seven out of ten people with a first heart attack and eight out of ten people with a first stroke. In addition, excessive sodium intake and excessively high serum LDL lipoprotein levels are also identified as risk factors [1,[6][7][8]. Although some risk factors are not firmly established in the scientific evidence, they are still considered to be among the main ones.…”