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Behavioral cardiology: Recognizing and addressing the profound impact of psychosocial stress on cardiovascular health

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Abstract

Psychosocial stress exerts independent adverse effects on cardiovascular health. The recent INTERHEART study reported that psychosocial stress accounted for approximately 30% of the attributable risk of acute myocardial infarction. Prospective studies consistently indicate that hostility, depression, and anxiety are all related to increased risk of coronary heart disease and cardiovascular death. A sense of hopelessness, in particular, appears to be strongly correlated with adverse cardiovascular outcomes. Time urgency and impatience have not been consistently related to risk of coronary disease, but do increase the likelihood of developing hypertension. Psychosocial stress appears to adversely affect autonomic and hormonal homeostasis, resulting in metabolic abnormalities, inflammation, insulin resistance, and endothelial dysfunction. Additionally, stress is often associated with self-destructive behavior and non-compliance with medications. Psychosocial stress is a highly modifiable risk and many factors have been shown to be protective. These include psychosocial support, regular exercise, stress reduction training, sense of humor, optimism, altruism, faith, and pet ownership. Simple screening questions are available to reliably indicate a patient at risk for psychosocial stress-related health problems.

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References and Recommended Reading

  1. Rosengren A, Hawken S, Ounpuu S, et al.: Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004, 364:953–962.

    Article  PubMed  Google Scholar 

  2. Rugulies R: Depression as a predictor for coronary heart disease a review and meta-analysis. Am J Prev Med 2002, 23:51–61.

    Article  PubMed  Google Scholar 

  3. Rozanski A, Blumenthal JA, Davidson KW, et al.: The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005, 45:637–651.

    Article  PubMed  Google Scholar 

  4. Curtis BM, O’Keefe JH Jr: Autonomic tone as a cardiovascular risk factor: the dangers of chronic fight or flight. Mayo Clin Proc 2002, 77:45–54.

    Article  PubMed  Google Scholar 

  5. Eaker ED, Sullivan LM, Kelly-Hayes M, et al.: Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom Med 2005, 67:692–696.

    Article  PubMed  Google Scholar 

  6. Suarez EC: C-reactive protein is associated with psychological risk factors of cardiovascular disease in apparently healthy adults. Psychosom Med 2004, 66:684–691.

    Article  PubMed  CAS  Google Scholar 

  7. Mayou RA, Gill D, Thompson DR, et al.: Depression and anxiety as predictors of outcome after myocardial infarction. Psychosom Med 2000, 62:212–219.

    PubMed  CAS  Google Scholar 

  8. Matthews KA, Gump BB, Harris KF, et al.: Hostile behaviors predict cardiovascular mortality among men enrolled in the Multiple Risk Factor Intervention Trial. Circulation 2004, 109:66–70.

    Article  PubMed  Google Scholar 

  9. Dong M, Giles WH, Felitti VJ, et al.: Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation 2004, 110:1761–1766.

    Article  PubMed  Google Scholar 

  10. Kim CK, McGorray SP, Bartholomew BA, et al.: Depressive symptoms and heart rate variability in postmenopausal women. Arch Intern Med 2005, 165:1239–1244.

    Article  PubMed  Google Scholar 

  11. Rumsfeld JS, Havranek E, Masoudi FA, et al.: Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol 2003, 42:1811–1817.

    Article  PubMed  Google Scholar 

  12. Lesperance F, Frasure-Smith N, Talajic M, Bourassa MG: Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 2002, 105:1049–1053.

    Article  PubMed  Google Scholar 

  13. Rozanski A, Blumenthal JA, Kaplan J: Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999, 99:2192–2217.

    PubMed  CAS  Google Scholar 

  14. Lucini D, Norbiato G, Clerici M, Pagani M: Hemodynamic and autonomic adjustments to real life stress conditions in humans. Hypertension 2002, 39:184–188.

    Article  PubMed  CAS  Google Scholar 

  15. Hedblad B, Wikstrand J, Janzon L, et al.: Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: main results from the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001, 103:1721–1726.

    PubMed  CAS  Google Scholar 

  16. Lavie CJ, Milani RV: Prevalence of hostility in young coronary artery disease patients and effects of cardiac rehabilitation and exercise training. Mayo Clin Proc 2005, 80:335–342.

    PubMed  Google Scholar 

  17. Iribarren C, Sidney S, Bild DE, et al.: Association of hostility with coronary artery calcification in young adults: the CARDIA study. Coronary Artery Risk Development in Young Adults. JAMA 2000, 283:2546–2551.

    Article  PubMed  CAS  Google Scholar 

  18. Agatisa PK, Matthews KA, Bromberger JT, et al.: Coronary and aortic calcification in women with a history of major depression. Arch Intern Med 2005, 165:1229–1236.

    Article  PubMed  Google Scholar 

  19. Bunker SJ, Colquhoun DM, Esler MD, et al.: “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust 2003, 178:272–276.

    PubMed  Google Scholar 

  20. Yan LL, Matthews KA: Time urgency/ipatience(TUI) predicts incident hypertension 13 years later. Circulation 2002, 106(Suppl II):II-755.

    Google Scholar 

  21. Lampert R, Joska T, Burg MM, et al.: Emotional and physical precipitants of ventricular arrhythmia. Circulation 2002, 106:1800–1805.

    Article  PubMed  Google Scholar 

  22. Lampert R, Shusterman V, Burg MM, et al.: Effects of psychologic stress on repolarization and relationship to autonomic and hemodynamic factors. J Cardiovasc Electrophysiol 2005, 16:372–377.

    Article  PubMed  Google Scholar 

  23. Elliot WJ: Cyclic and circadian variations in cardiovascular events. Am J Hypertens 2001, 14(9 Pt 2):291S-295S.

    Article  PubMed  CAS  Google Scholar 

  24. Huang JL, Chiou CW, Ting CT, et al.: Sudden changes in heart rate variability during the 1999 Taiwan earthquake. Am J Cardiol 2001, 87:245–248.

    Article  PubMed  CAS  Google Scholar 

  25. Meisel SR, Kutz I, Dayan KI, et al.: Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 1991, 338:660–661.

    Article  PubMed  CAS  Google Scholar 

  26. Steinberg JS, Arshad A, Kowalski M, et al.: Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attack. J Am Coll Cardiol 2004, 44:1261–1264.

    Article  PubMed  Google Scholar 

  27. Lampert R, Baron SJ, McPherson CA, Lee FA: Heart rate variability during the week of September 11, 2001. JAMA 2002, 288:575.

    Article  PubMed  Google Scholar 

  28. Wittstein IS, Thiemann DR, Lima JA, et al.: Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005, 352:539–548.

    Article  PubMed  CAS  Google Scholar 

  29. Hemingway H, Shipley M, Brunner E, et al.: Does autonomic function link social position to coronary risk? The White-hall II study. Circulation 2005, 111:3071–3077.

    Article  PubMed  Google Scholar 

  30. Clays E, De Bacquer D, Delanghe J, et al.: Associations between dimensions of job stress and biomarkers of inflammation and infection. J Occup Environ Med 2005, 47:878–883.

    Article  PubMed  Google Scholar 

  31. Kivimaki M, Ferrie JE, Brunner E, et al.: Justice at work and reduced risk of coronary heart disease among employees: The Whitehall II Study. Arch Intern Med 2005, 165:2245–2251.

    Article  PubMed  Google Scholar 

  32. Broadley AJ, Korszun A, Abdelaal E, et al.: Inhibition of cortisol production with metyrapone prevents mental stress-induced endothelial dysfunction and baroreflex impairment. J Am Coll Cardiol 2005, 46:344–350.

    Article  PubMed  CAS  Google Scholar 

  33. Sherwood A, Hinderliter AL, Watkins LL, et al.: Impaired endothelial function in coronary heart disease patients with depressive symptomatology. J Am Coll Cardiol 2005, 46:656–659.

    Article  PubMed  Google Scholar 

  34. Brunner EJ, Hemingway H, Walker BR, et al.: Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study. Circulation 2002, 106:2659–2665.

    Article  PubMed  CAS  Google Scholar 

  35. Blumenthal JA, Sherwood A, Babyak MA, et al.: Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial. JAMA 2005, 293:1626–1634.

    Article  PubMed  CAS  Google Scholar 

  36. Buettner D: The secrets of living longer. National Geographic 2005, 11:2–21.

    Google Scholar 

  37. Williams RB, Barefoot JC, Califf RM, et al.: Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. JAMA 1992, 267:520–524.

    Article  PubMed  CAS  Google Scholar 

  38. Orth-Gomer K, Wamala SP, Horsten M, et al.: Marital stress worsens prognosis in women with coronary heart disease: the Stockholm Female Coronary Risk Study. JAMA 2000, 284:3008–3014.

    Article  PubMed  CAS  Google Scholar 

  39. Gallo LC, Troxel WM, Kuller LH, et al.: Marital status, marital quality, and atherosclerotic burden in postmenopausal women. Psychosom Med 2003, 65:952–962.

    Article  PubMed  Google Scholar 

  40. Coyne JC, Rohrbaugh MJ, Shoham V, et al.: Prognostic importance of marital quality for survival of congestive heart failure. Am J Cardiol 2001, 88:526–529.

    Article  PubMed  CAS  Google Scholar 

  41. Tobe SW, Kiss A, Szalai JP, et al.: Impact of job and marital strain on ambulatory blood pressure results from the double exposure study. Am J Hypertens 2005, 18:1046–1051.

    Article  PubMed  Google Scholar 

  42. Clark A, Seidler A, Miller M: Inverse association between sense of humor and coronary heart disease. Int J Cardiol 2001, 80:87–88.

    Article  PubMed  CAS  Google Scholar 

  43. Miller MM, Park Y, Goel R, et al.: Divergent effects of laughter and mental stress on endothelial function: potential impact of entertainment. In The Scientific Session of the American College of Cardiology, March 6–9, Orlando, FL, 2005.

  44. Maruta T, Colligan RC, Malinchoc M, Offord KP: Optimists vs pessimists: survival rate among medical patients over a 30-year period. Mayo Clin Proc 2000, 75:140–143.

    PubMed  CAS  Google Scholar 

  45. Maruta T, Colligan RC, Malinchoc M, Offord KP: Optimism-pessimism assessed in the 1960s and self-reported health status 30 years later. Mayo Clin Proc 2002, 77:748–753.

    PubMed  Google Scholar 

  46. Matthews KA, Raikkonen K, Sutton-Tyrrell K, Kuller LH: Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women. Psychosom Med 2004, 66:640–644.

    Article  PubMed  Google Scholar 

  47. Di S, Malcher-Lopes R, Marcheselli VL, et al.: Rapid glucocorticoid-mediated endocannabinoid release and opposing regulation of glutamate and gamma-aminobutyric acid inputs to hypothalamic magnocellular neurons. Endocrinology 2005, 146:4292–4301.

    Article  PubMed  CAS  Google Scholar 

  48. Ducobu J: The endocannabinoid system and the regulation of the metabolism. J Pharm Belg 2005, 60:84–88.

    PubMed  CAS  Google Scholar 

  49. Hill MN, Gorzalka BB: Enhancement of anxiety-like responsiveness to the cannabinoid CB(1) receptor agonist HU-210 following chronic stress. Eur J Pharmacol 2004, 499:291–295.

    Article  PubMed  CAS  Google Scholar 

  50. Engeli S, Bohnke J, Feldpausch M, et al.: Activation of the peripheral endocannabinoid system in human obesity. Diabetes 2005, 54:2838–2843.

    Article  PubMed  CAS  Google Scholar 

  51. Van Gaal LF, Rissanen AM, Scheen AJ, et al.: Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 2005, 365:1389–1397.

    Article  PubMed  CAS  Google Scholar 

  52. Liu Y, Tanaka H: Overtime work, insufficient sleep, and risk of non-fatal acute myocardial infarction in Japanese men. Occup Environ Med 2002, 59:447–451.

    Article  PubMed  CAS  Google Scholar 

  53. Karasek R, Baker D, Marxer F, et al.: Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health 1981, 71:694–705.

    PubMed  CAS  Google Scholar 

  54. Siegrist J: Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996, 1:27–41.

    Article  PubMed  CAS  Google Scholar 

  55. Gump BB, Matthews KA: Are vacations good for your health? The 9-year mortality experience after the multiple risk factor intervention trial. Psychosom Med 2000, 62:608–612.

    PubMed  CAS  Google Scholar 

  56. Ornish D: Love & Survival: The Scientific Basis for the Healing Power of Intimacy, edn 1. New York: Harper Collins; 1998.

    Google Scholar 

  57. Wannamethee SG, Shaper AG, Walker M: Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation 2000, 102:1358–1363.

    PubMed  CAS  Google Scholar 

  58. Friedmann E, Thomas SA: Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST). Am J Cardiol 1995, 76:1213–1217.

    Article  PubMed  CAS  Google Scholar 

  59. Friedmann E, Thomas SA, Stein PK, Kleiger RE: Relation between pet ownership and heart rate variability in patients with healed myocardial infarcts. Am J Cardiol 2003, 91:718–721.

    Article  PubMed  Google Scholar 

  60. Larson DB, Larson SS, Koenig HG: Mortality and religion/spirituality: a brief review of the research. Ann Pharmacother 2002, 36:1090–1098.

    Article  PubMed  Google Scholar 

  61. McCullough ME, Hoyt WT, Larson DB, et al.: Religious involvement and mortality: a meta-analytic review. Health Psychol 2000, 19:211–222.

    Article  PubMed  CAS  Google Scholar 

  62. Bernardi L, Sleight P, Bandinelli G, et al.: Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. BMJ 2001, 323:1446–1449.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Mid America Heart Institute, 4330 Wornall Road, Suite 2000, 64111, Kansas City, MO, USA

    James H. O’Keefe MD

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  1. Sajal Das MD
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  2. James H. O’Keefe MD
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Correspondence to James H. O’Keefe MD.

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Das, S., O’Keefe, J.H. Behavioral cardiology: Recognizing and addressing the profound impact of psychosocial stress on cardiovascular health. Curr Atheroscler Rep 8, 111–118 (2006). https://doi.org/10.1007/s11883-006-0048-2

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