Impact of Chronic Psychological Stress on Cardiovascular Disease Risk: A Narrative Review

Abstract

Cardiovascular disease (CVD) remains a leading cause of death worldwide, and identification of its risk factors is pivotal in ensuring a lower socioeconomic burden on society. Psychological stress shows a strong causal link with CVD through the interaction of physiological and behavioral risk factors. Importantly, there is an association between the duration and level of stress and propensity for CVD. Chronic stress exerts its physiological effects through the release of glucocorticoids (GCs) such as cortisol, which subsequently promote proinflammatory effects, exacerbating atherosclerotic plaque development. Stress also exacerbates the secretion of cardiokines such as tumor necrosis factor-alpha (TNF-α). Elevated TNF-α is associated with endothelial dysfunction and angiogenesis-mediated atherosclerotic plaque progression, with increased secretion as the duration of stress is extended. Stress-induced GC secretion also inhibits glucose uptake leading to hyperglycemia and consequent hyperinsulinemia. This increases an individual’s susceptibility to another CVD risk factor, type 2 diabetes mellitus (T2DM). These risk factors are further exacerbated by the impact of chronic stress on behavior such as eating habits. Increased consumption of comfort foods, typically containing high fat and sugar contents, is directly associated with increased body mass index and increased low-density lipoprotein (LDL) cholesterol, both of which are well-known drivers of atherosclerosis. Moreover, chronic stress often results in reductions in physical activity, particularly in individuals at low baseline levels of activity. This further increases an individual’s susceptibility to obesity, T2DM, and increased LDL-cholesterol levels, all of which promote the development of CVD. This review outlines key research findings relating to the role chronic psychological stress plays in altering physiological and behavioral risk factors for CVD.