Personality Disorders and Coronary Atherosclerotic Plaque: A New Perspective

Abstract

The work of Suarez-Bagnasco et al, published in this issue of the Journal, (1) depicts not only an innovative and original contribution but has also considerable clinical value. With the simple language of specialists in the field of neuroscience and psychoimmunoendocrinology, they characterize different personality disorders and their relationship with the presence of coronary atherosclerotic plaque, presenting hypotheses on the possible pathophysiological mechanisms involved. To date, much has been written about the relationship between certain personality types and diverse cardiovascular complications and patient outcomes. However, even though the evidence has been clearly significant in some studies, the relationship between psychosocial factors and cardiovascular disease is rarely accepted in routine practice as a scientifically sustainable argument. Usually, it is difficult to accurately assess psychological illness as a defined noxa, or the consequences at this level of psychosocial aspects, with a pathophysiological basis enabling its correlation with cardiovascular disease. Today, there is proven evidence that these arguments are becoming less valid. (2) Currently, concepts such as allostasis, allostatic network and allostatic load have established a connection between neuroscience and cardiology, as the allostatic network is a supra-system linking the autonomic nervous system, the hypothalamic-pituitaryadrenal axis and the immune system with the cardiovascular system as one of its effectors. (3) These are familiar areas to the cardiologist who can relate them to each other from a different perspective and thus understand the association between the development of risk factors such as metabolic syndrome or atherosclerosis with the central nervous system and its responses to stress, and how different psychological disorders or psychosocial aspects impact at the cardiovascular level. (4, 5) (Figure 1) In this sense, the study of Suarez-Bagnasco et al is a pioneering work that focuses on the early stages of two processes: personality disorders and coronary atherosclerosis prior to the cardiac event.