A narrative review on mental stress and cardiovascular disease: Evidence, mechanisms, and potential interventions

Cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. Psychosocial stress is an important risk factor implicated in a higher incidence of CVD. There are two prevalent categories of stress – acute psychosocial stress (APS) and chronic psychosocial stress (CPS). APS is typically caused by acute dramatic events such as natural disasters, sexual abuse, terroristic attacks, and sudden death of a loved one, while CPS is usually related to environmental, relationship, and work stressors. Both categories of psychosocial stress are associated with substantial CVD morbidity and mortality that carries a magnitude of risk equal to that of conventional CVD risk factors. As a result, more research is needed to understand the detrimental impacts of psychosocial stress on cardiovascular health and related mechanistic underpinnings that, in turn, would further facilitate the development of novel therapeutic targets. This review aims to elucidate the potential pathophysiological mechanisms by which psychosocial stress can influence CVD. In addition, we aim to discuss the current targeted therapeutic interventions (pharmacological and nonpharmacological) and possible future research directions.