Psychosocial Risk Factors and Cardiovascular Disease: Epidemiology, Screening, and Treatment Considerations

The recognition that psychosocial risk factors contribute to the pathogenesis of cardiovascular disease has led to the development of a new field of behavioral cardiology. The initial impetus for this field was studies performed in the 1980s and 1990s that provided epidemiological evidence and a pathophysiological basis for a strong link between a number of psychosocial risk factors and cardiovascular disease, including depression, anxiety, hostility, job stress, and poor social support. In recent years, additional psychosocial risk factors have been identified, including pessimism; other forms of chronic stress, such as childhood abuse and trauma, and the psychological stress that may be associated with chronic medical illness; lack of life purpose; and the syndrome of “vital exhaustion,” which consists of a triad of exhaustion, demoralization, and irritability. New research in the last decade has also established that positive psychosocial factors, such as optimism, positive emotions, a vibrant social life, and a strong sense of life purpose, can have an important health-buffering effect through their favorable influence on health behaviors and promotion of positive physiological functioning. Patients can be screened for psychosocial risk factors in clinical practice through either the use of open-ended questions, which can be integrated into a physician’s standard review of systems, or the use of short questionnaires. Physicians can assist in the treatment of psychosocial risk factors in various ways, such as screening patients for psychological distress and making appropriate referrals when indicated, providing patients with practical lifestyle suggestions, and employing office personnel to teach patients behavioral or psychosocial interventions that can promote a sense of well-being and/or reduce stress.