Emotional stress is recognized as a prognostic factor in cardiovascular disease that influences outcomes through activation of the sympathetic nervous system, renin-angiotensin system, and hypothalamic-pituitary-adrenal axis.
Emotional stress that aggravates symptoms of depression, anxiety, and/or perceived mental stress is common in patients with chronic diseases, such as CVD. It is a newly recognized risk and prognosticator for several CVDs. It can influence CV outcomes, and also affect health care utilization. The biological systems activated by mental stress comprise the SNS, the RAS, and the HPA axis, while several other biological processes are disrupted.
Manolis et al. (2025) studied this question.