The cardiovascular toll of stress
Abstract
Psychological stress elicits measurable changes in sympathetic-parasympathetic balance and the tone of the hypothalamic-pituitary-adrenal axis, which might negatively affect the cardiovascular system both acutely-by precipitating myocardial infarction, left-ventricular dysfunction, or dysrhythmia; and chronically-by accelerating the atherosclerotic process. We provide an overview of the association between stress and cardiovascular morbidity, discuss the mechanisms for this association, and address possible therapeutic implications.
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Stress and trauma are risk factors for cardiovascular disease.
“Stress and trauma are also risk factors for a range of non-communicable diseases, including cardiovascular disease [5,6], diabetes [7], and cognitive impairment [8,9], and can contribute to cancer incidence and survival [10].”
Cortisol suppresses inflammatory responses and stimulates the cardiovascular system, which increases blood pressure by working with the sympathetic system.
“The release of cortisol suppresses inflammatory responses and stimulates the cardiovascular system, which increases blood pressure by working with the sympathetic system 1, 2.”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [1]
Psychological stress mobilizes biological responses implicated in type 2 diabetes mellitus (T2DM), including the release of glucose and lipids into the circulation, inflammatory cytokine expression and increased blood pressure.
“Psychological stress mobilizes biological responses implicated in type 2 diabetes mellitus (T2DM), including the release of glucose and lipids into the circulation, inflammatory cytokine expression and increased blood pressure”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [1]
In response to stress, cortisol promotes the mobilization of energy stores, which induces the release of glucose and lipids into the circulation.
“In response to stress, cortisol promotes the mobilization of energy stores, which induces the release of glucose and lipids into the circulation.”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [1]
When faced with a threat, animals and humans respond rapidly with sympathetic nervous system activation coupled with upregulation of the hypothalamic-pituitary-adrenal axis, which results in increased release of cortisol from the adrenal cortex.
“When faced with a threat, animals and humans respond rapidly with sympathetic nervous system activation coupled with upregulation of the hypothalamic-pituitary- adrenal (HPA) axis 1, 2, which results in increased release of the glucocorticoid cortisol from the adrenal cortex”
From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [1]
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References 176 · Cited by 713
- Authors
- Brotman, D. J., Golden, S. H., & Wittstein, I. S.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Brotman, Daniel J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 370
- Issue
- 9592
- Pages
- 1089-1100
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2149257689
- Cited by
- 713
- References
- 176
- Citations by year
- 2026: 18 · 2025: 21 · 2024: 26 · 2023: 36 · 2022: 43 · 2021: 42 · 2020: 43 · 2019: 39 · 2018: 46 · 2017: 48 · 2016: 44 · 2015: 47 · 2014: 39 · 2013: 55 · 2012: 44
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (5 K23 D K071565)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- psychological stress, cardiovascular disease, sympathetic and parasympathetic balance, hypothalamic-pituitary-adrenal axis, myocardial infarction, left ventricular dysfunction, cardiac arrhythmias, atherosclerosis
- MeSH terms
- Cardiovascular Diseases, Circadian Rhythm, Electrocardiography, Emotions, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Stress, Psychological, Sympathetic Nervous System
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