State of the art review: depression, stress, anxiety, and cardiovascular disease
Open accessAbstract
The notion that psychological states can influence physical health is hardly new, and perhaps nowhere has the mind-body connection been better studied than in cardiovascular disease (CVD). Recently, large prospective epidemiologic studies and smaller basic science studies have firmly established a connection between CVD and several psychological conditions, including depression, chronic psychological stress, posttraumatic stress disorder (PTSD), and anxiety. In addition, numerous clinical trials have been conducted to attempt to prevent or lessen the impact of these conditions on cardiovascular health. In this article, we review studies connecting depression, stress/PTSD, and anxiety to CVD, focusing on findings from the last 5 years. For each mental health condition, we first examine the epidemiologic evidence establishing a link with CVD. We then describe studies of potential underlying mechanisms and finally discuss treatment trials and directions for future research.
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Negative psychological health, including depression, anxiety, and stress, is associated with smoking, lower levels of physical activity, poorer diet quality, and being overweight or obese.
“As described earlier, negative psychological health, including depression, anxiety, and stress, is associated with smoking, lower levels of physical activity, poorer diet quality, and being overweight or obese. 25,95”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [95]
The Discussion (page unavailable) associates depression, stress, and anxiety with unhealthy lifestyle behaviors and names smoking, poor diet, and a sedentary lifestyle. The Potential mechanisms section also links anxiety to smoking, lower physical activity, and poor diet. The retrieved passages do not support the additional association with being overweight or obese. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDepression is an established prognostic risk factor for cardiovascular disease, whereas anxiety is not.
“Depression is an established prognostic risk factor for cardiovascular disease (CVD), which is not the case for anxiety. 1”
From The effects of internet-based cognitive behaviour therapy for depression in cardiovascular disease on symptoms of anxiety: a secondary analysis of a randomized trial. (2024) · cites this paper as [1]
The Abstract and Discussion report strong evidence for depression as a prognostic risk factor, particularly after acute coronary syndrome. The Epidemiology section describes evidence on anxiety and adverse outcomes as mixed, supporting a distinction in certainty. But the Discussion also says European guidelines identify anxiety as a risk factor for adverse outcomes in patients with existing CVD, so the categorical contrast overstates the review. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMost forms of psychological distress lead to activation of the hypothalamic-pituitary-adrenal axis, resulting in dysregulation of the autonomic nervous system and downstream effects that can increase the risk of developing cardiovascular disease.
“Most forms of psychological distress (eg, anger, anxiety, depression, PTSD) lead to activation of the hypothalamic-pituitary-adrenal axis, resulting in dysregulation of the autonomic nervous system and a cascade of downstream effects that can increase the risk of developing CVD. 95,101”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [95]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAlthough some pathways are shared across negative and positive psychological factors, specific manifestations of psychological health may have distinct biobehavioral effects.
“Although some pathways are shared across negative and positive psychological factors, 11,53,77,94,95 specific manifestations of psychological health may also have distinct biobehavioral effects. 96”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [95]
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Attention based hybrid deep learning model for wearable based stress recognition
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Xu, B., Lang, L., Li, S., Guo, J., Wang, J., Wang, D., Zhang, L.-P., Yang, H.-M., & Lian, S. (2019) · Cells · doi:10.3390/cells8060612 · Cited by 59 · see citing works
Increased Cardiovascular Disease Risk in Veterans With Mental Illness
Vance, M. C., Wiitala, W. L., Sussman, J. B., Pfeiffer, P., & Hayward, R. A. (2019) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.119.005563 · Cited by 57 · see citing works
Taylor‐Piliae, R. E., & Finley, B. A. (2020) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515120926068 · Cited by 56 · see citing works
Anxiety, Depression, and Colorectal Cancer Survival: Results from Two Prospective Cohorts
Trudel-Fitzgerald, C., Tworoger, S., Zhang, X.-H., Giovannucci, E., Meyerhardt, J., & Kubzansky, L. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103174 · Cited by 50 · see citing works
Grauerholz, K. R., Berry, S. N., Capuano, R. M., & Early, J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.673050 · Cited by 60 · see citing works
Anxiety and Depression: What Do We Know of Neuropeptides?
Kupcová, I., Danišovič, Ľ., Grgac, I., & Harsányi, Š. (2022) · Behavioral Sciences · doi:10.3390/bs12080262 · Cited by 57 · see citing works
Dyball, D. M., Evans, S., Boos, C. J., Stevelink, S. A. M., & Fear, N. T. (2019) · International Review of Psychiatry · doi:10.1080/09540261.2019.1580686 · Cited by 56 · see citing works
O’Riordan, A., Howard, S., & Gallagher, S. M. (2022) · Health Psychology Review · doi:10.1080/17437199.2022.2068639 · Cited by 54 · see citing works
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Beerse, M. E., Van Lith, T., & Stanwood, G. D. (2019) · Sage Open · doi:10.1177/2158244019854646 · Cited by 56 · see citing works
Anxiety, depression, and stress in Korean patients with chronic urticaria
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Association between depression, anxiety and weight change in young adults
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Implications of the COVID-19 Pandemic for Cardiovascular Disease and Risk-Factor Management
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A Public Health Perspective on Mental and Medical Comorbidity
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- Authors
- Cohen, B. E., Edmondson, D., & Kronish, I. M.
- Affiliations
- San Francisco VA Medical Center (US)
- Columbia University Irving Medical Center (US)
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-04-24
- Volume
- 28
- Issue
- 11
- Pages
- 1295-1302
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- PMC
- PMC4612342
- OpenAlex
- W2017141822
- Cited by
- 955
- References
- 97
- Citations by year
- 2026: 51 · 2025: 93 · 2024: 99 · 2023: 150 · 2022: 128 · 2021: 128 · 2020: 115 · 2019: 72 · 2018: 67 · 2017: 27 · 2016: 22 · 2015: 3
- FWCI
- 6.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- American Journal of Hypertension (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Heart Association (UL1 TR000040)
- National Institutes of Health (UL1TR000040)
- National Heart, Lung, and Blood Institute (K23HL094765, HL117832, K23HL098359, R01HL117832)
- National Center for Advancing Translational Sciences (TR000040)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- depression, psychological stress, post-traumatic stress disorder, anxiety, cardiovascular disease, mind-body problem, psychocardiology, cardiovascular risk factors
- MeSH terms
- Anxiety, Cardiovascular Diseases, Depression, Humans, Psychological Techniques, Psychotropic Drugs, Risk Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, Comorbidity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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