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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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“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]
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“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]
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“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]
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“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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Metadata
- 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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