“Stress” and coronary heart disease: psychosocial risk factors
Abstract
An Expert Working Group of the National Heart Foundation of Australia undertook a review of systematic reviews of the evidence relating to major psychosocial risk factors to assess whether there are independent associations between any of the factors and the development and progression of coronary heart disease (CHD), or the occurrence of acute cardiac events. The expert group concluded that (i) there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and (ii) there is no strong or consistent evidence for a causal association between chronic life events, work-related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD. The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking, dyslipidaemia and hypertension. The identified psychosocial risk factors should be taken into account during individual CHD risk assessment and management, and have implications for public health policy and research.
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Acute life-event stress can trigger coronary events.
“Acute life-event stress can trigger coronary events [1,2]”
Depression and poor social support are significant risk factors for the causes and prognosis of coronary heart disease.
“There is strong and consistent evidence of a causal association between both depression and social isolation or lack of quality social support, and the causes and prognosis of coronary heart disease (CHD) [1].”
There is strong and consistent evidence for an independent causal association between levels of social isolation and the risk of CVD.
“This is supported by findings of a systematic overview which found strong and consistent evidence for an independent causal association between levels of social isolation and the risk of CVD 40 .”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [40]
The overview found an association (++) between social isolation and cardiovascular disease, supported by one or more higher quality reviews.
“| Cardiovascular disease (Bunker et al 2003, Cuffee et al 2015, Glozier et al 2013, Mookadam et al 2004, Steptoe et al 2013) | ++ | | |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Bunker et al 2003
Cites
The environment and disease: association or causation?
Hill, A. B. (2015) · Journal of the Royal Society of Medicine · doi:10.1177/0141076814562718 · Cited by 7,302 · see citing works
The Environment and Disease: Association or Causation?
Hill, A. B. (1965) · Proceedings of the Royal Society of Medicine · doi:10.1177/003591576505800503 · Cited by 6,974 · see citing works
Publication bias in clinical research
Easterbrook, P. J., Gopalan, R., Berlin, J. A., & Matthews, D. R. (1991) · The Lancet · doi:10.1016/0140-6736(91)90201-y · Cited by 3,109 · see citing works
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999) · Circulation · doi:10.1161/01.cir.99.16.2192 · Cited by 2,846 · see citing works
The Relationship of Depression to Cardiovascular Disease: Epidemiology, Biology, and Treatment
Musselman, D. L., Evans, D. L., & Nemeroff, C. B. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.7.580 · Cited by 1,532 · see citing works
A meta-analytic review of research on hostility and physical health.
Miller, T. Q., Smith, T. W., Turner, C. W., Guijarro, M. L., & Hallet, A. J. (1996) · Psychological Bulletin · doi:10.1037/0033-2909.119.2.322 · Cited by 952 · see citing works
Guide to Clinical Preventive Services
&NA; (1997) · The Nurse Practitioner · doi:10.1097/00006205-199705000-00020 · Cited by 918 · see citing works
Job Strain and Cardiovascular Disease
Schnall, P. L., Landsbergis, P. A., & Baker, D. B. (1994) · Annual Review of Public Health · doi:10.1146/annurev.pu.15.050194.002121 · Cited by 800 · see citing works
Validation of an index of the quality of review articles
Oxman, A. D., & Guyatt, G. H. (1991) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(91)90160-b · Cited by 788 · see citing works
A Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines
(1999) · PsycEXTRA Dataset · doi:10.1037/e508692012-001 · Cited by 531 · see citing works
Formulating Questions and Locating Primary Studies for Inclusion in Systematic Reviews
Counsell, C. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-5-199709010-00008 · Cited by 505 · see citing works
Going to the heart of the matter
Kubzansky, L. D., & Kawachi, I. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00091-4 · Cited by 442 · see citing works
Kuper, H., Marmot, M., & Hemingway, H. (2002) · Seminars in Vascular Medicine · doi:10.1055/s-2002-35401 · Cited by 415 · see citing works
Jadad, A. R., & McQuay, H. J. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(95)00062-3 · Cited by 205 · see citing works
Scheier (1995) · doi:10.1097/00006842-199505000-00007 · Cited by 205 · see citing works
Hemingway, H. (2001) · European Heart Journal · doi:10.1053/euhj.2000.2534 · Cited by 151 · see citing works
Is panic disorder associated with coronary artery disease? A critical review of the literature
Fleet, R. P., Lavoie, K., & Beitman, B. D. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(99)00101-4 · Cited by 135 · see citing works
Life Stress, Social Support and Coronary Heart Disease
Tennant, C. (1999) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.1999.00616.x · Cited by 108 · see citing works
Self-citationThe Role of Social Support in the Pathogenesis of Coronary Heart Disease. A Literature Review
Eriksen, W. (1994) · Family Practice · doi:10.1093/fampra/11.2.201 · Cited by 69 · see citing works
Stress and cardiovascular disease: a report from the National Heart Foundation of Australia
Richards, J. G., Byrne, D. G., Dwyer, T., et al. (1988) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.1988.tb99461.x · Cited by 23 · see citing works
Peach, H. G. (2002) · PubMed · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017) · Public Health · doi:10.1016/j.puhe.2017.07.035 · Cited by 2,158 · see citing works
Clarke, D. M., & Currie, K. C. (2009) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2009.tb02471.x · Cited by 661 · see citing works
The effects of gender and age on health related behaviors
Deeks, A., Lombard, C., Michelmore, J., & Teede, H. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-213 · Cited by 367 · see citing works
Sympathetic activity in major depressive disorder: identifying those at increased cardiac risk?
Barton, D. A., Dawood, T., Lambert, E. A., Esler, M. D., Haikerwal, D., Brenchley, C., Socratous, F., Kaye, D. M., Schlaich, M. P., Hickie, I., et al. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e32829baae7 · Cited by 291 · see citing works
Self-citationInnes, K. E., & Vincent, H. K. (2007) · Evidence-Based Complementary and Alternative Medicine · doi:10.1093/ecam/nel103 · Cited by 268 · see citing works
Cardiovascular risk factors and dementia
Fillit, H., Nash, D. T., Rundek, T., & Zuckerman, A. (2008) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2008.06.004 · Cited by 225 · see citing works
Mental stress and human cardiovascular disease
Esler, M. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.10.011 · Cited by 197 · see citing works
Self-citationAnxiety worsens prognosis in patients with coronary artery disease
Shibeshi, W. A., Young-Xu, Y., & Blatt, C. M. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.03.007 · Cited by 182 · see citing works
The short-term health of Canada's new immigrant arrivals: evidence from LSIC
Newbold, B. (2009) · Ethnicity & Health · doi:10.1080/13557850802609956 · Cited by 166 · see citing works
Nestel, P., Clifton, P., Colquhoun, D., Noakes, M., Mori, T. A., Sullivan, D., & Thomas, B. (2015) · Heart, Lung and Circulation · doi:10.1016/j.hlc.2015.03.020 · Cited by 160 · see citing works
Self-citationTargeted primary care‐based mental health services for young Australians
Scott, E. M., Hermens, D. F., Glozier, N., Naismith, S. L., Guastella, A. J., & Hickie, I. B. (2012) · Medical Journal of Australia · doi:10.5694/mja11.10481 · Cited by 155 · see citing works
Self-citationInfluence of social support on progression of coronary artery disease in women
Wang, H.-X., Mittleman, M. A., & Orth-Gomer, K. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2004.05.021 · Cited by 113 · see citing works
Psychosocial risk factors for coronary heart disease
Glozier, N., Tofler, G. H., Colquhoun, D. M., Bunker, S. J., Clarke, D. M., Hare, D. L., Hickie, I. B., Tatoulis, J., Thompson, D. R., Wilson, A., et al. (2013) · Medical Journal of Australia · doi:10.5694/mja13.10440 · Cited by 103 · see citing works
Self-citationHickie, I. (2004) · Australasian Psychiatry · doi:10.1080/j.1039-8562.2004.02097.x-2 · Cited by 93 · see citing works
Self-citationProspective cohort study of hostility and the risk of cardiovascular disease mortality
Surtees, P. G., Wainwright, N. W. J., Luben, R., Day, N. E., & Khaw, K.-T. (2005) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.01.014 · Cited by 80 · see citing works
Burton, N. W., Pakenham, K. I., & Brown, W. J. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-427 · Cited by 76 · see citing works
Depression, isolation, social support, and cardiovascular disease in older adults
Arthur, H. M. (2006) · The Journal of Cardiovascular Nursing · doi:10.1097/00005082-200609001-00002 · Cited by 70 · see citing works
Ennis, J., & Majid, U. (2021) · Death Studies · doi:10.1080/07481187.2019.1661884 · Cited by 68 · see citing works
Wang, H.-X., Mittleman, M. A., Leineweber, C., & Orth-Gomer, K. (2006) · Psychotherapy and Psychosomatics · doi:10.1159/000090893 · Cited by 53 · see citing works
Heart rate variability in drug-naive patients with panic disorder and major depressive disorder
Kikuchi, M., Hanaoka, A., Kidani, T., Remijn, G. B., Minabe, Y., Munesue, T., & Koshino, Y. (2009) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2009.08.002 · Cited by 39 · see citing works
Morgan, M., Dunbar, J., Reddy, P., Coates, M., & Leahy, R. (2009) · BMC Family Practice · doi:10.1186/1471-2296-10-46 · Cited by 38 · see citing works
Hickie, I. (2004) · Australasian Psychiatry · doi:10.1111/j.1039-8562.2004.02098.x-i1 · Cited by 93 · see citing works
Self-citationNakagawa-Toyama, Y., Zhang, S., & Krieger, M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0047965 · Cited by 22 · see citing works
Hambridge, J. A., Turner, A., & Baker, A. L. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903270415 · Cited by 21 · see citing works
- Authors
- Bunker, S. J., Colquhoun, D. M., Esler, M. D., Hickie, I. B., Hunt, D., Jelinek, V. M., Oldenburg, B. F., Peach, H. G., Ruth, D., Tennant, C. C., & Tonkin, A. M.
- Affiliations
- National Heart Foundation of Australia (AU)
- Monash University (AU)
- Beyondblue (AU)
- The Royal Melbourne Hospital (AU)
- St Vincent's Hospital Melbourne (AU)
- Queensland University of Technology (AU)
- Ballarat Health Services (AU)
- The University of Melbourne (AU)
- The University of Sydney (AU)
- The University of Queensland (AU)
- Venue
- Medical Journal of Australia
- Publisher
- Wiley
- Published
- 2003-03
- Volume
- 178
- Issue
- 6
- Pages
- 272-276
- ISSN
- 0025-729X (ISSN-L)
- 1326-5377
- OpenAlex
- W2416897121
- Cited by
- 560
- References
- 21
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 29 · 2023: 14 · 2022: 8 · 2021: 17 · 2020: 18 · 2019: 24 · 2018: 15 · 2017: 16 · 2016: 26 · 2015: 24 · 2014: 21 · 2013: 30 · 2012: 28
- FWCI
- 23.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Medical Journal of Australia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart Foundation of Australia
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- coronary artery disease, psychosocial risk factors, depression, social isolation, social support, occupational stress, job control, Type A behavior pattern, hostility, anxiety disorders, panic disorder, cardiac risk assessment, cardiovascular risk management
- MeSH terms
- Anxiety Disorders, Coronary Disease, Depression, Hostility, Humans, Hyperlipidemias, Hypertension, Life Change Events, Prognosis, Risk Factors, Smoking, Social Isolation, Social Support, Stress, Psychological, Type A Personality, Work, Panic Disorder, Risk Assessment
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