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STATE-OF-THE-ART PAPER

Psychological Stress and Cardiovascular Disease

University of California, San Diego, La Jolla, California.

Manuscript received October 16, 2007; revised manuscript received December 5, 2007, accepted December 17, 2007.

^_* Reprint requests and correspondence: Dr. Joel E. Dimsdale, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093. (Email: jdimsdale{at}ucsd.edu).

There is an enormous amount of literature on psychological stress and cardiovascular disease. This report reviews conceptual issues in defining stress and then explores the ramifications of stress in terms of the effects of acute versus long-term stressors on cardiac functioning. Examples of acute stressor studies are discussed in terms of disasters (earthquakes) and in the context of experimental stress physiology studies, which offer a more detailed perspective on underlying physiology. Studies of chronic stressors are discussed in terms of job stress, marital unhappiness, and burden of caregiving. From all of these studies there are extensive data concerning stressors’ contributions to diverse pathophysiological changes including sudden death, myocardial infarction, myocardial ischemia, and wall motion abnormalities, as well as to alterations in cardiac regulation as indexed by changes in sympathetic nervous system activity and hemostasis. Although stressors trigger events, it is less clear that stress "causes" the events. There is nonetheless overwhelming evidence both for the deleterious effects of stress on the heart and for the fact that vulnerability and resilience factors play a role in amplifying or dampening those effects. Numerous approaches are available for stress management that can decrease patients’ suffering and enhance their quality of life.

Abbreviations and Acronyms   BP = blood pressure   CAD = coronary artery disease   EF = ejection fraction   HR = heart rate   MI = myocardial infarction   SNS = sympathetic nervous system