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Figure 7 Pathophysiologic mechanisms by which chronic stress and affective disorders, such as depression, appear to promote atherosclerosis. These stressors activate the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) and affect behaviors. Multiple adverse peripheral effects can ensue from this neuroendocrine, sympathetic, and behavioral activation, as shown. The neuroendocrine and neuroplastic changes emanating from these stressors can also induce a state of heightened physiologic responsivity to acute stress which may interact with chronic stressors to cause more adverse effects. ANS = autonomic nervous system; Endo. = endothelial.
