Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence

Abstract

An increasing number of studies has tested whether greater cardiovascular responses to acute mental stress predict future cardiovascular disease, but results have been variable. This review aimed quantitatively to evaluate the association between cardiovascular responses to laboratory mental stress and subsequent cardiovascular risk status in prospective cohort studies. We searched general bibliographic databases, PsycINFO, Web of Science, and PubMed, up to December 2009. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. There were 169 associations (36 articles) of stress reactivity and 30 associations (5 articles) of poststress recovery in relation to future cardiovascular risk status, including elevated blood pressure, hypertension, left ventricular mass, subclinical atherosclerosis, and clinical cardiac events. The overall meta-analyses showed that greater reactivity to and poor recovery from stress were associated longitudinally with poor cardiovascular status (r=0.091 [95% CI: 0.050 to 0.132], P<0.001, and r=0.096 [95% CI: 0.058 to 0.134], P<0.001, respectively). These findings were supported by more conservative analyses of aggregate effects and by subgroup analyses of the methodologically strong associations. Notably, incident hypertension and increased carotid intima-media thickness were more consistently predicted by greater stress reactivity and poor stress recovery, respectively, whereas both factors were associated with higher future systolic and diastolic blood pressures. In conclusion, the current meta-analysis suggests that greater responsivity to acute mental stress has an adverse effect on future cardiovascular risk status, supporting the use of methods of managing stress responsivity in the prevention and treatment of cardiovascular disease.