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Review
. 2021 Jul:328:74-82.
doi: 10.1016/j.atherosclerosis.2021.05.020. Epub 2021 May 30.

Brain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient

Viola Vaccarino  1 , Amit J Shah  2 , Puja K Mehta  3 , Brad Pearce  4 , Paolo Raggi  5 , J Douglas Bremner  6 , Arshed A Quyyumi  7
Affiliations
Review

Brain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient

Viola Vaccarino et al. Atherosclerosis. 2021 Jul.

Abstract

The influence of psychological stress on the physiology of the cardiovascular system, and on the etiology and outcomes of cardiovascular disease (CVD) has been the object of intense investigation. As a whole, current knowledge points to a "brain-heart axis" that is especially important in individuals with pre-existing CVD. The use of acute psychological stress provocation in the laboratory has been useful to clarify the effects of psychological stress on cardiovascular physiology, immune function, vascular reactivity, myocardial ischemia, neurobiology and cardiovascular outcomes. An emerging paradigm is that dynamic perturbations of physiological and molecular pathways during stress or negative emotions are important in influencing cardiovascular outcomes, and that some patient subgroups, such as women, patients with an early-onset myocardial infarction, and patients with adverse psychosocial exposures, may be at especially high risk for these effects. This review summarizes recent knowledge on mind-body connections in CVD among cardiac patients and highlights important pathways of risk which could become the object of future intervention efforts. As a whole, this research suggests that an integrated study of mind and body is necessary to fully understand the determinants and consequences of CVD.

Keywords: Cardiovascular disease; Inflammation; Myocardial ischemia; Prognosis; Psychological stress; Vascular function.

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Conflict of interest statement

Declaration of competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.. A schematic illustration of the main pathways linking psychological stress with cardiovascular risk.
A chronic background of stress acts together and interacts with acute episodes of stress in everyday life to influence regulatory centers in the brain that control emotional responses, neuroendocrine stress systems and the autonomic nervous system. These, in turn, influence a number of risk pathways for cardiovascular disease that are responsive to stress. These processes are modulated by traditional risk factors, behaviors and genetic background, as well as by concurrent social and environmental exposures and mental health conditions. Abbreviations: SNS: sympathetic nervous system; PNS: parasympathetic nervous system; HR: heart rate; BP: blood pressure; PTSD: posttraumatic stress disorder.
Figure 2.
Figure 2.. Pathophysiological pathways responsive to acute stress that are postulated to be determinants of adverse prognosis with mental stress.
MS: mental stress; SDF1: stromal cell-derived factor-1.
Figure 3.
Figure 3.. Pathophysiological determinants of mental stress-induced myocardial ischemia and its consequences.
BNP: brain natriuretic peptide; SDF1: stromal cell-derived factor-1.
See this image and copyright information in PMC

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