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Review
. 2024 Jul 16;84(3):298-314.
doi: 10.1016/j.jacc.2024.05.016.

The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review

Imo A Ebong  1 , Odayme Quesada  2 , Ida T Fonkoue  3 , Deirdre Mattina  4 , Samaah Sullivan  5 , Glaucia Maria Moraes de Oliveira  6 , Telisa Spikes  7 , Jyoti Sharma  8 , Yvonne Commodore  9 , Modele O Ogunniyi  10 , Niti R Aggarwal  11 , Viola Vaccarino  12 ; American College of Cardiology Cardiovascular Disease in Women Committee
Affiliations
Review

The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review

Imo A Ebong et al. J Am Coll Cardiol. .

Abstract

Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.

Keywords: cardiovascular disease; coronary heart disease; mental stress; psychosocial stress; women.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Ebong is supported by grants R21 HL165018-01 and U01 HL160274 from the National Heart, Lung, and Blood Institute (NHLBI) and grant 23SFRNPCS1064232 from the American Heart Association Strategically Focused Research Network. Dr Quesada is supported by National Institutes of Health (NIH) grant K23 HL151867. Dr Fonkoue is supported by NIH grants K01HL161027 and UL1TR002494. Dr Ogunniyi has received institutional research support grants from AstraZeneca, Boehringer Ingelheim, Cardurion Pharmaceuticals, and Pfizer, outside the submitted work. Dr Vaccarino is supported by NHLBI grants R01 HL109413 and R01 HL163998. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. Schematic Presentation of Psychosocial Stress and Cardiovascular Disease (CVD) in Women
Acute psychosocial stress can trigger coronary events in women with underlying coronary disease or undergo resolution to create adaptation. Chronic stress can contribute to progression of coronary atherosclerosis and other chronic risk pathways for cardiovascular disease. Reproductive events can worsen stress responses favoring adverse cumulative effects of stressful exposures.
FIGURE 2
FIGURE 2. Biological Effects of Psychosocial Stress and Cardiovascular Sequelae in Women
The neuroendocrine axis interacts in a bidirectional manner with the autonomic nervous system and inflammatory pathways to promote adverse cardiovascular sequelae from stress. Although stress-related risk pathways for cardiovascular disease are multifactorial, the dominant mechanisms for women are inflammation and microvascular dysfunction resulting from neuroendocrine dysregulation and sympathetic nervous system activation.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Maladaptive Stress Responses and Cardiovascular Disease in Women
Maladaptive responses to stress that influence cardiovascular disease risk involve biological and behavioral pathways. The coexistence of mental disorders and comorbidities can facilitate cardiovascular disease progression in response to psychosocial stress.
See this image and copyright information in PMC

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