Stress and coronary heart disease (CHD)

Stress and coronary heart disease:

The evidence is not definitive although there is a growing evidence base linking psychosocial stressors with coronary heart disease:

A systematic review investigating the possible link between "stress" and coronary heart disease (CHD) revealed (1):

1. there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and
2. there is no strong or consistent evidence for a causal association between chronic life events, work-related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD

A more recent review however stated that psychosocial risk factors like low socio-economic status, lack of social support and social isolation, chronic work or family stress, as well as negative emotions, e. g. depression and hostility, contribute significantly to the development and adverse outcome of coronary heart disease (CHD)

• negative effects of psychosocial risk factors are conveyed via behavioural pathways including unhealthy lifestyle, e. g. food choice, smoking, sedentary life, inadequate utilisation of medical resources, and psychobiological mechanisms like disturbed autonomic and hormonal regulation: all these factors contribute to metabolic dysfunction and inflammatory and haemostatic processes, which are directly involved in the pathogenesis of CHD (2)

Stress and non-specific mortality and risk of cardiovascular disease (3):

• a cohort study has assessed the effect of psychological stress on total and cause-specific mortality among men and women
  • in 1981-1983, the 12,128 Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency and were followed in a nationwide registry until 2004, with <0.1% loss to follow-up
    • sex differences were found in the relations between stress and mortality (p = 0.02)
      • men with high stress versus low stress had higher all-cause mortality (hazard ratio (HR) = 1.32, 95% confidence interval (CI): 1.15, 1.52)
        • finding was most pronounced for deaths due to respiratory diseases (high vs. low stress: HR = 1.79, 95% CI: 1.10, 2.91), external causes (HR = 3.07, 95% CI: 1.65, 5.71), and suicide (HR = 5.91, 95% CI: 2.47, 14.16)
        • in this study high stress was related to a 2.59 (95% CI: 1.20, 5.61) higher risk of ischemic heart disease mortality for younger, but not older, men
        • in general, the effects of stress were most pronounced among younger and healthier men
      • no associations were found between stress and mortality among women
• a Dutch study revealed anxiety predicted premature all-cause and cardiovascular death in middle-aged women (3)
  • at baseline, 5,073 healthy Dutch women aged 46-54 years (mean=50.4+/-2.1) and living in Eindhoven, completed a three-item anxiety scale ("being anxious/worried," "feeling scared/panicky," "ruminating about things that went wrong;" Cronbach's alpha=0.77)
    • primary outcome was all-cause mortality at 10-year follow-up; secondary outcomes were cardiovascular and lung/breast cancer death
    • at follow-up, 114 (2.2%) women had died at the mean age of 56.4+/-3.1 years
      • anxiety was associated with a 77% increase in mortality risk (hazard ratio [HR]=1.77, 95% confidence interval [CI]: 1.14-2.74, P=0.011). Anxiety was related to cardiovascular death (HR=2.77, 95% CI: 1.17-6.58, P=0.021)
        • there was also a trend for lung cancer death (HR=1.91, 95% CI: 0.90-4.06, P=0.095) but not for breast cancer death

Reference:

• 1. Bunker SJ et al. Stress and coronary heart disease: psychosocial risk factors. Med J Aust 2003; 178:272-6.
• 2. Albus C et al. Psychosocial factors in coronary heart disease -- scientific evidence and recommendations for clinical practice.Gesundheitswesen. 2005 Jan;67(1):1-8.
• 3. Nielsen NR, Kristensen TS, Schnohr P, Grønbaek M. Perceived stress and cause-specific mortality among men and women: results from a prospective cohort study.Am J Epidemiol. 2008 Sep 1;168(5):481-91; discussion 492-6
• 4. Denollet J et al. Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women.J Clin Epidemiol. 2009 Apr;62(4):452-6.