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

Author: Viola Vaccarino1, Amit J Shah2, Puja K Mehta3, Brad Pearce4, Paolo Raggi5, J Douglas Bremner6, Arshed A Quyyumi7
Affiliation:
1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: viola.vaccarino@emory.edu.
2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA.
3 Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
4 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
5 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
6 Atlanta VA Medical Center, Decatur, GA, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
7 Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: aquyyum@emory.edu.
Conference/Journal: Atherosclerosis
Date published: 2021 May 30
Other: Volume ID: 328 , Pages: 74-82 , Special Notes: doi: 10.1016/j.atherosclerosis.2021.05.020. , Word Count: 201

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.

PMID: 34102426 DOI: 10.1016/j.atherosclerosis.2021.05.020

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