Bidirectional associations between cardiovascular disease (CVD) on the one hand and psychological stress on the other have been extensively documented. Indeed, researchers and psychologists have positively correlated postulated long-term psychological stressors to the rapid progression of CVD and deaths that are directly related to the condition. This section aims to offer facts relating to psychological stress, poor health behaviors, and the manifestation of CVD.
A multiplicity of psychological stressors, such as loss of a loved one, financial instability, job strain, low job control, unstable marital relationship, lack of social support, and loss of a job, may trigger psychological distress, negative affectivity, and social isolation to unprecedented levels, in the process becoming potential risk factors for both the etiology and the prognostic effects of CVD (Groble & Grande, 2008). In addition, studies have shown that some conditions occasioned by psychological stress such as post-traumatic stress disorder (PTSD) can adversely alter CVD outcomes through the disrupted hypothalamic pituitary-adrenal axis (HPA). Such alteration, according to Lin et al (2010) propels disease progression and recurrent episodes. It should not be forgotten that the bidirectional nature of this association implies that the occurrence of CVD episodes can initiate or worsen psychological stress.
Some recent studies as postulated by Groble & Grande (2008) have substantiated the association between psychological stress and atheromatous plaque, the critical injury that occurs in most cardiovascular conditions. In CVD, for instance, the mechanical and chemical aspects engaged in the development of this plaque are fundamentally influenced by psychological processes and particularly by the stress response. In these processes, psychologically stressful events occasion a more rapid heart rate and elevated blood pressure, leading to enhanced blood flow and instability, not to mentioning the fact that mobilization of lipids occurs that surpass the body’s metabolic requirements to assist in the further aggregation of the artery walls and the sensitive heart tissue (Groble & Grande, 2008). As such, it can be argued that people with CVD conditions need not engage in psychologically stressful situations as stress only serves to worsen the condition.
Consecutive studies as cited by Groble & Grande (2008) and Lin et al (2010) reveal convincingly that the adverse quantifiable outcomes of CVD incidences are not only induced by external psychological stressors but are also stimulated by undesirable health behaviors mainly related to aspects of personality. Such undesirable health behaviors, according to the authors, include smoking, poor eating habits, lack of physical activity and sluggishness, high intake of cholesterol, and increased body mass.
Of the diverse psychological risk factors for CVD, depression has inarguably received the most attention, being implicated as enhancing the risk of both developing CVD and triggering undesirable outcomes following Acute Coronary Syndrome (ACS) episodes. Parker et al (2010) argues that depression not only influences survival of victims following an acute ACS, but it appears strongly correlated to a poorer prognosis of ACS especially when it commences following the ACS episodes. This information implies that depressive episodes occurring after the ACS events are usually more lethal for patients than pre-existing depressive episodes.
Consecutive studies have demonstrated that a considerable number of people suffering from ACS events also experience lifetime depression. Indeed, depressive episodes form a major risk factor for grave ACS episodes, particularly abrupt cardiac death (Parker et al., 2010). A study conducted by these researchers found that depression is positively associated with a two to threefold elevated risk of developing one or more cardiac events.
Depression, according to Vural et al (2008), does not only interfere with neurobiological processes that may adversely affect the proper functioning of the cardiovascular system, including altering the sympathetic drive and contributing to cardiac rate and rhythm turbulences, but it also encourages some unhealthy personality behaviors such as physical inactivity and social inhibition. These factors are major recipes for the progression of ACS and eventual heart disease-related morbidity and mortality, not mentioning that the association between depression and ACS is bidirectional by virtue of the fact that ACS events can enhance depressive episodes and vice-versa. This assertion is based on the fact that the presence of ACS can to a large extent directly or indirectly trigger depressive symptoms and other emotional states such as anxiety and feelings of remorse. In equal measure, the existence of depressive signs enhances the possibility of experiencing ACS in patients with well ascertained CVD (Vural et al., 2008).
The task, therefore, is for patients of cardiovascular conditions to avoid developing affective states that will undoubtedly facilitate psychological stress and depressive episodes while ensuring that they develop desirable health behaviors.
Reference List
Globle, A., & Grande, M. (2008). Do chronic psychological stressors accelerate the progress of cardiovascular disease? Stress and Health: Journal of the International Society for the Investigation of Stress, 24(3), 203-212. Retrieved from Academic Search Premier Database.
Lin, J.S., O’Conner, E., Whitlock, E.P., & Beil, T.L. (2010). Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: A systematic review for the U.S. preventive services task force. Annals of Internal Medicine, 153(11), 736-750. Retrieved from Academic Search Premier Database.
Parker, G.B., Owen, C.A., Brotchie, H.L., & Hyett, M.P. (2010). The impact of differing anxiety disorders on outcome following an acute coronary syndrome: Time to start worrying? Depression & Anxiety, 27(3), 302-309. Retrieved from Academic Search Premier Database.
Vural, M., Acer, M., & Akbas, B. (2008). The scores of Hamilton Depression, Anxiety, and Panic Agoraphobia rating scales in patients with acute coronary syndrome. Anatolian Journal of Cardiology, 8(1), 43-47. Retrieved from Academic Search Premier Database.