HOW STRESS INFLUENCES THE DEVELOPMENT OF CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW

Abstract

Background: Psychosocial stress has emerged as a critical determinant of cardiovascular disease (CVD), influencing both the initiation and progression of pathology through behavioral, neuroendocrine, and inflammatory mechanisms. Despite extensive evidence, the precise pathways and magnitude of stress-related cardiovascular risk remain under debate.

Objectives: This systematic review aimed to synthesize recent empirical findings on how acute, chronic, and perceived stress contribute to the development of CVD, integrating epidemiological, physiological, and mechanistic evidence.

Methods: Following PRISMA 2020 guidelines, ten peer-reviewed studies were analyzed, including population-based, cohort, and experimental designs. Data were extracted on stress exposure, cardiovascular outcomes, and mediating pathways such as inflammation, autonomic dysregulation, and behavioral changes.

Results: Across studies, stress was associated with a 1.3–2.1-fold increased risk of CVD. Song et al. (2019) found the highest early risk (HR = 6.95 for heart failure in the first year post-stress diagnosis). Socioeconomic disparities amplified this association (Redmond et al., 2013), while mechanistic research linked amygdalar hyperactivity and inflammation to vascular dysfunction (Osborne et al., 2020; Civieri et al., 2024). Women and younger adults exhibited heightened vulnerability (Pimple et al., 2019).

Conclusion: Evidence supports a robust, multifactorial relationship between psychological stress and cardiovascular risk, mediated by neuro-immune, behavioral, and metabolic pathways. Preventive and therapeutic strategies addressing chronic stress could significantly reduce global CVD burden.