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Research Commentary;

 Stress in Cardiovascular Disease

Tobias Esch1,2, George B. Stefano1,3, Gregory L. Fricchione4, Herbert Benson1

Research Reviewed by Dr. Travis Downs

 Stress in Cardiovascular Disease


Summarized Review Conclusions

When we look at this review of the existing research involving stress and cardiovascular disease it is clear that the more chronic stress we are under the increased risk of onset, development, and progression of cardiovascular disease will happen.

I chose to review this particular literature because I really think we are having a hard time distinguishing between good stress and bad stress when discussing health. Our bodies are designed to help us stay safe through our “fight or flight response” meaning that when we need to react to challenges within our environment we take action.  Our adrenaline kicks in, our blood pressure rises and we become extremely alert. These can all be positives but if we forget how to go back to a resting state they can also quickly turn back into negatives.

In today’s modern environment we are constantly being stressed out by some kind of mental, physical, or chemical stress and our bodies are not having the chance to fully recover from the constant bombardment. These stressors over time start to break our bodies down and as we lose a healthy balance, known as homeostasis, cardiovascular disease starts to set in. Managing our chronic stressors is the key to decreasing and maintaining a healthy cardiovascular system. Below you will find direct quotes of the referenced article along with my synopses of the research query, methodology and findings including references used by the research authors.


“Here, the activation of stress response-related pathways seems to be crucial and is capable of facilitating deleterious processes in the long-term: Via its actions on the central and autonomic nervous systems, stress can produce a cascade of regulatory responses that may actually lead, in vulnerable individuals, to myocardial ischemia, ventricular fibrillation, plaque rupture, or coronary thrombosis”

Krantz DS, Kop WJ, Santiago HT, Gottdiener JS: Mental stress as a trigger of myocardial ischemia and infarction. Cardiology Clinics 1996; 14: 271-287

“The atherosclerosis-associated endothelial dysfunction has been shown to ‘cause’ abnormal vascular responses to stress, leading to a paradoxical constriction, especially at points of a preexisting stenosis”

Yeung AC, Vekshtein VI, Krantz DS et al: The effect of atheroscle- rosis on the vasomotor response of coronary arteries to mental stress. New England Journal of Medicine, 1991; 325: 1551-1556

The actual induction of an ischemic response via mental stress represents a risk factor for future car- diac events: mental stress-related myocardial ischemia adversely affects prognosis in CAD patients and predicts a greater severity of CAD in its course

Jiang W, Babyak M, Krantz DS et al: Mental Stress-Induced Myocardial Ischemia and Cardiac Events.Journal of the American Association of Medicine, 1996; 275: 1651-1656

Legault SE, Freeman MR, Langer A, Armstrong PW: Pathophysiology and time course of silent myocardial ischemia dur- ing mental stress: clinical, anatomical, and physiological correlates. British Heart Journal, 1995; 73: 242-249


Introduction to the Research

This article reviews the research on stress and how it affects the cardiovascular system in addition to chronic lifestyle stressors and how they are major contributors to the development of cardiovascular disease.  Stress in life is inevitable and normal.  This review of the research shows us that it is how we manage and acknowledge the stress that can make all the difference when examining cardiovascular disease.  If we allow the stress to build and do not “decompress” or make time to alleviate the stress, we will continue to move away from homeostasis, which will result in a higher incidence and earlier onset of cardiovascular disease.  These researchers took the time to review the research trials from numerous authors examining stress and its effects on cardiovascular health.

When we are under these chronic stressors multiple cardiovascular diseases can start to develop including: Hypertension (high blood pressure), Atherosclerosis (plaque in the arteries), Coronary Artery Disease (atherosclerosis of coronary arteries), Myocardial Infarction (heart attack), Heart rate variability (inconsistent heart rate) and Arrythmia (irregular heartbeat). We want to remember that these conditions are lifestyle issues related to chronic stress and not hereditary.  We need to make sure to manage our chronic stressors to help maintain a proper cardiovascular system and homeostasis. When we have proper acute stress the research in this article shows that it can improve the performance of the cardiovascular system. This is important because it lets us know that we are in control and the better we manage our stress, the less likely we are to develop cardiovascular disease.


Research Methodology

The stress phenomenon is illustrated and the impact of stress on the circulatory system is examined. In particular, the pathophysiological significance of stress in hypertension, atherosclerosis, coronary artery disease, myocardial infarction (and others) is described.


Research Findings

Stress plays a major role in various (patho)physiological processes associated with the circulatory system. Thereby, it potentially has ameliorating or detrimental capacities. However, with regard to cardiovascular diseases, stress most often is related to deleterious results. The specific outcome depends on multiple variables (amount of stress, duration of its influence, patient’s history/predisposition, genetic components – as they all may alter functions of the basic stress response components: the hypothalamic-pituitary-adrenal axis and the sympathoadrenal medullary system).

Stress has a major impact upon the circulatory system. It plays a significant role in susceptibility, progress, and outcome of cardiovascular diseases. Subjective or individual differences have also to be taken into account. Stress, especially ‘adequate’ acute stress – stress that is not ‘over- whelming’ – may improve performance and thus be beneficial in certain cases. The close relationship between stress and cardiovascular diseases may represent an important aspect of modern medicine. New therapeutic strategies have to be set in place.


Research References

As always with these reviews, these are my takeaways from the article and I encourage you to read the article in its entirety.  The references used in this article by the authors of this article are listed here.