Introduction to Cardiovascular Disease, Stress and Adaptation

  • Andrew SteptoeEmail author
  • Annika Rosengren
  • Paul Hjemdahl


Psychological stress is increasingly being recognised as a modifiable cardiovascular risk factor, and is being vigorously investigated in animal studies, human experimental and clinical research, and in population-level epidemiological studies.1 There is a growing trend for the incorporation of stress management into cardiac rehabilitation programmes and into preventive cardiology. However, stress is multifaceted and often misunderstood, and requires as much scientific scrutiny as other pathological processes relevant to cardiology. There is thus a need for better understanding of stress and its ramifications by cardiologists and other clinicians caring for cardiac patients, and by those involved in primary prevention. The quality of research into stress management is variable, and care is required in identifying effective evidence-based methods.


Cardiovascular disease Stress Adaptation Animal research Naturalistic monitoring Ambulatory monitoring 


  1. 1.
    Fink G (ed.) Encyclopedia of Stress, 4 vols. Oxford: Academic Press; 2007.Google Scholar
  2. 2.
    Rosengren A, Hawken S, Ounpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953-962.PubMedCrossRefGoogle Scholar
  3. 3.
    Petticrew MP, Lee K. The “Father of Stress” meets “Big Tobacco”: Hans Selye and the tobacco industry. Am J Public Health. 2010;101(3):411-418.PubMedCrossRefGoogle Scholar
  4. 4.
    McCarty R, Pacak K. Alarm phase and general adaptation syndrome. In: Fink G, ed. Encyclopedia of Stress, vol. 1. 2nd ed. Oxford: Elsevier; 2007:119-123.CrossRefGoogle Scholar
  5. 5.
    Munck A, Guyre PM, Holbrook NJ. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev. 1984;5:25-44.PubMedCrossRefGoogle Scholar
  6. 6.
    McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993;153:2093-2101.PubMedCrossRefGoogle Scholar
  7. 7.
    McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338:171-179.PubMedCrossRefGoogle Scholar
  8. 8.
    Lazarus RS. Psychological Stress and the Coping Process. New York: McGraw-Hill; 1966.Google Scholar
  9. 9.
    Brydon L, Walker C, Wawrzyniak AJ, et al. Dispositional optimism and stress-induced changes in immunity and negative mood. Brain Behav Immun. 2009;23:810-816.PubMedCrossRefGoogle Scholar
  10. 10.
    Chida Y, Hamer M. Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations. Psychol Bull. 2008;134:829-885.PubMedCrossRefGoogle Scholar
  11. 11.
    Eisenberger NI, Taylor SE, Gable SL, et al. Neural pathways link social support to attenuated neuroendocrine stress responses. Neuroimage. 2007;35:1601-1612.PubMedCrossRefGoogle Scholar
  12. 12.
    Grant N, Hamer M, Steptoe A. Social isolation and stress-related cardiovascular, lipid, and cortisol responses. Ann Behav Med. 2009;37:29-37.PubMedCrossRefGoogle Scholar
  13. 13.
    Horsten M, Ericson M, Perski A, et al. Psychosocial factors and heart rate variability in healthy women. Psychosom Med. 1999;61:49-57.PubMedGoogle Scholar
  14. 14.
    Abbott DH, Keverne EB, Bercovitch FB, et al. Are subordinates always stressed? A ­comparative analysis of rank differences in cortisol levels among primates. Horm Behav. 2003;43:67-82.PubMedCrossRefGoogle Scholar
  15. 15.
    Ely D, Caplea A, Dunphy G, et al. Physiological and neuroendocrine correlates of social ­position in normotensive and hypertensive rat colonies. Acta Physiol Scand Suppl. 1997;640:92-95.PubMedGoogle Scholar
  16. 16.
    Singer MT. Engagement – involvement: a central phenomenon in psychophysiological research. Psychosom Med. 1974;36:1-17.PubMedGoogle Scholar
  17. 17.
    Kamarck TW, Lovallo WR. Cardiovascular reactivity to psychological challenge: conceptual and measurement considerations. Psychosom Med. 2003;65:9-21.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamer M, Gibson EL, Vuononvirta R, et al. Inflammatory and hemostatic responses to repeated mental stress: individual stability and habituation over time. Brain Behav Immun. 2006;20:456-459.PubMedCrossRefGoogle Scholar
  19. 19.
    Bohlin G, Eliasson K, Hjemdahl P, et al. Pace variation and control of work pace as related to cardiovascular, neuroendocrine and subjective responses. Biol Psychol. 1986;23:247-263.PubMedCrossRefGoogle Scholar
  20. 20.
    Kamarck TW, Manuck SB, Jennings JR. Social support reduces cardiovascular reactivity to psychological challenge: a laboratory model. Psychosom Med. 1990;52:42-58.PubMedGoogle Scholar
  21. 21.
    Steptoe A, Feldman PM, Kunz S, et al. Stress responsivity and socioeconomic status: a mechanism for increased cardiovascular disease risk? Eur Heart J. 2002;23:1757-1763.PubMedCrossRefGoogle Scholar
  22. 22.
    Steptoe A, Poole L. Use of biological measures in behavioral medicine. In: Steptoe A, ed. Handbook of Behavioral Medicine. New York: Springer; 2010:619-632.CrossRefGoogle Scholar
  23. 23.
    Steptoe A, Vögele C. The methodology of mental stress testing in cardiovascular research. Circulation. 1991;83:II14-II24.PubMedGoogle Scholar
  24. 24.
    Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-­analytic study of 30 years of inquiry. Psychol Bull. 2004;130:601-630.PubMedCrossRefGoogle Scholar
  25. 25.
    Kiecolt-Glaser JK, Loving TJ, Stowell JR, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry. 2005;62:1377-1384.PubMedCrossRefGoogle Scholar
  26. 26.
    Parati G, Trazzi S, Ravogli A, et al. Methodological problems in evaluation of cardiovascular effects of stress in humans. Hypertension. 1991;17(4 Suppl):III50-III55.PubMedCrossRefGoogle Scholar
  27. 27.
    Chida Y, Steptoe A. Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence. Hypertension. 2010;55:1026-1032.PubMedCrossRefGoogle Scholar
  28. 28.
    Landsbergis PA, Schnall PL, Pickering TG, et al. Life-course exposure to job strain and ­ambulatory blood pressure in men. Am J Epidemiol. 2003;157:998-1006.PubMedCrossRefGoogle Scholar
  29. 29.
    Vrijkotte TG, van Doornen LJ, de Geus EJ. Effects of work stress on ambulatory blood ­pressure, heart rate, and heart rate variability. Hypertension. 2000;35:880-886.PubMedCrossRefGoogle Scholar
  30. 30.
    Conen D, Bamberg F. Noninvasive 24-h ambulatory blood pressure and cardiovascular ­disease: a systematic review and meta-analysis. J Hypertens. 2008;26:1290-1299.PubMedCrossRefGoogle Scholar
  31. 31.
    Schwartz JE, Stone AA. Strategies for analyzing ecological momentary assessment data. Health Psychol. 1998;17:6-16.PubMedCrossRefGoogle Scholar
  32. 32.
    Costa M, Cropley M, Griffith J, et al. Ambulatory blood pressure monitoring is associated with reduced physical activity during everyday life. Psychosom Med. 1999;61:806-811.PubMedGoogle Scholar
  33. 33.
    Elwood M. Critical Appraisal of Epidemiological Studies and Clinical Trials. 3rd ed. Oxford: Oxford University Press; 2007.CrossRefGoogle Scholar
  34. 34.
    Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303:1159-1166.PubMedCrossRefGoogle Scholar
  35. 35.
    Strike PC, Steptoe A. Behavioral and emotional triggers of acute coronary syndromes: a ­systematic review and critique. Psychosom Med. 2005;67:179-186.PubMedCrossRefGoogle Scholar
  36. 36.
    Rissanen V, Romo M, Siltanen P. Premonitory symptoms and stress factors preceding sudden death from ischaemic heart disease. Acta Med Scand. 1978;204:389-396.PubMedCrossRefGoogle Scholar
  37. 37.
    Greene WA, Goldstein S, Moss AJ. Psychosocial aspects of sudden death. A preliminary report. Arch Intern Med. 1972;129:725-731.PubMedCrossRefGoogle Scholar
  38. 38.
    Pickering TG. Now we are sick: labeling and hypertension. J Clin Hypertens (Greenwich). 2006;8:57-60.CrossRefGoogle Scholar
  39. 39.
    Hamer M, Batty GD, Stamatakis E, et al. Hypertension awareness and psychological distress. Hypertension. 2010;56:547-550.PubMedCrossRefGoogle Scholar
  40. 40.
    Rostrup M, Kjeldsen SE, Eide IK. Awareness of hypertension increases blood pressure and sympathetic responses to cold pressor test. Am J Hypertens. 1990;3(12 Pt 1):912-917.PubMedGoogle Scholar
  41. 41.
    Rostrup M, Mundal HH, Westheim A, et al. Awareness of high blood pressure increases ­arterial plasma catecholamines, platelet noradrenaline and adrenergic responses to mental stress. J Hypertens. 1991;9:159-166.PubMedCrossRefGoogle Scholar
  42. 42.
    Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.PubMedCrossRefGoogle Scholar
  43. 43.
    Ogilvie D, Craig P, Griffin S, et al. A translational framework for public health research. BMC Public Health. 2009;9:116.PubMedCrossRefGoogle Scholar
  44. 44.
    Lewin B, Robertson IH, Cay EL, et al. Effects of self-help post-myocardial-infarction ­rehabilitation on psychological adjustment and use of health services. Lancet. 1992;339:1036-1040.PubMedCrossRefGoogle Scholar
  45. 45.
    Moore RK, Groves DG, Bridson JD, et al. A brief cognitive-behavioral intervention reduces hospital admissions in refractory angina patients. J Pain Symptom Manage. 2007;33:310-316.PubMedCrossRefGoogle Scholar
  46. 46.
    Freedland KE, Carney RM, Lustman PJ. Trial design in behavioral medicine. In: Steptoe A, ed. Handbook of Behavioral Medicine. New York: Springer; 2010:925-939.CrossRefGoogle Scholar
  47. 47.
    Boutron I, Moher D, Altman DG, et al. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:295-309.PubMedCrossRefGoogle Scholar
  48. 48.
    Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.PubMedCrossRefGoogle Scholar
  49. 49.
    Melander H, Ahlqvist-Rastad J, Meijer G, et al. Evidence b(i)ased medicine – selective ­reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ. 2003;326:1171-1175.PubMedCrossRefGoogle Scholar
  50. 50.
    Turner EH, Matthews AM, Linardatos E, et al. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008;358:252-260.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Andrew Steptoe
    • 1
    Email author
  • Annika Rosengren
    • 2
  • Paul Hjemdahl
    • 3
  1. 1.Department of Epidemiology and Public HealthUniversity College LondonLondonUK
  2. 2.Institute of Medicine, Sahlgrenska AcademySahlgrenska University HospitalGothenburgSweden
  3. 3.Department of Medicine, Solna, Clinical Pharmacology Unit, Karolinska InstituteKarolinska University Hospital/SolnaStockholmSweden

Personalised recommendations