Speaker: Recognizing patients’ emotional stress can reduce CV risk, improve outcomes
Click Here to Manage Email Alerts
LOUISVILLE, Ky. — A speaker at the American Society for Preventive Cardiology Congress on CVD Prevention called on clinicians to have greater consideration for the effects of psychosocial factors on CVD and related outcomes.
During a presentation, Kavitha Chinnaiyan, MD, FACC, FSCCT, professor of medicine at Oakland University William Beaumont School of Medicine and Beaumont Hospital in Royal Oak, Michigan, detailed the potential psychosocial and emotional triggers of incident CVD and emphasized the importance of cultivating resilience and neuroplasticity in at-risk patients.
“Mental stress is a complex issue that involves the central nervous system, the autonomic nervous system, the hormonal and immune systems and pretty much every organ system. Stress is also diverse, ranging from severe mental health disorders to the so-called ordinary stress of day-to-day life. In fact, anything that surpasses our capacity to cope can become a stressor,” Chinnaiyan told Healio. “Depending on what our particular stressors are — health, financial, relationship, survival, perceived inequalities, etc — our body-mind tries to cope with it in various ways, including the flooding of the system with stress chemicals — neurotransmitters and hormones that are pro-inflammatory to the CV system, resulting in endothelial dysfunction, atherosclerosis, CAD, acute MI, myocardial dysfunction, arrhythmias, sudden cardiac death and so on.”
Chinnaiyan stated that approximately 80% of human decisions are based on emotion and mental stressors; however, metrics in medicine are based on logic.
“The most important thing to understand and acknowledge is that stress is a risk for cardiovascular disease,” Chinnaiyan told Healio. “In the INTERHEART study, psychosocial stress was the most significant risk factor for acute myocardial infarction in comparison to traditional risk factors.”
The 2004 INTERHEART study was a standardized case-control study in 52 countries that evaluated the association between smoking, hypertension, diabetes, waist-to-hip ratio, diet, physical activity, alcohol intake, blood apolipoprotein and psychosocial factors on incident MI.
Researchers reported that psychosocial factors were associated with an OR for MI of 2.67, translating to a population-attributable risk of 32.5%, compared with controls without psychosocial risk factors.
Another study published in Dialogues in Clinical Neuroscience assessed the relationship between CHD and mental disorders. Researchers found that disorders such as schizophrenia, bipolar disorder and depressive disorder were associated with elevated risk for CHD compared with controls (adjusted HR = 1.54; 95% CI, 1.3-1.82; P < .0001), according to the study. Although to a lesser degree, disorders such as anxiety (RR = 1.41; 95% CI, 1.23-1.61; P < .0001) and persistent or intense stress or PTSD (aHR = 1.27; 95% CI, 1.08-1.49) were also tied to elevated risk for CHD.
“Unfortunately, we assume that stress is a given and often don’t acknowledge or even ask our patients about stress in their lives,” Chinnaiyan told Healio. “When patients are stressed, they are less likely to be compliant with medications and lifestyle, or even care about their health. On the other hand, cultivation of resilience and attributes such as gratitude are associated with the opposite effects. Recognizing stress and referring patients to appropriate professionals is very important in the overall care of the patient.”
Chinnaiyan added that stress triggers can include life events, natural calamities, financial crises, terroristic attacks, wars, sport matches and holidays.
Such stressors can impact neuroplasticity, which the presenter defined as the brain’s ability to adapt to changing stimuli via altered functional and structural properties.
Exposures such as exercise, music and language promote beneficial neuroplasticity, according to the presentation; however, the brain can also learn maladaptive behaviors. Chinnaiyan said unlearning maladaptive behaviors can result in a reduced stress and increased telomere length, although more research is needed in the area of epigenetics and neuroplasticity.
“Mental health professionals, counselors, therapists and those who understand the benefits of modalities such as meditation are very important to incorporate into the patient’s care team,” Chinnaiyan told Healio. “The mind is a very complex and nuanced subject, and the driver of our choices and lives. We can want to do all the good to a patient’s body, but if their mind doesn’t cooperate, therapies can only go so far.”
References:
- De Hert M, et al. Dialogues Clin Neurosci. 2018;doi:10.31887/DCNS.2018.20.1/mdehert.
- Yusuf S, et al. Lancet. 2004;doi:10.1016/S0140-6736(04)17018-9.
Collapse
Chinnaiyan K. The Role of Stress Management on CVD. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 29-31, 2022; Louisville, Kentucky.
Read more about
Click Here to Manage Email Alerts