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Figure 1. Central autonomic network, a flexible network of interconnected brain areas that regulate the physiological effects of emotions by way of the neurohormonal autonomic nervous system. Ang: Angiotensin; NE: Norepinephrine.
(Figure omitted. See article PDF.)
Cardiovascular disease (CVD) is the most prevalent public health problem on a worldwide scale [1,2]. Dyslipidemias, smoking, diabetes mellitus, arterial hypertension, obesity, a positive family history for early coronary artery disease and a sedentary lifestyle are well-established risk factors for the development of CVD. The prevention and treatment of these risk factors significantly reduces morbidity and mortality [1-3].
Nevertheless, CVD remains the main cause of illness and death in the world [1,2]. It is just as clearly established in the relevant literature that a high number of cardiovascular events occur in people with one or no risk factor at all [4-6]. Moreover, although the risk factors for atheroma formation are known, much less information is available on the factors which act upon the vascular lesion at different stages in its pathobiological history, determining its clinical evolution towards a catastrophic acute event [5].
The impact of psychological aspects as cardiovascular risk factors, while amply described, has certainly been underplayed in comparison with traditional risk factors [7].
Initially, studies were prevalently oriented to the description of pernicious personality traits in atherogenesis [7-73], then broadened their scope to the role of negative reactions to personal or community relationships or events in triggering acute coronary syndrome [74-94]. These studies led to the identification of mental stress as an important variable in the pathogenesis of myocardial ischemia.
This article aims to outline the main landmarks in the identification of psychological aspects as cardiovascular risk factors and emphasize the relevance of emotional stress as a trigger of acute cardiovascular events. It will also discuss mental stress-provoking procedures and how they can induce, in different laboratory models, reversible impairment of myocardial perfusion, depolarization anomalies and arrhythmias. The article will also describe the pathophysiological mechanisms behind mental stress-induced myocardial ischemia (MSIMI) and will illustrate the pathways connecting the heart and brain through which such mechanisms can exert their influence.
Psychological factors & cardiovascular risk
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