Meta-analysis results appear to confirm that greater vascular responsivity to acute mental stress is associated with worsened cardiovascular disease (CVD) risk status.
This supports "use of methods of managing stress responsivity in the prevention and treatment of CVD," say the authors, who report their findings in the journal Hypertension. There is a limited amount of information coming from population-based assessments of the role of psychological stress on CVD risk, explain Yoichi Chida and Andrew Steptoe from University College London, UK. An alternative strategy to study this association is measuring CV responses to experimentally induced acute mental stress – the hypothesis being that large, mental stress-induced CV responses, including both heightened reactivity and slow poststress recovery, lead to above-normal elevations of tonic blood pressure and development of CVD. Several studies have tested the association in this way, but results have been variable. Chida and Steptoe sought to evaluate the evidence to date. The researchers searched general bibliographic databases, PsycINFO, Web of Science, and PubMed, up to December 2009, identifying 36 articles reporting on CVD-risk associations of stress reactivity and five of poststress recovery. Overall, they found that greater reactivity to and poorer recovery from stress both significantly correlated with worse CVD risk status in the future (both p<0.001). Of note, greater stress reactivity and poorer poststress recovery were more consistently associated with incident hypertension and carotid intima-media thickness, respectively, whereas both measures of stress response were consistently associated with increased future systolic and diastolic blood pressures. In a related editorial, however, William Lovallo (University of Oklahoma, Oklahoma City, USA) questioned the clinical applicability of the findings, highlighting that reactivity scores were good predictors in men but not women, while the range of associations was wide across studies, indicating that the predictive value likely varies across subgroups and individuals. Furthermore, the range of possible prevention strategies for what may be an ingrained tendency is limited, he added. "Reducing salt intake is a difficult but manageable behavioral intervention. Teaching patients to be less reactive to stress may prove more challenging," Lovallo commented. Nevertheless, he concluded: "The data assembled by Chida and Steptoe support the idea that persons who are highly reactive to stress are at higher risk of poorer CV outcomes, including hypertension." Read the abstract
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