Tuesday, September 14, 2010

Long term psychological stress and cardiovascular risk

We have pretty good evidence for the influence of short term stress (fright, acute emotional surge) on sudden cardiac death with contraction band necrosis, Takotsubo cardiomyopathy and probably myocardial infarction. Long term stress is a different story. Although we have always suspected it as an antecedent of cardiovascular disease evidence has been harder to come by.

My interest in this field originated with the influence of the late Robert S. Eliot, as a result of my attendance at this meeting (which I have continued to attend almost every year since 1981---I'll be blogging in more detail about my experience at the 2010 meeting soon). Eliot long ago believed that long term stress contributed to cardiovascular disease in a manner independent of traditional risk factors. He was prescient. Evidence is slowly accumulating. Chronic stress induced hypercortisolism appears to be an important mechanism.

Today I found this recent paper and this background reference on the topic. I've never heard the term vital exhaustion before but it's apt. Most of us physicians can easily identify with the concept.

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