Considerable progress has been made during the past decade in research
on cardiovascular effects of stress. Early-life stressors, such as childhood
abuse and early socioeconomic adversity, are linked to increased
cardiovascular morbidity in adulthood. Our updated meta-analyses of
prospective studies published until 2011 show a 1.5-fold (95% confi-
dence interval 1.2–1.9) increased risk of coronary heart disease among
adults experiencing social isolation and a 1.3-fold (1.2–1.5) excess risk
for workplace stress; adverse metabolic changes are one of the underlying
plausible mechanisms. Stress, anger, and depressed mood can act
as acute triggers of major cardiac events; the pooled relative risk of
acute coronary syndrome onset being preceded by stress is 2.5 (1.8–3.5)
in case-crossover studies. Stress is also implicated in the prognosis of
cardiovascular disease and in the development of stress (takotsubo) cardiomyopathy.
A major challenge over the next decade is to incorporate
stress processes into the mainstream of cardiovascular pathophysiological
research and understanding.