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INTRODUCTION

Recently, the rate of cardiovascular diseases such as hypertension, atherosclerosis, coronary artery disease, myocardial infarction is alarming. For example, Worldwide, it is estimated that 1.28 billion individuals between the age of 30-79 suffer from hypertension (WHO, 2021). As of 1975, about 594 million were hypertensive, by 2015, it reached 1.13 billion and currently, in 2021 it jumped to 1.28 billion (WHO, 2021). As the prevalence of hypertension kept increasing at this rate, other cardiovascular diseases followed a similar trend. The big question is, Why the sudden increase?  Many researchers have attributed the increase to conditions related to chronic stress.   

According to Golbidi et al. stress is a subjective perception of the adverse environmental change that leads to stress response to allow the body to adjust to a new condition (Golbidi et al., 2015). Stress is a physiological and psychological response experienced on encountering a stressor (Song et al., 2019). A stressor is a stimulus (or threat) that causes stress, examples include; exam, divorce, death of loved one, loss of job, a diagnosis of life-threatening illness, natural disasters, or violence (Song et al., 2019). Lots of people are exposed to such psychological trauma or stressful life experiences (Song et al., 2019)

Stress is classified into acute and chronic stress (Osborne et al., 2020). Chronic stress occurs over a period of time (for example, work-related stress) and this cumulatively affects health negatively. Different studies, irrespective of the study design adopted, subject demographics, stressor type, assessment of confounders all suggest an association between stress and cardiovascular diseases, hence the reason medical practitioners assess the stress level of patients presented with cardiovascular diseases (Osborne et al., 2020). Other studies have also shown that stressors can lead to an increased risk of cardiovascular diseases, therefore increasing mortality rate (Song et al., 2019; Kessler et al., 2017; Gradus et al 2015; Golbidi et al., 2015).

The pathophysiology mechanism at which this occurs is that the stressors activate the Hypothalamic Pituitary Axis. Then, the hypothalamus stimulates the pituitary gland, which secretes adrenocorticotropic hormone (ACTH). The adrenocorticotropic hormone induces the adrenal glands to produce corticosteroid hormone (Osborne et al., 2020). The corticosteroid hormones act on the adrenal cortex to produce cortisol that regulates the supply of blood sugar needed for an individual to cope with the prolonged stressor and help the body to return to normal (homeostatic condition). As cortisols play an important counter-productive role in they also contribute to increased adiposity, hypertension, and insulin resistance (Osborne et al., 2020; Jaret, 2015). The stress-induced changes also affect the systemic and Parasympathetic Nervous system to maintain normal body physiology. The sympathetic nervous system induces vasoconstriction, thereby increasing peripheral vascular resistance leading to increased blood pressure and heart rate (Osborne et al., 2020). A persistent increase in the activities of cortisol will lead to serious cardiovascular dysfunction leading to diseases such as hypertension (when blood pressure is too high), hypertension also induces atherosclerosis, myocardial infarction, coronary artery disease, stroke, and eventually death. Hence this present study, to study the effect of stress on cardiovascular diseases (WHO, 2021; Spruill, et al., 2019; Muci, et al., 2016).

AIM

• To determine the effect of stress on cardiovascular diseases

SPECIFIC OBJECTIVES

• To determine the effect of stress on hypertension
• To determine the effect of stress on atherosclerosis
• To determine the effect of stress on coronary artery disease
• To determine the effect of stress on myocardial infarction
• To understand the role of stress in stroke condition
• To understand the role of stress in heart attack
• To understand the relationship between stress on cardiovascular mortality rate

PROBLEM STATEMENT

The rate of cardiovascular diseases is steadily increasing. According to a recent report from World Health Organization, the number of people suffering from hypertension in 1975, was at 594 million, by 2015, it reached 1.13 billion and currently, in 2021 it jumped to 1.28 billion (WHO, 2021). The same is applicable to other cardiovascular diseases. However, several research has reported that stressors and action of stress may have a causal relationship with cardiovascular diseases (Osborne et al., 2020; Golbidi et al., 2015; Kessler et al., 2017; Gradus et al 2015;). Therefore, this present study will determine the effect of stress on cardiovascular diseases and also deduce the association of stress on cardiovascular outcomes.

RESEARCH QUESTIONS

• What is the effect of stress on hypertension?
• What is the effect of stress on atherosclerosis?
• What is the effect of stress on coronary artery disease?
• What is the effect of stress on myocardial infarction?
• Is there any association between the role of stress in stroke conditions?
• Is there any association between the role of stress in a heart attack?
• Is there any relationship between stress on cardiovascular mortality rate?

SIGNIFICANCE OF THE STUDY

Several studies have shown that stress may be one of the major risk factors associated with hypertension (Spruill, et al., 2019; Muci, et al., 2016). Only a few studies have reported the role of stress in other cardiovascular diseases and cardiovascular outcomes (Osborne et al., 2020). Also, our ever-changing world has made our body keep on adjusting and readjusting to adapt to the changes and the outcome has a great effect on our cardiovascular system. This study will investigate the effect of stress on different cardiovascular diseases and also deduce the association of stress on cardiovascular outcomes.

METHODOLOGY

• Study Design: This study will review current literature to determine the effect of stress on cardiovascular diseases. In the search for this literature, keywords such as “Stress”, “Stressors”, “Cardiovascular diseases”, “Hypertension”, “Atherosclerosis”, “Myocardial infarction”, “Chronic arterial disease’’, and other related terms will be utilized. Databases such as Pubmed/ Medline, Google Scholar, Cochrane library, will also be used to source data Also, Inclusion and exclusion criteria will be used in selecting relevant literature for this study.
• ANALYSIS

The following will be used for analysis in this review, they are; cluster analysis (CA) and/or factor analysis (FA), and/or principal component analysis (PCA). The results will be presented as odds ratios (OR).

• RISK ASSESSMENT

The risk assessment conducted for this project is provided in the table below:

Table 1:  Risk assessment

• SCHEDULE

    Table 2: Project Plan

REFERENCES

Golbidi, S., Frisbee, J.C., Laher, I. (2015) Chronic stress impacts the cardiovascular system: animal models and clinical outcomes. Am J Physiol Heart Circ Physiol 308: H1476–H1498.

Gradus, J.L., Antonsen, S., Svensson, E., Lash, T.L., Resick, P.A, Hansen, J.G. (2015) Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study. Am J Epidemiol 182:451-8.

Jaret, P. (2015) The Surprising benefit of stress. Greater Good Magazine Science-Based Insight foe a Meaningful life (online)

Kessler, R.C., Aguilar-Gaxiola, S. and Alonso J, (2017) Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol 8(5):1353383.

Mucci, N., Giorgi, G., De Pasquale, S., Fiz-Pérez, J., Mucci, F. and Arcangeli, G. (2016) Anxiety, Stress-Related Factors, and Blood Pressure in Young Adults. Front. Psychol. 7:1682.:

Osborne, M.T., Shin, M.L., Mehta, N.N., Pitman, R.K., Fayad, A.Z., Tawakol, A. (2020) Disentangling the Links Between Psychosocial Stress and Cardiovascular Disease. Circ Cardiovasc Imaging. 13: e010931.

Song, H., Fang, F., Arnberg, F.A., Mataix-Cols, D., de la Cruz, F.L., Almqvist, C., Fall, K., Lichtenstein, P., 

Thorgeirsson, G. and Valdimarsdóttir, U.A. (2019) Stress-related disorders and risk of cardiovascular disease: Population-based, sibling controlled cohort study. BMJ,  365:l1255

Spruill, T., Butler, M.J., Thomas, S.J. Tajeu, G.S., Kalinowski, J.E., Casta~neda, S.F., Langford, T.A., Abdalla, M., Blackshear, C., Allison, M., Ogedegbe, G., Sims, M., Shimbo, D. (2019) Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson. Heart StudyJ Am Heart Assoc. 8: e012139.

World Health Organization (2021) Hypertension. https://www.who.int/news-room/fact-sheet/detail/hypertension.

Last updated: Jan 17, 2022 05:13 PM