Mental stress and ischaemic heart disease: an underestimated connection.

Abstract

In this paper a theoretical framework is offered for mental stress as a risk factor for the development of ischaemic heart disease (IHD). The development of IHD related to mental stress can be described as dependent on interaction between the following factors: (1) the presence of stressors, (2) activation of a receptor and transformation system (i.e. the central nervous system) and (3) physiological effector systems. Stressors are defined as external or internal, nomothetic or idiosyncratic and are exemplified. A prerequisite for the psychological stress reaction is the existence of a central nervous system in which stimuli are perceived, interpreted and responded to. The interaction between neocortex and paleocortex is discussed as well as the initiation of the cerebral stress reaction. Four physiological effector systems seem to be related to mental stress: (1) the autonomic nervous system (ANS), (2) the hypothalamic-pituitary-adrenal (HPA) axis, (3) the peripheral nervous system (PNS) and (4) the endorphin system. In the development of cardiovascular diseases the pathophysiological changes in the ANS and in the HPA axis play the most important roles.