Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.

人们普遍认为心理压力与心血管疾病 (CVD) 风险增加有关，但在压力的测量方式和关联强度方面，结果有所不同。此外，尽管经过了数十年的研究，其机制和潜在的因果关系仍然是推测性的。对压力的生理反应已得到很好的表征，但它们对 CVD 发生和进展的贡献在实证研究中却很少受到关注。有证据表明，对压力的生理反应在心血管疾病风险中起着重要作用，压力引发的血流动力学、血管和免疫扰动尤其重要。应激反应生理学受到大脑皮质边缘区域的调节，该区域向自主神经系统输出。这些调节途径的变化可能解释了个体之间对压力的脆弱性的差异。自主神经、免疫和血管功能的动态扰动也可能与慢性、反复和累积压力暴露的CVD风险机制有关，但需要来自前瞻性研究和现实生活情况评估的更多数据。心理评估在临床护理和预防中仍未得到充分认识。尽管减压干预措施可能会减轻感知的压力水平并可能降低心血管风险，但仍需要来自随机试验的更多数据。