Stress, cardiovascular diseases and exercise – A narrative review

The assuredness that adverse life stressors can lead to major negative impacts on an individual's health has been held since antiquity. Stress is considered a state of homeostasis being challenged, with biological consequences that can cause cardiovascular diseases (CVD). Stressors may be diverse and include a variety of psychological stressors, such as family stress, job strain, effort-award imbalance, long working hours, insecurity, social isolation, and lack of purpose in life. However, stressors may also be physical, immunological, metabolic, or environmental. Type of personality, anxiety, depression, pessimism or hostility, previous experience, genomics, body composition, nutritive and training status modulate stress responses and are important co-stressors. Chronic stress is linked with altered neurohormonal activity, which increases apoptotic pathways in cardiomyocytes. These pathways contribute to impaired myocardial contractility, increased risk of myocardial ischemia, infarction, heart failure, and arrhythmias. While stress is a vital risk factor for CVD, it has not been a major focus of preventive strategies. The purpose of this article is to review the impact of stress on CVD risk with an emphasis on approaches for stress reduction. Strength and endurance exercise, although being stress itself, leads to better adaptiveness to other types of stress, and by far has played an inevitable role in CVD risk reduction. Innovative strategies to combat CVD are strongly needed and exercise may be the best population-level cost-effective approach.