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Central stress pathways in the development of cardiovascular disease

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Abstract

Purpose

Mental stress is of essential consideration when assessing cardiovascular pathophysiology in all patient populations. Substantial evidence indicates associations among stress, cardiovascular disease and aberrant brain–body communication. However, our understanding of the flow of stress information in humans, is limited, despite the crucial insights this area may offer into future therapeutic targets for clinical intervention.

Methods

Key terms including mental stress, cardiovascular disease and central control, were searched in PubMed, ScienceDirect and Scopus databases. Articles indicative of heart rate and blood pressure regulation, or central control of cardiovascular disease through direct neural innervation of the cardiac, splanchnic and vascular regions were included. Focus on human neuroimaging research and the flow of stress information is described, before brain–body connectivity, via pre-motor brainstem intermediates is discussed. Lastly, we review current understandings of pathophysiological stress and cardiovascular disease aetiology.

Results

Structural and functional changes to corticolimbic circuitry encode stress information, integrated by the hypothalamus and amygdala. Pre-autonomic brain–body relays to brainstem and spinal cord nuclei establish dysautonomia and lead to alterations in baroreflex functioning, firing of the sympathetic fibres, cellular reuptake of norepinephrine and withdrawal of the parasympathetic reflex. The combined result is profoundly adrenergic and increases the likelihood of cardiac myopathy, arrhythmogenesis, coronary ischaemia, hypertension and the overall risk of future sudden stress-induced heart failure.

Conclusions

There is undeniable support that mental stress contributes to the development of cardiovascular disease. The emerging accumulation of large-scale multimodal neuroimaging data analytics to assess this relationship promises exciting novel therapeutic targets for future cardiovascular disease detection and prevention.

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Authors and Affiliations

  1. School of Health Sciences, Swinburne University of Technology, PO Box 218, Hawthorn, Melbourne, VIC, 3122, Australia

    Joe Braun, Mariya Patel, Gavin Lambert & Elisabeth Lambert

  2. Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia

    Tatiana Kameneva, Gavin Lambert & Elisabeth Lambert

  3. Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia

    Tatiana Kameneva

  4. School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia

    Tatiana Kameneva & Charlotte Keatch

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  1. Joe Braun
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Braun, J., Patel, M., Kameneva, T. et al. Central stress pathways in the development of cardiovascular disease. Clin Auton Res 34, 99–116 (2024). https://doi.org/10.1007/s10286-023-01008-x

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