Stress and the Development of Atherosclerotic Cardiovascular Disease

The question of whether stress contributes to the development of cardiovascular disease (CVD) is a central research question in the field of cardiovascular behavioral medicine. Many of the sources of stress that we review in the present chapter (e.g., work stress) are covered in much greater detail in other chapters in this volume. Our goal is to frame the research question more broadly rather than to provide an exhaustive review of the literature within each stress category. Potential mediators for the stress-CVD link are considered, as are potential moderators for such an association. To date, there is limited evidence that stress is a significant contributor to the development of CVD. One concern raised in our chapter is that requiring stress-disease associations be demonstrated independent of health behaviors fails to consider the fact that confounding and mediation are statistically indistinguishable. Therefore, when addressing the question of whether stress can cause organic disease, covariate adjustment for potential mediators may constitute model over-adjustment. Finally, stress would need to be sustained over a span of years in order to affect a disease that develops over a corresponding period of time - this may explain why the strongest evidence to date for a stress-CVD association is in the area of work stress, a stressor that is likely to be sustained over many years.