# Chronic Stress, Diabetes, and Cardiovascular Disease: Epidemiologic Evidence, Pathogenetic Insights, and Therapeutic Strategies

## TL;DR

Chronic stress is linked to diabetes and heart disease through complex biological mechanisms, and managing stress may help reduce these health risks.

## Contribution

This review provides updated evidence and mechanistic insights on how chronic stress contributes to diabetes and cardiovascular disease.

## Key findings

- Chronic stress is strongly associated with diabetes, hypertension, and cardiovascular disease.
- Stress activates biological pathways like the HPA axis and RAAS, leading to increased inflammation and blood pressure.
- Evidence-based stress interventions can reduce cardiovascular risk and may be useful in clinical practice.

## Abstract

Chronic stress has been shown in cross-sectional as well as longitudinal studies to be strongly associated with diabetes, hypertension, and cardiovascular disease (CVD). These studies have used various methods of stress assessment. Proposed pathogenetic mechanisms linking psychological distress with diabetes and CVD are complex and include stimulation of the hypothalamic-pituitary-adrenal axis with excess cortisol release, as well as stimulation of the renin-angiotensin-aldosterone system, resulting in elevated blood pressure, in addition to an altered immune system, increased inflammation, and oxidative stress, among others. In this review, we provide the reader with cutting-edge information on the current evidence for the association between chronic psychological stress, diabetes, and CVD, highlighting the major studies addressing this important topic. We also provide a detailed mechanistic overview of the pathogenesis of diabetes and CVD in psychologically stressed individuals, including experimental and laboratory evidence. We finally discuss the major evidence-based therapeutic interventions for psychological stress and their effects on CVD risk reduction, with the aim of presenting these therapeutic options as potentially effective ways to implement in clinical practice.