Stress and Social Support in Cardiovascular Disease

Abstract

The concept and the impact of inadequate social networks and poor social support on health have been intuitively known since long. But it was not until the 1970s that the significance of social relations was demonstrated, for the first time in the Alameda county study in California.

Within a few years, several population-based prospective studies came to the same conclusion: Poor social networks and support increased total and cardiovascular mortality. This was true even in the North Karelia, Eastern Finland, but only in men. In North Karelian women, and also in other groups of women, the function of the social relationships appeared to be more important than the structure. North Karelia is a part of rural Finland, situated directly at the border between Russia and Finland.

In Stockholm, women patients with coronary disease and social isolation modified the role of depression so that only when they exist together, the factors worsen prognosis and accelerate progression of coronary artery disease, as measured by quantitative coronary angiography (QCA). Similarly using QCA methodology, we could show that exhaustion, more clearly than depression, worsened prognosis in women. The stress burden originating from the family was more important than the stress burden of the job, although almost all of the Stockholm women were employed outside home. Therefore, we designed a cognitive behavioral intervention to reduce women’s stress. In a randomized controlled trial, this proved to both prolong women’s lives and attenuate their negative emotions.

Altogether around 800 women patients have been followed for up to 20 years. They have been examined with a variety of psychosocial measures. Of psychosocial measures, vital exhaustion was best fitting to the pattern of coronary artery atherosclerosis progression and also seemed to yield the best fit to the multivariate model of disease progression. Their precise psychobiological mechanisms remain unclear. However, multivariate evaluations suggest that standard coronary risk factors partly “explain” and metabolic, hemodynamic, immunologic, and autonomic imbalances contribute to the final and complete remaining psychobiological pathogenic pathways.