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Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study

BMJ 2019; 365 doi: (Published 10 April 2019) Cite this as: BMJ 2019;365:l1255

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Stress, psychiatric disorders, and cardiovascular disease

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Re: Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study

We read with great interests the paper by Huan Song and colleagues,1 which examined the associations between stress-induced disorders, including but not restricted to post-traumatic stress disorder (PTSD) as well as acute stress reaction, and the risks of cardiovascular diseases. The results strongly suggest that psychiatric disorders primarily due to acute stress are associated with several cardiovascular diseases, after adjusting for potential confounders (by both study design and modeling). In the article, the authors very well addressed the effects of “acute stressors” on the risk of cardiovascular diseases. Nonetheless, it is also relevant for the general population to understand how “chronic and stable stressors” across the lifespan may affect cardiovascular disease risks, In fact, many people are frequently exposed to increased stress during everyday social interaction with others.
Genetically, anxiety and stress-related disorders share high genetic correlations with subjective well-being (genetic correlation=-0.46) and neuroticism (genetic correlation=0.49),2 which seems to imply a common genetic basis between acute stress-induced disorders and “a general susceptibility to psychological distress”.3 People may experience depressive and anxious episodes during the lifespan and recover spontaneously or after interventions, but the intrinsic tendency to experience psychological distress may easily lead to recurrent episodic distress. The “distressed” or Type D personality was specifically defined to delineate the broad and stable tendency to experience negative emotions and to inhibit the expression of emotion and behavior. This personality profile has been shown to associate with the risk of coronary heart disease in cross-sectional studies.4 Further evidence from high-quality observational studies, like the article presented here, is undoubtedly warranted to disentangle the effects of acute distress and a chronic, general propensity to psychological distress on the risk of cardiovascular diseases.

1. Song H, Fang F, Arnberg FK, et al. Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ 2019;365:l1255. doi: 10.1136/bmj.l1255 [published Online First: 2019/04/12]
2. Mattheisen M. Genome-wide association study of anxiety and stress-related disorders in the iPSYCH cohort. Behav Genet 2018;48(6):494-94.
3. Denollet J, Schiffer AA, Spek V. A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile. Circ Cardiovasc Qual Outcomes 2010;3(5):546-57. doi: 10.1161/CIRCOUTCOMES.109.934406 [published Online First: 2010/09/16]
4. Beutel ME, Wiltink J, Till Y, et al. Type D Personality as a Cardiovascular Risk Marker in the General Population: Results from the Gutenberg Health Study. Psychother Psychosom 2012;81(2):108-17. doi: 10.1159/000331776

Competing interests: No competing interests

18 April 2019
Ruifang Li-Gao
Johan Denollet
CoRPS Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
Warandelaan 2 5037 AB Tilburg The Netherlands