Abrignani MG, Renda N, Abrignani V, Lombardo A, Lucà F. Mental stress: A novel cardiovascular risk factor. World J Cardiol 2026; 18(5): 119108 [DOI: 10.4330/wjc.v18.i5.119108]
Corresponding Author of This Article
Maurizio Giuseppe Abrignani, MD, Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, 175 Via Salemi, Marsala 91025, Trapani, Italy. maur.abri@alice.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
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Review
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Abrignani MG, Renda N, Abrignani V, Lombardo A, Lucà F. Mental stress: A novel cardiovascular risk factor. World J Cardiol 2026; 18(5): 119108 [DOI: 10.4330/wjc.v18.i5.119108]
World J Cardiol. May 26, 2026; 18(5): 119108 Published online May 26, 2026. doi: 10.4330/wjc.v18.i5.119108
Mental stress: A novel cardiovascular risk factor
Maurizio Giuseppe Abrignani, Nicolò Renda, Vincenzo Abrignani, Alberto Lombardo, Fabiana Lucà
Maurizio Giuseppe Abrignani, Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, Marsala 91025, Trapani, Italy
Nicolò Renda, Operative Unit of Psychiatry, Mental Health Department, ASP 2 Caltanissetta, Caltanissetta 93100, Sicilia, Italy
Vincenzo Abrignani, Operative Unit of Internal Medicine, P. Borsellino Hospital, ASP Trapani, Marsala 91025, Trapani, Italy
Alberto Lombardo, Operative Unit of Cardiology, S. Antonio Abate Hospital, ASP Trapani, Erice 91100, Trapani, Italy
Fabiana Lucà, Department of Cardiology, Grande Ospedale Metropolitano di Reggio Calabria, A.O. Bianchi Melacrino Morelli, Reggio di Calabria 89121, Calabria, Italy
Author contributions: Abrignani MG conceptualized and designed the study, created the artwork, supervised, and made critical revisions; Renda N, Abrignani V, Lombardo A, and Lucà F conducted the literature review, did the analysis, interpretation of data and drafted the original manuscript; and authors gave substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, drafted the article or made critical revisions related to important intellectual content of the manuscript, and provided final approval of the version of the article to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Maurizio Giuseppe Abrignani, MD, Operative Unit of Cardiology, P. Borsellino Hospital, ASP Trapani, 175 Via Salemi, Marsala 91025, Trapani, Italy. maur.abri@alice.it
Received: January 19, 2026 Revised: February 17, 2026 Accepted: April 23, 2026 Published online: May 26, 2026 Processing time: 120 Days and 8.5 Hours
Abstract
Many acute coronary syndromes or strokes occur in patients without arterial hypertension, diabetes mellitus, dyslipidaemia, or smoking habits. Therefore, it is essential to identify new cardiovascular (CV) risk factors, among which psychosocial elements are gaining increasing importance. Recent guidelines recognize psychosocial factors, such as mental stress, as risk modifiers that can improve risk prediction and clinical decision-making. Stressful stimuli are processed by cortical and subcortical brain regions, which, through the autonomic nervous system and the hypothalamic-pituitary-adrenal axis, generate neuroendocrine, hemodynamic, and immune changes. Mental stress can be acute or chronic. Acute stress results from sudden emotions and may trigger acute cardiac or cerebral events. Chronic stress, instead, develops from prolonged exposure to family, work, or financial problems. It can induce endothelial dysfunction and low-grade systemic inflammation, contributing to atherogenesis. Like physical stress tests, mental stress tests can provoke transient myocardial ischemia even without significant coronary obstruction. Therapeutic strategies reducing adrenergic activity or mitigating negative emotions associated with psychological stress may lower CV risk. This narrative review synthesizes current epidemiological data on interactions between stress and CV disease, explores potential mechanisms, and outlines future research directions for holistic treatment approaches.
Core Tip: Many acute coronary syndromes and strokes occur in patients without traditional risk factors. This highlights the growing importance of psychosocial factors, especially mental stress, as recognized by recent guidelines. Acute stress can trigger severe cardiovascular (CV) events, while chronic stress - often linked to ongoing personal or professional issues - promotes inflammation and endothelial dysfunction, contributing to atherosclerosis. Mental stress tests can induce transient myocardial ischemia even without significant coronary obstruction. Therapeutic strategies targeting stress reduction may help lower CV risk. This narrative review synthesizes epidemiological data and explores potential mechanisms regarding interactions between stress and CV disease, outlining future research directions.
