Clinical focus
Psychosocial risk factors for coronary heart disease
Nick Glozier MB BS, FRANZCP, PhD,
Geoffrey H Tofler MB BS, MD, FRACP,
David M Colquhoun MB BS, FRACP, FCSANZ,
Stephen J Bunker RN, PhD,
David M Clarke PhD, FRACGP, FRANZCP,
David L Hare DPM, FRACP, FCSANZ,
Ian B Hickie MD, FRANZCP, FASSA,
James Tatoulis MB BS, MD, FRACS,
David R Thompson MA, PhD, FRCN,
Alison Wilson MBA,
Maree G Branagan MPH,
Nick Glozier MB BS, FRANZCP, PhD
Professor of Psychological Medicine
Brain and Mind Research Institute, University of Sydney, Sydney, NSW.
Search for more papers by this authorGeoffrey H Tofler MB BS, MD, FRACP
Professor of Preventive Cardiology
Cardiology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW.
Search for more papers by this authorDavid M Colquhoun MB BS, FRACP, FCSANZ
Associate Professor of Medicine
University of Queensland, Brisbane, QLD.
Search for more papers by this authorStephen J Bunker RN, PhD
Adjunct Senior Lecturer
Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC.
Search for more papers by this authorDavid M Clarke PhD, FRACGP, FRANZCP
Professor and Psychiatrist, Consultation–Liaison Psychiatry Service, Monash Medical Centre
School of Psychology and Psychiatry, Monash University, Melbourne, VIC.
Search for more papers by this authorDavid L Hare DPM, FRACP, FCSANZ
Professorial Fellow and Coordinator of Cardiovascular Research
University of Melbourne, Melbourne, VIC.
Search for more papers by this authorIan B Hickie MD, FRANZCP, FASSA
Professor of Psychiatry
Brain and Mind Research Institute, University of Sydney, Sydney, NSW.
Search for more papers by this authorJames Tatoulis MB BS, MD, FRACS
Chief Medical Advisor
National Heart Foundation of Australia, Melbourne, VIC.
Search for more papers by this authorDavid R Thompson MA, PhD, FRCN
Professor of Nursing
Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC.
Search for more papers by this authorAlison Wilson MBA
National Manager, Clinical Programs
National Heart Foundation of Australia, Melbourne, VIC.
Search for more papers by this authorCorresponding Author
Maree G Branagan MPH
Project Officer, Clinical Programs
National Heart Foundation of Australia, Melbourne, VIC.
Correspondence: [email protected]Search for more papers by this authorNick Glozier MB BS, FRANZCP, PhD,
Geoffrey H Tofler MB BS, MD, FRACP,
David M Colquhoun MB BS, FRACP, FCSANZ,
Stephen J Bunker RN, PhD,
David M Clarke PhD, FRACGP, FRANZCP,
David L Hare DPM, FRACP, FCSANZ,
Ian B Hickie MD, FRANZCP, FASSA,
James Tatoulis MB BS, MD, FRACS,
David R Thompson MA, PhD, FRCN,
Alison Wilson MBA,
Maree G Branagan MPH,
Nick Glozier MB BS, FRANZCP, PhD
Professor of Psychological Medicine
Brain and Mind Research Institute, University of Sydney, Sydney, NSW.
Search for more papers by this authorGeoffrey H Tofler MB BS, MD, FRACP
Professor of Preventive Cardiology
Cardiology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW.
Search for more papers by this authorDavid M Colquhoun MB BS, FRACP, FCSANZ
Associate Professor of Medicine
University of Queensland, Brisbane, QLD.
Search for more papers by this authorStephen J Bunker RN, PhD
Adjunct Senior Lecturer
Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC.
Search for more papers by this authorDavid M Clarke PhD, FRACGP, FRANZCP
Professor and Psychiatrist, Consultation–Liaison Psychiatry Service, Monash Medical Centre
School of Psychology and Psychiatry, Monash University, Melbourne, VIC.
Search for more papers by this authorDavid L Hare DPM, FRACP, FCSANZ
Professorial Fellow and Coordinator of Cardiovascular Research
University of Melbourne, Melbourne, VIC.
Search for more papers by this authorIan B Hickie MD, FRANZCP, FASSA
Professor of Psychiatry
Brain and Mind Research Institute, University of Sydney, Sydney, NSW.
Search for more papers by this authorJames Tatoulis MB BS, MD, FRACS
Chief Medical Advisor
National Heart Foundation of Australia, Melbourne, VIC.
Search for more papers by this authorDavid R Thompson MA, PhD, FRCN
Professor of Nursing
Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC.
Search for more papers by this authorAlison Wilson MBA
National Manager, Clinical Programs
National Heart Foundation of Australia, Melbourne, VIC.
Search for more papers by this authorCorresponding Author
Maree G Branagan MPH
Project Officer, Clinical Programs
National Heart Foundation of Australia, Melbourne, VIC.
Correspondence: [email protected]Search for more papers by this authorSummary
- In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD.
- Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD.
- Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort–reward imbalance and job loss is inconclusive.
- Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD.
- Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes.
- Acute emotional stress may trigger MI or takotsubo (“stress”) cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low.
- Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study.
- Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning.
- Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.
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