A review published in Precision Clinical Medicine, led by researchers at West China Hospital and West China Second University Hospital, Chengdu, China, explores the complex relationship between mental health and cardiovascular disease (CVD). Cardiovascular disease is the leading cause of death globally, and the burden of mental disorders, such as depression and anxiety, is on the rise. These mental health conditions are associated with increased risks of myocardial infarction, stroke, heart failure, and cardiovascular mortality. Patients with pre-existing CVD are also more likely to experience comorbid mental disorders.
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The article synthesizes findings from various studies across epidemiology, neuroendocrine, autonomic, immune, and molecular domains to construct the psycho-cardiovascular interaction network (PCIN) framework. This framework aims to unify the fragmented understanding of how psychological factors influence cardiovascular health through shared biological pathways.
The review identifies six key mechanisms at the system level: imbalance in the hypothalamic-pituitary-adrenal (HPA) axis, autonomic nervous system (ANS) imbalance, chronic inflammation, platelet activation, unhealthy behaviors, and sleep/circadian disruptions. Each of these mechanisms can lead to elevated cortisol levels, a shift in sympathetic-parasympathetic balance, increased production of inflammatory markers such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), and poorer adherence to health protocols.
On a molecular level, the authors highlight five specific pathways: BDNF (brain-derived neurotrophic factor) signaling, PROK/PKR receptor effects, MAPK pathways, serotonin receptor signaling, and NLRP3 inflammasome activation. These pathways interact in an interconnected network, contributing to the coexistence of mental and cardiovascular conditions and highlighting the limitations of single-target treatments.
The researchers emphasize that the PCIN serves as a practical tool for connecting psychosocial factors with measurable molecular signals, making it essential to integrate mental health assessments into routine cardiovascular care for patients struggling with mental health issues. Future research should focus on rigorous clinical trials evaluating whether therapies targeting these pathways can provide benefits for both mental health and cardiovascular outcomes.
In clinical practice, the PCIN framework could enable a holistic risk assessment approach that incorporates psychological, molecular, genetic, and physiological data. Potential interventions include cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and pharmacological options such as selective serotonin reuptake inhibitors (SSRIs) and NLRP3 inhibitors. Emerging strategies like BDNF gene therapy and exosome delivery methods show promise but remain experimental. The authors call for extensive studies, randomized controlled trials, and personalized prevention initiatives based on the brain-heart axis.