Stress, sleep and wellbeing

Risposta: The modern view of cardiology and neurology is based on the concept that the heart and the brain are not separate organs, but components of an integrated system in constant, two-way communication. Clinical conditions such as chronic stress, structured anxiety disorders, major depression and sleep disorders (including obstructive sleep apnoea syndrome) significantly increase overall cardiovascular risk through complex pathophysiological and neuroendocrine mechanisms.

When our body is subjected to continuous stress, the hypothalamic-pituitary-adrenal axis is persistently activated, leading to excessive and prolonged secretion of cortisol and catecholamines (adrenaline and noradrenaline). This over-activation of the sympathetic nervous system causes a systematic rise in blood pressure, an increase in resting heart rate, peripheral vasoconstriction and a concomitant reduction in heart rate variability (HRV), a key indicator of autonomic imbalance. At the cellular level, stress hormones stimulate the release of pro-inflammatory cytokines (such as IL-6 and TNF-alpha), which damage the endothelial layer of the arteries and promote thrombus formation.

Neuroimaging research has identified the key role played by the amygdala, the brain structure responsible for processing emotions and fear responses. Hyperactivity of the amygdala, observed in individuals suffering from chronic stress or trauma, correlates directly with increased bone marrow activity (leukocytosis), increased vascular inflammation and a higher rate of adverse coronary events.

As mentioned, the relationship is two-way: a sudden diagnosis of a serious heart condition — such as an acute myocardial infarction or a diagnosis of atrial fibrillation — has a significant psychological impact that can lead to anxiety disorders and depression. This debilitating emotional state often compromises adherence to treatment and healthy lifestyle choices, creating a harmful vicious circle. Nor should we overlook clinical conditions such as Takotsubo cardiomyopathy (or ‘broken heart syndrome’), triggered by intense emotional stress – whether negative or positive – which can mimic a heart attack in the absence of obstructive coronary lesions. Looking after one’s mental health, whilst also ensuring restful sleep, is, to all intents and purposes, a fundamental pillar of cardiovascular prevention and care.