Psychosocial stress and cardiovascular disease.

Mahatma Gandhi once famously said: "poverty is the worst type of violence". He was referring to the state of political and social unrest that was pervading his nation, and the impact that humiliating defeat had on those who suffered in dire straits. Today, there is mounting evidence that social disparities cause intense psychosocial stress on those on whom they are imposed and can result in adverse cardiovascular outcomes. In modern society we still witness large disparities in living conditions between races, regions, continents and nations. Even in more privileged nations, we often witness the existence of "food and social deserts" in the middle of large urban centers. Sizable segments of the population are deprived of the comforts and privileges enjoyed by others; food quality and choices are limited, opportunities to exercise and play are scarce or unsafe, physical and verbal violence are prevalent, and racially driven conflicts are frequent. It has become apparent that these conditions predispose to the development of cardiovascular disease and affect its outcome negatively. Besides the increase in incidence of traditional risk factors, such as smoking, hypertension, insulin resistance and obesity, several other pathophysiological mechanisms involving the neuro-endocrine, inflammatory and immune pathways may be responsible for the noted negative outcomes. In this manuscript we review some of the evidence linking social distress with adverse cardiovascular outcomes and the potential subtending mechanisms and therapeutic interventions.