Social Relationships, Stress, & Cardiac Health

A diverse group of seniors practice yoga in their local park.
Read Time: 4 Minutes

Work-related stressors, poor sleep, and emotional disturbances have been correlated with adult-related cardiovascular disease.1 Large bodies of research indicate that chronic stress, whether experienced in early life or as an adult, is linked to increased coronary heart disease risk.1,2 In particular, childhood adversity, including physical and sexual abuse in childhood, has been shown to relate to higher morbidity of cardiovascular events.3,4 Racism and discrimination create additional daily stressors for Black, Indigenous, and People of Color (BIPOC) communities, impacting their increased cardiovascular disease risks.5-8

A 2018 finding using data from the Jackson Heart Study suggested that in African American adults, global stress (overall stress level) and major life events were associated with increased risk of metabolic syndrome (MetS) severity.9 Additionally, men and women’s MetS and stress responses varied in severity. For example, men significantly increased their MetS severity at medium levels of stress, whereas women significantly increased their MetS severity at high levels of stress.9

Healthy lifestyles begin in our homes, workplaces, and communities. And the conditions in which we live can shape our health and longevity. IFM Executive Director of Medical Education Robert Luby, MD, talks about how everyday stress and social relationships affect the cardiovascular system:


The vascular endothelium responds to its environment. The environment of the vascular endothelium is what passes through the lumen. What passes through the lumen are molecules of information. These molecules of information go a long way to determine the health and the reactivity of that endothelium, therefore that reactivity of the blood vessel.

Some of the most potent messengers of communication to these blood vessels are hormones that are released during times of stress. When there are stressful social relationships, there will be adverse reactions of these heart vessels. That’s the crux of the matter. Over time, in low doses, if we can say, social stressors, relationship stressors can cause problems, which build up as antecedents to finally result in a heart attack, for example, or a cardiovascular event. We also know that acute emotional stressors and social stressors can actually trigger that ultimate heart event, heart attack, or other. We know that when somebody is suffering from a broken heart, their physiological and anatomical heart suffers.

That’s the art of medicine that we can address as functional medicine practitioners, as well as the molecules of medicine. That’s the great opportunity we have, and that’s the kind of training you’ll get with IFM: addressing the molecules and addressing the human element of cardiovascular health.


Many diseases stemming from chronic stress and inflammation have early warning signs, meaning some cases may be prevented or improved with lifestyle changes that help manage stress. The functional medicine model focuses in on identifying stress as a cause of dysfunction and utilizing specific interventions like exercise, meditation, and yoga that work for the individual patient. Tools such as the functional medicine timeline can also help clinicians identify areas of life where stress may be problematic and design treatments that focus on improving stress management. Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

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  1. Liu YZ, Wang YX, Jiang CL. Inflammation: the common pathway of stress-related diseases. Front Hum Neurosci. 2017;11:316. doi:10.3389/fnhum.2017.00316
  2. Su S, Jimenez MP, Roberts CTF, Loucks EB. The role of adverse childhood experiences in cardiovascular disease risk: a review with emphasis on plausible mechanisms. Curr Cardiol Rep. 2015;17(10):88. doi:1007/s11886-015-0645-1
  3. Rich-Edwards JW, Mason S, Rexrode K, et al. Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation. 2012;126(8):920-927. doi:10.1161/CIRCULATIONAHA.111.076877
  4. Kreatsoulas C, Fleegler EW, Kubzansky LD, McGorrian CM, Subramanian SV. Young adults and adverse childhood events: a potent measure of cardiovascular risk. Am J Med. 2019;132(5):605-613. doi:10.1016/j.amjmed.2018.12.022
  5. Acosta JN, Leasure AC, Both CP, et al. Cardiovascular health disparities in racial and other underrepresented groups: initial results from the All of Us research program. J Am Heart Assoc. 2021;10(17):e021724. doi:10.1161/JAHA.121.021724
  6. Javed Z, Maqsood MH, Amin Z, Nasir K. Race and ethnicity and cardiometabolic risk profile: disparities across income and health insurance in a national sample of US adults. J Public Health Manag Pract. 2022;28(Suppl 1):S91-S100. doi:10.1097/PHH.0000000000001441
  7. Javed Z, Haisum Maqsood M, Yahya T, et al. Race, racism, and cardiovascular health: applying a social determinants of health framework to racial/ethnic disparities in cardiovascular disease. Circ Cardiovasc Qual Outcomes. 2022;15(1):e007917. doi:10.1161/CIRCOUTCOMES.121.007917
  8. Panza GA, Puhl RM, Taylor BA, Zaleski AL, Livingston J, Pescatello LS. Links between discrimination and cardiovascular health among socially stigmatized groups: a systematic review. PLoS One. 2019;14(6):e0217623. doi:10.1371/journal.pone.0217623
  9. Cardel MI, Min YI, Sims M, et al. Association of psychosocial stressors with metabolic syndrome severity among African Americans in the Jackson Heart Study. Psychoneuroendocrinology. 2018;90:141-147. doi:10.1016/j.psyneuen.2018.02.014

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