Cardiovascular diseases and psychological factors: Insights from a cardiac surgery patient cohort

Introduction: The association between psychological and stress factors and the development and progression of cardiovascular diseases (CVD) is widely documented in the literature. Personality characteristics, anxiety, depression, and perceived stress, exposure to traumatic events in adulthood or early life, may have a role in the onset of CVD as well as in the convalescence and rehabilitation process after adverse cardiovascular events or a cardiac surgery. An ineffective parasympathetic modulation of the heart, indicated by low heart rate variability (HRV), is a common factor shared between CVD and these psychological variables. The present study aims to evaluate whether high incidence of anxiety-depressive symptoms, stress, and the presence of adverse childhood experiences (ACE), along with reduced HRV, can be found in patients with CVD who require cardiac surgery. Methods: The study is conducted in the cardiac surgery unit at Sant'Andrea Hospital (Rome) in a population of patients awaiting cardiac surgery. The protocol includes an initial clinical interview and screening by self-report questionnaires on anxiety and depressive symptomatology, perceived stress, and coping strategies in the preoperative phase. Two months after the intervention, the same indicators are explored again at follow-up. Contextually, attachment style, the presence of ACE, and posttraumatic stress or growth are examined. Resting HRV is measured at the patient's admission, on the seventh postoperative day, and during the follow-up. Results: Self-report data indicate high levels of perceived stress and average levels of anxiety-depressive symptoms in the preoperative phase. Significant gender differences are found: women show higher levels of depression and perceived stress than men. In addition, most patients experienced significant stressful events in the previous year. Among coping strategies, the passive/negative coping strategy appears to be the most used in this population. Discussion: These preliminary findings illustrate how stress perception and exposure to recent stressful events may influence CVD. Ultimately, our data can contribute to the development of a clinical psychological support protocol within a cardiac surgical course that could consider gender differences and include interventions aimed at improving parasympathetic functioning.