In adults, the role of psychosocial stress in the development of cardiovascular disease (CVD) is well established. However, there is less focus on the effect of psychosocial stress on the cardiovascular health of children and adolescent.


Children and adolescents face several stressors daily from academic load, parental expectations, interpersonal conflicts, and peer pressure. These stressors can influence their cardiovascular (CV) risk and predispose to CVD later in life.

Prolonged exposure to psychological stress, whether in childhood or adulthood, is associated with increases in intermediate markers of CVD, such as blood inflammation markers.

Another predisposing factor is a child's cardiovascular reactivity (i.e., responses manifested as changes in heart rate, blood pressure, and total peripheral resistance) to stress. Cardiovascular reactivity may be computed as the stress-induced increase over the resting value. Children with increased reactivity to stress are more prone to essential hypertension, central adiposity, greater left ventricular mass, and subclinical atherosclerosis (measured by carotid artery intima media thickness).

In addition to high stress reactivity, other predisposing factors include reactivity to a greater variety of stressors, a greater duration of response to stress, slower habituation to stress, and frequency of stressors.

One mechanism behind these adverse CV effects is the effect of stress on behavior. For example, stress has found to shift food choices to more energy-dense and palatable (sweeter) foods and reduce willingness to exercise. As in adults, psychological stressors, especially interpersonal stressors, are powerful disruptors of control of eating in children.

Stress can also induce other forms of coping behaviors. Watching television is a common but sedentary distractor from stress. All these behaviors, while providing relief from stress, also promote a positive energy balance and fat deposition.

A second mechanism for stress-induced increase in CV risk among the youth is the stimulation of the sympathetic nervous system (SNS). Increased SNS tone and reduced vagal tone increases heart rate, myocardial contractility, and vascular resistance. This leads to elevated blood pressure and turbulent blood flow that produces mechanical injury to the endothelial lining. SNS activation also promotes platelet aggregation, endothelial dysfunction, proinflammatory cytokine release, and a procoagulant state.

Exercise seems to help alleviate many of the detrimental effects of stress, and can be cardioprotective in the youth. Exercise has been found to reduce CV reactivity to psychological stress and dampen SNS activation. However, care should be taken in motivating children to exercise, because negative affects to exercise can lead to exercise being perceived as a stressor. Interval exercises were found to be more reinforcing and motivating than constant-load exercises.

Adapted from: Roemmich JN, et al. Risk Factors for Cardiovascular Diseases in Youth. Exerc Sport Sci Rev 2014;42(4):145-152.