3c - PNEI & CARDIOVASCULAR DISEASE

Question 1

Core concept

Answer 1

• PNEI explores dynamic interactions between psychological processes, nervous system, endocrine responses
  & immune functions
• It proposes that health & disease arise from integrated functioning or dysfunction of these systems—not
  from isolated organs

Question 2

Cardiovascular disease in PNEI paradigm

Answer 2

CVD as Multi-System Disorder
- Cardiovascular diseases not only metabolic or vascular, but also linked to chronic inflammation, stress &
immune dysregulation
- Chronic psychological stress = trigger & perpetuator of inflammation, which plays central role in
atherosclerosis, hypertension & heart failure

Question 3

Mechanisms linking stress to CVD

Answer 3

Table

Question 4

scientific evidence

Answer 4

• Elevated C-reactive protein (CRP) & IL-6 are predictors of future cardiovascular events.
• Stress alter heart rate variability (HRV): marker of autonomic imbalance predictive of sudden cardiac death
• Chronic inflammation promotes atherosclerosis by damaging endothelial cells & promoting plaque
  formation

Question 5

Allostasis and allostatic load

Answer 5

• Allostasis = body’s adaptive response to maintain homeostasis under stress.
• Allostatic load = wear and tear from chronic overactivation of stress systems → contributes to hypertension, atherosclerosis, metabolic syndrome

Question 6

Epigenetics and CVD

Answer 6

• Environmental & psychosocial stress can alter gene expression (epigenetic modifications)
• Epigenetic dysregulation may influence susceptibility to hypertension, diabetes & heart failure by altering immune-endocrine balance

Question 7

Clinical implications:
- diagnostic approach
- therapeutic directions

Answer 7

Diagnostic Approach
- Assess stress, lifestyle, psychological state as part of cardiovascular risk evaluation.
- Look for signs of chronic inflammation beyond standard lipid panels.

Therapeutic Directions
- Anti-inflammatory treatments may be beneficial beyond lipid-lowering drugs.
- Psychological interventions (CBT, mindfulness) and lifestyle changes are crucial.
- Integrated care involving cardiologists, psychologists, and immunologists is needed