Psychosocial Risk Factors in Atherosclerotic Cardiovascular Disease: Mechanisms, Assessment, and Management – A Narrative Review

Abstract

Cardiovascular disease remains the leading cause of death in Europe, with atherosclerotic cardiovascular disease (ASCVD) accounting for a substantial share of this burden despite progress in controlling lipids, blood pressure, glycemia, and smoking. Epidemiological evidence indicates that psychosocial factors, including depression, anxiety, chronic occupational stress, social isolation, and personality-related distress, are associated with the development and prognosis of ASCVD and may contribute to the broader burden of residual cardiovascular risk. European cardiology has moved decisively on this question: psychosocial factors were recognized as risk modifiers in the 2021 prevention guidelines, and in 2025 the European Society of Cardiology published a dedicated Clinical Consensus Statement on mental health and cardiovascular disease. This narrative review summarizes evidence linking psychosocial factors to ASCVD, outlines plausible neurobiological, inflammatory and behavioral pathways, and considers practical implications for assessment and management. PubMed, Scopus, and the Cochrane Library were searched for English-language literature published between January 1995 and July 2026, with priority given to prospective cohorts, meta-analyses, randomized trials, society statements, and guidelines. Current European consensus favors two-stage screening only when a defined referral pathway is available, with care delivered through a multidisciplinary team that includes a mental health professional. Psychological interventions reliably improve psychological symptoms and may reduce cardiac mortality, although an effect on total mortality remains unproven.