Chronic stress and endothelial dysfunction: mechanisms, experimental challenges, and the way ahead

Am J Physiol Heart Circ Physiol. 2020 Aug 1;319(2):H488-H506. doi: 10.1152/ajpheart.00244.2020. Epub 2020 Jul 3.


Although chronic stress is an important risk factor for cardiovascular diseases (CVD) onset, the underlying mechanisms driving such pathophysiological complications remain relatively unknown. Here, dysregulation of innate stress response systems and the effects of downstream mediators are strongly implicated, with the vascular endothelium emerging as a primary target of excessive glucocorticoid and catecholamine action. Therefore, this review article explores the development of stress-related endothelial dysfunction by focusing on the following: 1) assessing the phenomenon of stress and complexities surrounding this notion, 2) discussing mechanistic links between chronic stress and endothelial dysfunction, and 3) evaluating the utility of various preclinical models currently employed to study mechanisms underlying the onset of stress-mediated complications such as endothelial dysfunction. The data reveal that preclinical models play an important role in our efforts to gain an increased understanding of mechanisms underlying stress-mediated endothelial dysfunction. It is our understanding that this provides a good foundation going forward, and we propose that further efforts should be made to 1) more clearly define the concept of stress and 2) standardize protocols of animal models with specific guidelines to better indicate the mental complications that are simulated.

Keywords: animal models; cardiovascular diseases; chronic stress; endothelial dysfunction.

Publication types

  • Review

MeSH terms

  • Animals
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / metabolism
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / psychology
  • Catecholamines / metabolism
  • Chronic Disease
  • Disease Models, Animal
  • Endothelium, Vascular / metabolism
  • Endothelium, Vascular / physiopathology*
  • Glucocorticoids / metabolism
  • Humans
  • Hypothalamo-Hypophyseal System / metabolism
  • Hypothalamo-Hypophyseal System / physiopathology
  • Risk Factors
  • Signal Transduction
  • Stress, Psychological / complications*
  • Stress, Psychological / metabolism
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology


  • Catecholamines
  • Glucocorticoids