Figure 1.

Conceptual illustration of brain-body pathways linking psychological stress to stressor-evoked cardiovascular reactions linked to cardiovascular disease risk. A network of forebrain areas appraise psychological stimuli as threats that tax or exceed coping capacities. These appraisals lead to visceromotor commands or ‘predictions’ for anticipated metabolic support for motivated behaviors. These commands are relayed via subcortical and brainstem cell groups to influence autonomic and neuroendocrine outflow to the heart and vasculature. Chronically exaggerated or metabolically disproportionate stressor-evoked cardiovascular (e.g., BP) reactions may exert shear or tensile stress on blood vessel walls over time, and they may accelerate atherosclerosis or influence risk for later cardiovascular disease endpoints. Vagal and other viscerosensory channels relay feedback signals from visceral organs and systems in the periphery, enabling the afferent representation of peripheral stressor-evoked physiological reactions by forebrain areas. Afferent feedback may influence the magnitude, duration, or general patterning of stressor-evoked reactions and may also affect appraisal-related neural activity.