Stress and the metabolic syndrome: an interesting but enigmatic association.

Modern society has brought with it profound changes in lifestyle and an increased incidence of atherosclerotic vascular disease. Body weights are on the rise, diets are becoming less healthy, and people are becoming increasingly sedentary, resulting in elevations of blood pressure and metabolic alterations that increase atherothrombotic risk. In fact, obesity, insulin resistance, and diabetes are becoming a public health problem of epidemic proportions.1,2 In addition, modern society imposes demands on many that lead to difficulties in coping with their situations and more chronic “stress.” Stress engages the central nervous system and activates behavioral and physiological response patterns, such as the “defense” and “defeat” reactions, which have been beneficial for the survival of the individual and the species but may become maladaptive when stress is chronic.3–5 The concepts of “allostasis,” ie, adaptation to physiological states and the environment, and “allostatic load” are helpful in understanding how responses to stress may become maladaptive and damaging.5