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Meta-analyses of prospective cohort studies have shown that psychosocial stress might increase the risk of cardiovascular disease and diabetes.1, 2, 3, 4 The underlying pathophysiological mechanisms include disturbed sympathetic-parasympathetic balance and dysregulation of the hypothalamic–pituitary–adrenal axis, which can accelerate the development of metabolic syndrome and lead to left-ventricular dysfunction, dysrhythmia, and proinflammatory and procoagulant responses.5, 6 Stress has also been linked to worsening health-related lifestyle factors, such as physical inactivity and increased alcohol consumption, and, in people with existing illness, suboptimal treatment adherence.6

Although prevention guidelines for cardiovascular disease do not prioritise the management of stress in the general population,7, 8, 9 some guidelines recommend stress management for individuals with established cardiovascular disease or major cardiovascular risk factors, such as diabetes.7 The rationale for these recommendations is that people with cardiometabolic disease have many more adversehttps://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30140-2/fulltext?rss=yes&utm_campaign=update-lancar&utm_source=hs_email&utm_medium=email&utm_content=64170440&_hsenc=p2ANqtz-_MqRtJp64WsWqpZBTvcwDtIt4QMzLR5VNX9zFiCoQm0PKePBWSa6w6jnrfn5F_fKrJnT_MXIHqThuBekW_tOVWkMd3JA&_hsmi=64170440