{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:36:15Z","timestamp":1786628175385,"version":"build-2736575974"},"reference-count":114,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Postoperative cardiovascular complications remain a leading cause of morbidity and mortality after noncardiac surgery, yet current risk models do not incorporate psychosocial stress. With over 300 million noncardiac surgeries performed annually worldwide and a substantial burden of perioperative cardiovascular complications, preoperative chronic stress is increasingly recognized as a potentially modifiable risk factor. Chronic stress produces HPA axis dysregulation, glucocorticoid resistance, sympathetic activation, inflammation, endothelial dysfunction, and hypercoagulability. These pathways overlap with the mechanisms underlying perioperative myocardial injury, arrhythmogenesis, and venous thromboembolism. Prospective data demonstrated that preoperative psychological distress independently predicted 30-day cardiovascular complications and 1-year mortality after noncardiac surgery. Allostatic load studies in noncardiac surgery patients showed that high preoperative physiological burden was associated with up to twofold increases in postoperative mortality and elevated rates of myocardial infarction and venous thromboembolism. Epidemiological evidence further supports that anxiety and depression independently increase cardiovascular risk. Converging evidence suggests that preoperative psychological distress is a relevant perioperative cardiovascular risk factor. However, no randomized controlled trial has evaluated whether targeted preoperative stress reduction can decrease postoperative cardiovascular events, representing a critical gap warranting prospective investigation.<\/jats:p>","DOI":"10.3390\/biom16081183","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:47:11Z","timestamp":1786625231000},"page":"1183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomolecular Pathways Linking Preoperative Chronic Stress to Postoperative Cardiovascular Dysfunction in Noncardiac Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3103-2822","authenticated-orcid":false,"given":"Predrag","family":"Jancic","sequence":"first","affiliation":[{"name":"The Wright Center for Graduate Medical Education, Scranton, PA 18505, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Kovac","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9278-7635","authenticated-orcid":false,"given":"Halil Emre","family":"Demirtas","sequence":"additional","affiliation":[{"name":"The Wright Center for Graduate Medical Education, Scranton, PA 18505, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8028-1495","authenticated-orcid":false,"given":"Nebojsa Nick","family":"Knezevic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA"},{"name":"Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA"},{"name":"Department of Surgery, University of Illinois, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9542-8306","authenticated-orcid":false,"given":"Graham Trevor","family":"Lubinsky","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA"},{"name":"Department of Anesthesiology, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0140-6736(08)60878-8","article-title":"An Estimation of the Global Volume of Surgery: A Modelling Strategy Based on Available Data","volume":"372","author":"Weiser","year":"2008","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/S0140-6736(15)60806-6","article-title":"Estimate of the Global Volume of Surgery in 2012: An Assessment Supporting Improved Health Outcomes","volume":"385","author":"Weiser","year":"2015","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1016\/j.jacc.2024.06.013","article-title":"2024 AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"84","author":"Thompson","year":"2024","journal-title":"J. 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