{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:32:35Z","timestamp":1787725955384,"version":"build-2784847793"},"reference-count":118,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Residual cardiovascular risk remains substantial despite widespread adoption of intensive lipid-lowering strategies\u2014statins, PCSK9 inhibitors, and RNA-based agents\u2014that achieve very low LDL-C and apoB levels. Over the past three years, converging epidemiologic and mechanistic evidence has highlighted emotional stress\u2014including anger, grief, anxiety, and chronic psychosocial strain\u2014as a biologically active determinant of atherosclerotic disease and a frequent trigger of acute events. We propose the Emotion\u2013Lipid Synergy Model, in which lipid burden establishes the atherothrombotic substrate while emotion-driven autonomic and vascular perturbations amplify endothelial dysfunction, microvascular constriction, inflammation, and thrombogenicity\u2014thereby widening the residual-risk gap even when lipid targets are met. From this perspective, prevention should evolve toward precision psychocardiology: systematically screening for distress and stress reactivity; leveraging wearables to detect high-risk emotional states; and delivering timely, scalable, just-in-time behavioral interventions alongside guideline-directed lipid management. Particular attention is warranted for women and patients with angina and no obstructive coronary disease, who appear disproportionately susceptible to mental-stress ischemia. We outline a research agenda\u2014flagship outcomes trials, mechanistic studies, and multimodal phenotyping\u2014and discuss implementation pathways that integrate emotion metrics into cardiac rehabilitation and routine care. Integrating emotion assessment and modulation with lipid control offers a pragmatic route to reduce residual risk and advance equitable, personalized cardiovascular prevention.<\/jats:p>","DOI":"10.3390\/jcm14207208","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T11:57:42Z","timestamp":1760529462000},"page":"7208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Integrating Emotional Stress and Lipid Lowering in Cardiovascular Disease Management: The Future of Precision Cardiovascular Prevention"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-5477","authenticated-orcid":false,"given":"Emmanuel","family":"Eroume A Egom","sequence":"first","affiliation":[{"name":"Heart and Vascular Institute, Department of Medicine, Hartford HealthCare, Hartford, CT 06106, USA"},{"name":"Institut du Savoir Montfort (ISM), Ottawa, ON K1K 0T2, Canada"},{"name":"Laboratory of Human Metabolism and Non-Communicable Diseases, Institute of Medical Research Medicinal Plants Studies (IMPM), Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette Sandrine","family":"Lema","sequence":"additional","affiliation":[{"name":"Harmony Care, Heaven Foundation CIEL, Hartford, CT 06105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Reijnders, E., van der Laarse, A., Jukema, J.W., and Cobbaert, C.M. 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