Psychological stress and pain contribute to cardiovascular disease in asylum seekers

Many individuals seeking asylum in the United States show increased stress and pain symptoms that are associated with indications of cardiovascular disease according to Weill Cornell Medicine researchers.

We would not have expected the rates of these illnesses or conditions to be this high in such a young, otherwise healthy population.”

Dr. Gunisha Kaur, study’s senior author, associate professor of anesthesiology and an anesthesiologist at NewYork-Presbyterian/Weill Cornell Medical Center

The study, published Dec. 5 in Nature Mental Health, analyzed medical evaluations from 453 U.S. asylum seekers for symptoms associated with psychological stress, cardiovascular disease risk and physical pain. The findings surprised researchers as the median age for the asylum seekers was 30, which is considered young to be showing cardiovascular concerns.

Co-first authors, Dr. Jacob Lurie, interventional pain medicine fellow at Brigham and Women‘s Hospital, and Dr. Harlan Linver Pietz, internal medicine resident at Yale New Haven Hospital, were with Weill Cornell Medicine when the study was conducted.

A confluence of stressors impact asylum seekers

Nearly 120 million people globally were affected by forced displacement by the end of 2023, an 8% rise from 2022, according to the United Nations Global Trends report. In addition to a high level of psychological trauma, survivors of torture report other health issues, including persistent physical pain related to traumatic injuries.

During a qualitative study about stress, legal status and pain, asylum seekers seen at the Human Rights Impact Lab at Weill Cornell Medicine, where Dr. Kaur is founding director, reported concerning symptoms of cardiovascular disease. “Clinicians and researchers aren’t typically looking for cardiovascular disease in these young patients,” Dr. Kaur said. This prompted the researchers to consider a larger cohort to determine the prevalence of these conditions.

With diagnosis comes appropriate treatment

They first reviewed evaluations of refugees from around the world who had visited the Weill Cornell Center for Human Rights between 2010 and 2020. The clinic, dedicated to survivors of torture who are seeking asylum, is run by medical students and supervised by faculty, including Dr. Kaur who is co-medical director.

They found that 47% of participants reported worrisome symptoms of cardiovascular disease, including heart palpitations, feeling like fainting, stroke and chest pain. In addition, 31% of those who experienced cardiovascular disease symptoms also reported feeling symptoms of psychological stress and physical pain. Having both stress and pain symptoms strongly predicted cardiovascular disease symptoms.

The findings may prompt clinicians to consider cardiovascular concerns more seriously when evaluating this younger population. “This will be valuable for clinicians to better understand how these characteristic symptoms of cardiovascular disease can manifest. Without accurate diagnosis, appropriate treatments aren’t possible,” said Annabel Lee, a fourth-year medical student at Weill Cornell Medical College, and a co-author of the study. 

The authors plan to further investigate the occurrence of these symptoms in this population and potential interventions that could mitigate them. They anticipate that the actual prevalence of stress, pain and cardiovascular disease symptoms is actually higher than the findings in this study.

“This is an unexplored, untapped area of scientific investigation,” Dr. Kaur said. “Now that we know these diseases are unexpectedly prevalent, we should be addressing this upfront. Increased rehabilitation and decreased healthcare costs benefit not only these individuals, but the communities in which they reside.”