Abstract
Psychocardiology has established psychosocial factors as contributors to cardiovascular risk, symptom burden, and prognosis. Although mechanistic research is growing, causal evidence remains inconsistent, while broad constructs, cross-sectional designs, and insufficiently specified pathways still limit clinical translation and treatment selection. The future lies in mechanism-based care that identifies modifiable biological, psychological, behavioral, and social processes linking psychosocial factors and cardiovascular disease bidirectionally. Mechanisms are temporally ordered causal processes through which changes in one factor produce changes in another; modifiable processes provide intervention targets. This evolution matters for psychosomatic medicine because psychocardiology offers a model for translating biopsychosocial theory into mechanism-based cardiovascular care. Advancing this framework requires mechanism-based phenotyping, temporally explicit research, repeated real-world assessment, and interventions testing target engagement and clinical benefit. Mechanism-based phenotyping identifies context-dependent profiles of interacting biological, psychological, behavioral, and social processes beyond diagnoses or symptom counts. Temporally explicit research distinguishes antecedents, triggers, maintaining factors, and consequences across disease stages and clinical contexts. Key opportunities include ambulatory and digital methods, experimental-medicine approaches testing causal hypotheses and target engagement, and integrated stepped-care models linking assessment to mechanism-informed treatment selection in cardiovascular disease-management pathways. Progress will depend on transdisciplinary training, clinical workflow integration, reimbursement structures, and equitable models of care.