Changes in the coronary vascular system following prolonged exposure to stress

Effect of cortisol on the proliferation and protein synthesis of human aortic smooth muscle cells in culture

The synthesis of collagen (measured as the formation of non-dialyzable hydroxyproline) and other proteins, and the activity of lysyl oxidase, the enzyme responsible for the formation of cross-links in elastin and collagen, were measured in cultured human aortic smooth muscle cells in the presence of various cortisol concentrations. In addition, the effect of cortisol on the proliferation of the cells was also studied. At concentrations of 10(-6) M and greater, cortisol retarded cell growth markedly, as judged by decreased incorporation of 3H-thymidine by the cells and decreased DNA content of the cultures. At the same concentrations, cortisol increased the synthesis of collagen and other proteins. The magnitude of the increase was similar for collagen and other proteins. The activity of lysyl oxidase was also increased in the presence of 10(-6) and 10(-5) M cortisol, but to a lesser extent than the synthesis of collagen. Other studies using cultured cells have shown that cortisol decreases the synthesis of hyaluronic acid but not of sulphated glycosaminoglycans by smooth muscle cells and does not injure endothelial cells. Considering these findings in the light of the present results, it is suggested that cortisol induces changes in the metabolism of connective tissue macromolecules of smooth muscle cells that can be regarded as atherogenic. However, some other important biological changes associated with atherogenesis (smooth muscle cell proliferation and endothelial injury) do not occur in vascular cells exposed to cortisol.

The physiological measurement of acute stress (public speaking) in bank employees

An evaluation of a number of non-invasive physiological measures of stress was conducted, using bank employees attending a two-week residential course. The stressor involved was the preparation and delivery of a 15-min public lecture. The physiological parameters measured were urinary excretion rates of noradrenaline (NA), adrenaline (A), dopamine and cortisol, the ratio of NA/A, salivary cortisol levels, heart rate and blood pressure. Measurements were taken at 08.30, 10.30, 12.30, 15.30 and 17.30 h on the day of the public lecture and on the following (control) day. The public lectures were given between 10.30 and 12.30 h. The urinary excretion rates of adrenaline and cortisol were significantly elevated immediately following, but not before, the public lectures. The ratio NA/A was significantly decreased and the salivary cortisol levels were significantly increased both immediately before and after the public lecture. Urinary excretion rates of noradrenaline and dopamine, blood pressure and heart rate were unchanged by the stressor. Measurement of salivary cortisol levels, as well as providing a simple, stress free, non-invasive collection procedure, more closely reflects in time the changes in plasma levels of the hormone, not suffering from the large lag-time involved with urinary hormone measurements. Salivary cortisol measurement would appear to be the measurement of choice in human stress studies where individual stress factors are to be identified and studied. The significance of the stress-induced elevation in cortisol and catecholamine levels in the link between illness and occupational stress is discussed.

The stabilizing effect of glucocorticoids on human endothelial cells in culture

The effect of hydrocortisone, prednisolone and dexamethasone on the stability and viability of cultured human endothelial cells was studied by measuring the release of 51Cr from pre-labelled cells by cell number calculation and by the Trypan-blue test. All glucocorticoids studied, stabilized endothelial cells as demonstrated by a decreased release of 51Cr. The maximal stabilizing effect of the steroids appeared to be equal, although the maximal effect of dexamethasone was seen at a lower concentration than that of prednisolone and hydrocortisone. However, at the very high concentration of 10(-4) mol/l, dexamethasone induced an increase in the release of 51Cr suggesting a toxic effect. The viability of cells was not affected by the steroids. The stabilizing effect of glucocorticoids at optimal concentrations in vitro may indicate strengthening of endothelial integrity by the steroids in vivo. This may explain their beneficial effect in the treatment of certain vascular disorders, e.g. thrombocytopenia.

The effect of sulfinpyrazone on morphological changes in the coronary vasculature induced by prolonged unpredictable stress in the rat

It was confirmed that prolonged unpredictable stress in the rat induces morphological change in the coronary microcirculation. These changes include dilation in venules, deposits staining positive with PAS in the venules due to platelet aggregation and a breakdown of the endothelial lining in arterioles. Sulfinpyrazone is reported to prevent platelet agglutination, and shows effectiveness in the clinic in preventing re-infarction following infarction. Accordingly rats were exposed to the stress regimen for 50 days, and groups were treated with sulfinpyrazone, either prophylactically (receive drug for 50 days) or therapeutically (receive drug Day 30 to Day 50). The morphology of the hearts of treated animals were compared with those of placebo treated controls. It was demonstrated that therapeutic sulfinpyrazone did not prevent (p less than 0.01), but reduced the incidence of morphological change in the coronary microcirculation. Prophylactic sulfinpyrazone had a distinct protective effect (p less than 0.001). It was demonstrated that the plasma corticosterone levels in both drug groups did not fall to the level found in control groups. The results are discussed in terms of a glucocorticoid-sulfinpyrazone interaction preventing prostaglandin release which will prevent platelet aggregation. It is possible that the interaction relates to maintaining the integrity of the microcirculatory endothelial cells, thus preventing the local release of inflammatory substances.

Type A behavior pattern and coronary atherosclerosis

Previous research has demonstrated an increased rate of clinical coronary heart disease (CHD) events among people who exhibit a "coronary prone" (Type A) behavior pattern. This study was undertaken to determine whether the association between behavior pattern Type A and CHD might be extended beyond clinical CHD events to include also the coronary atherosclerotic process. In addition to usual clinical evaluation, 156 consecutive patients referred for diagnostic coronary angiography were independently assessed on the basis of a structured interview and assigned a rating of Type A, Type B, or Type X (indeterminate). Traditional physiologic factors--age, sex, cholesterol and cigarette smoking--were found to correlate with atherosclerotic disease. Type A patients were found in increasing proportions among groups of patients with coronary occlusions of moderate to severe degree compared with patients with only mild occlusions. This increasing proportion of Type A patients with increasing disease severity remained significant, even when age, sex, blood pressure, serum cholesterol level and cigarette smoking history were all simultaneously covaried. These findings suggest that, independently of traditional risk factors, behavior pattern Type A may contribute to the risk of clinical CHD events via effects on the atherosclerotic process.