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Shimbo D, Cohen MT, McGoldrick M, Ensari I, Diaz KM, Fu J, Duran AT, Zhao S, Suls JM, Burg MM, Chaplin WF. Translational Research of the Acute Effects of Negative Emotions on Vascular Endothelial Health: Findings From a Randomized Controlled Study. J Am Heart Assoc 2024; 13:e032698. [PMID: 38690710 PMCID: PMC11179860 DOI: 10.1161/jaha.123.032698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Provoked anger is associated with an increased risk of cardiovascular disease events. The underlying mechanism linking provoked anger as well as other core negative emotions including anxiety and sadness to cardiovascular disease remain unknown. The study objective was to examine the acute effects of provoked anger, and secondarily, anxiety and sadness on endothelial cell health. METHODS AND RESULTS Apparently healthy adult participants (n=280) were randomized to an 8-minute anger recall task, a depressed mood recall task, an anxiety recall task, or an emotionally neutral condition. Pre-/post-assessments of endothelial health including endothelium-dependent vasodilation (reactive hyperemia index), circulating endothelial cell-derived microparticles (CD62E+, CD31+/CD42-, and CD31+/Annexin V+) and circulating bone marrow-derived endothelial progenitor cells (CD34+/CD133+/kinase insert domain receptor+ endothelial progenitor cells and CD34+/kinase insert domain receptor+ endothelial progenitor cells) were measured. There was a group×time interaction for the anger versus neutral condition on the change in reactive hyperemia index score from baseline to 40 minutes (P=0.007) with a mean±SD change in reactive hyperemia index score of 0.20±0.67 and 0.50±0.60 in the anger and neutral conditions, respectively. For the change in reactive hyperemia index score, the anxiety versus neutral condition group by time interaction approached but did not reach statistical significance (P=0.054), and the sadness versus neutral condition group by time interaction was not statistically significant (P=0.160). There were no consistent statistically significant group×time interactions for the anger, anxiety, and sadness versus neutral condition on endothelial cell-derived microparticles and endothelial progenitor cells from baseline to 40 minutes. CONCLUSIONS In this randomized controlled experimental study, a brief provocation of anger adversely affected endothelial cell health by impairing endothelium-dependent vasodilation.
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Affiliation(s)
- Daichi Shimbo
- Columbia University Irving Medical Center New York NY USA
| | | | | | - Ipek Ensari
- Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai Hasso Plattner Institute for Digital Health at Mount Sinai New York NY USA
| | - Keith M Diaz
- Columbia University Irving Medical Center New York NY USA
| | - Jie Fu
- Columbia University Irving Medical Center New York NY USA
| | - Andrea T Duran
- Columbia University Irving Medical Center New York NY USA
| | - Shuqing Zhao
- Columbia University Irving Medical Center New York NY USA
| | - Jerry M Suls
- Institute for Health System Science, Feinstein Institute for Medical Research/Northwell Health New York NY USA
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Helman TJ, Headrick JP, Stapelberg NJC, Braidy N. The sex-dependent response to psychosocial stress and ischaemic heart disease. Front Cardiovasc Med 2023; 10:1072042. [PMID: 37153459 PMCID: PMC10160413 DOI: 10.3389/fcvm.2023.1072042] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.
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Affiliation(s)
- Tessa J. Helman
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Sydney, Australia
- Correspondence: Tessa J. Helman
| | - John P. Headrick
- Schoolof Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia
| | | | - Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Sydney, Australia
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Cocoa Flavanols Improve Vascular Responses to Acute Mental Stress in Young Healthy Adults. Nutrients 2021; 13:nu13041103. [PMID: 33801767 PMCID: PMC8065749 DOI: 10.3390/nu13041103] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022] Open
Abstract
Mental stress has been shown to induce cardiovascular events, likely due to its negative impact on vascular function. Flavanols, plant-derived polyphenolic compounds, improve endothelial function and blood pressure (BP) in humans, however their effects during stress are not known. This study examined the effects of acute intake of cocoa flavanols on stress-induced changes on vascular function. In a randomised, controlled, double-blind, cross-over intervention study, 30 healthy men ingested a cocoa flavanol beverage (high-flavanol: 150 mg vs. low-flavanol < 4 mg (-)-epicatechin) 1.5 h before an 8-min mental stress task). Forearm blood flow (FBF), BP, and cardiovascular activity were assessed pre- and post-intervention, both at rest and during stress. Endothelial function (brachial flow-mediated dilatation, FMD) and brachial BP were measured before the intervention and 30 and 90 min post-stress. FMD was impaired 30 min post-stress, yet high-flavanol cocoa attenuated this decline and remained significantly higher compared to low-flavanol cocoa at 90 min post-stress. High-flavanol cocoa increased FBF at rest and during stress. Stress-induced cardiovascular and BP responses were similar in both conditions. Flavanols are effective at counteracting mental stress-induced endothelial dysfunction and improving peripheral blood flow during stress. These findings suggest the use of flavanol-rich dietary strategies to protect vascular health during stress.
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4
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Sun T, Matsuzawa Y, Widmer RJ, Hermann J, Lerman LO, Lerman A. Predictive value of vascular response to cuff inflation-induced pain in the control arm for adverse cardiovascular events. IJC HEART & VASCULATURE 2021; 33:100728. [PMID: 33665350 PMCID: PMC7905445 DOI: 10.1016/j.ijcha.2021.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
Background The high incidence rate of cardiovascular (CV) events had led to a comprehensive appraisal for identifying patients who are at risk for CV disease. However, CV traditional risk factors, such as Framingham risk score (FRS), failed exhaustively to predict CV events. Methods 402 participants (mean age, 58 [12] years; 45% male) using fingertip peripheral artery tonometry at Mayo Clinic in Rochester, Minnesota, were recruited in the present study. Measurements included reactive hyperemia index (RHI) and pain-induced peripheral artery tonometry (PIPAT). Results After a median follow-up of 3.8 (2.7–7.7) years, 95 CV events occurred. Both first minute PIPAT and RHI were independently associated with events (hazard ratio [HR], 0.77 [95% CI, 0.61–0.98]; P = 0.038 and HR, 0.75 [95% CI, 0.59–0.96]; P = 0.019, respectively). The C statistic values of FRS, FRS + first minute PIPAT, FRS + RHI, and FRS + RHI + first minute PIPAT were 0.704, 0.722, 0.694, and 0.726, respectively. Furthermore, the addition of first minute PIPAT, RHI, and first minute PIPAT + RHI to FRS results in net reclassification improvement (NRI) in the intermediate-risk group (18.1%, P = 0.031; 18.1%, P = 0.035; 21%, P = 0.013). Conclusion First minute PIPAT is a risk marker for adverse CV. Addition of first minute PIPAT to FRS increased the discrimination in the receiver operating characteristic analysis. It also increased NRI compared with FRS alone.
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Affiliation(s)
- Tao Sun
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yasushi Matsuzawa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Robert J Widmer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Joerg Hermann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. The Foundational Role of Cardiovascular Imaging in the Characterization of Mental Stress-Induced Myocardial Ischemia in Patients with Coronary Artery Disease. Curr Cardiol Rep 2020; 22:162. [PMID: 33037938 DOI: 10.1007/s11886-020-01407-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Mental stress-provoked myocardial ischemia (MSIMI) is an ischemic phenomenon provoked by the experience of psychologically stressful circumstances. While MSIMI was initially identified 50 years ago during activities of daily living through the use of wearable Holter monitor, subsequent research utilized the technologies of cardiac imaging-ventriculography and myocardial perfusion-under controlled conditions to pursue an understanding of pathophysiology and prognosis. This work revealed that MSIMI occurs in almost half of patients with stable coronary artery disease (CAD) and is associated with cardiac events and early mortality. We provide a focused review of the instrumental role that cardiac imaging has played in elucidating how stress affects cardiac physiology and how emerging diagnostic techniques will allow for further research on stress-mediated changes in the coronary macro- and microvasculature. RECENT FINDINGS Observations about the cardiac response to mental stress diverge from underlying cornerstones of the traditional CAD paradigm which is based upon myocardial oxygen demand and the degree of epicardial coronary stenosis. Evidence from studies utilizing non-invasive and invasive studies of coronary perfusion indicates perturbations in the microvascular compartment in response to mental stress. Cardiovascular imaging enjoined with mental stress provocation may be a commanding tool to advance our understanding of non-obstructive CAD and the coronary microvasculature. This further understanding will facilitate incorporation of mental stress testing in the clinical care of patients with discrepant diagnostic work-up of CAD and in patients who experience anginal symptoms due to non-exertional and/or emotional triggers. Such algorithms will be crucial to identify treatment targets to modify the risk associated with mental stress-associated ischemia and adverse prognosis.
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Affiliation(s)
- Judith L Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Samit Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven Pfau
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
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Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. Cardiovascular Imaging of Biology and Emotion: Considerations Toward a New Paradigm. Circ Cardiovasc Imaging 2020; 13:e011054. [PMID: 32762255 DOI: 10.1161/circimaging.120.011054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central activation in response to emotion and cognitive stress induces perturbations in the heart and the peripheral vasculature that differ in physiology and clinical manifestations when compared with exercise-induced changes. While our conventional framework of epicardial coronary artery disease is foundational in cardiology, an expanded paradigm is required to address the cardiovascular response to mental stress (MS) and its associated risks, thus addressing the intersection of the patient's ecological and psychosocial experience with cardiovascular biology. To advance the field of MS in cardiovascular health, certain core challenges must be addressed. These include differences in the trigger activation between exercise and emotion, identification and interpretation of imaging cues as measures of pathophysiologic changes, characterization of the vascular response, and identification of central and peripheral treatment targets. Sex and psychosocial determinants of health are important in understanding the emerging overlap of MS-induced myocardial ischemia with microvascular dysfunction and symptoms in the absence of obstructive disease. In overcoming these critical knowledge gaps, integration of the field of MS will require implementation studies to guide use of MS testing, to support diagnosis of MS induced cardiac and vascular pathophysiology, to assess prognosis, and understand the role of endotying to direct therapy.
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Affiliation(s)
- Judith L Meadows
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Samit Shah
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Matthew M Burg
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Steven Pfau
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
| | - Robert Soufer
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.).,VA Connecticut Healthcare System, West Haven, CT (J.L.M., S.S., M.M.B., S.P., R.S.)
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7
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Greaney JL, Koffer RE, Saunders EFH, Almeida DM, Alexander LM. Self-Reported Everyday Psychosocial Stressors Are Associated With Greater Impairments in Endothelial Function in Young Adults With Major Depressive Disorder. J Am Heart Assoc 2020; 8:e010825. [PMID: 30741602 PMCID: PMC6405663 DOI: 10.1161/jaha.118.010825] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Despite the epidemiological associations between psychological stress, depression, and increased cardiovascular disease risk, no studies have examined the relation between naturally occurring psychosocial stressors and directly measured microvascular function in adults with major depressive disorder (MDD). We tested the hypothesis that young adults with MDD exposed to everyday psychosocial stressors would exhibit more severe impairments in endothelium‐dependent dilation (EDD) compared with: (1) healthy nondepressed adults (HCs); and (2) adults with MDD without acute psychosocial stress exposure. Methods and Results Twenty HCs (22±1 years) and 23 otherwise healthy adults with MDD (20±0.3 years) participated in the study. Participants completed a psychosocial experiences survey to document their exposure to any of 6 stressors over the preceding 24 hours (eg, arguments, work stressors). Red cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of acetylcholine (10−10 to 10−1mol/L). EDD was expressed as a percentage of maximum vascular conductance (flux/mm Hg). Multiple linear regression was used to determine the associations between stress, EDD, and MDD. Adults with MDD reported a greater number and severity of psychosocial stressors compared with HCs (all P<0.05). EDD was blunted in adults with MDD (HCs: 91±2 versus MDD: 74±3%; P<0.001). Exposure to any stressor was related to more severe impairments in EDD in patients with MDD (no stressor: 81±3 versus 1+ stressors: 69±5%; P=0.04) but not in HCs (P=0.48). Conclusions These data indicate that exposure to everyday psychosocial stressors is associated with greater impairments in endothelial function in patients with MDD, suggesting a potential mechanistic link between daily stress and depression in increased cardiovascular risk.
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Affiliation(s)
- Jody L Greaney
- 1 Noll Laboratory Department of Kinesiology The Pennsylvania State University State College PA
| | - Rachel E Koffer
- 2 Department of Human Development and Family Studies The Pennsylvania State University State College PA
| | | | - David M Almeida
- 2 Department of Human Development and Family Studies The Pennsylvania State University State College PA
| | - Lacy M Alexander
- 1 Noll Laboratory Department of Kinesiology The Pennsylvania State University State College PA
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Chahal HS, Gelaye B, Mostofsky E, Salazar MS, Sanchez SE, Ananth CV, Williams MA. Relation of outbursts of anger and the acute risk of placental abruption: A case-crossover study. Paediatr Perinat Epidemiol 2019; 33:405-411. [PMID: 31642555 PMCID: PMC6823109 DOI: 10.1111/ppe.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roughly, a fourth of all placental abruption cases have an acute aetiologic underpinning, but the causes of acute abruption are poorly understood. Studies indicate that symptoms of stress, depression, and anxiety during pregnancy may be associated with a higher risk of abruption. OBJECTIVE We examined the rate of abruption in the 2 hours immediately following outbursts of anger. METHODS In a multicentre case-crossover study, we interviewed 663 women diagnosed with placental abruption admitted to one of the seven Peruvian hospitals between January 2013 and August 2015. We asked women about outbursts of anger before symptom onset and compared this with their usual frequency of anger during the week before abruption. RESULTS The rate of abruption was 2.83-fold (95% confidence interval [CI] 1.85, 4.33) higher in the 2 hours following an outburst of anger compared with other times. The rate ratio (RR) was lower for women who completed technical school or university (RR 1.38, 95% CI 0.52, 3.69) compared to women with secondary school education or less (RR 3.73, 95% CI 2.32, 5.99, P-homogeneity = .07). There was no evidence that the association between anger episodes and abruption varied by hypertensive disorders of pregnancy (ie preeclampsia/ eclampsia) or antepartum depressive symptoms. CONCLUSION There was a higher rate of abruption in the 2 hours following outbursts of anger compared with other times, providing potential clues to the aetiologic mechanisms of abruption of acute onset.
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Affiliation(s)
- Harpreet S. Chahal
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Mississauga Academy of Medicine, University of Toronto Mississauga, Mississauga, Canada
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Mostofsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Manuel S. Salazar
- Universidad Nacional Mayor de San Marcos, Departamento de Gineco Obstetricia, Lima, Peru
| | - Sixto E. Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina, Lima, Peru,Asociación Civil Proyectos en Salud, Lima, Peru
| | - Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Subchronic stress effects on vascular reactivity in C57BL/6 strain mice. Physiol Behav 2019; 204:283-289. [PMID: 30862478 DOI: 10.1016/j.physbeh.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS There is a close relationship between psychosocial stress and the development of cardiovascular diseases. It has been reported that there are different alterations in endothelial function in this relationship. However, results obtained in different experimental stress models are controversial. Herein, we studied the effects of subchronic stress induced by movement restraint on several cardiovascular responses and plasma corticosterone concentration in male adult mice. METHODS Experiments were performed in adult male mice of C57BL/6 strain. Animals were allocated into three groups: Control group A, without manipulation; Control group B, with manipulation (quantitation of blood pressure); and Experimental group, with quantitation of blood pressure and exposure to movement restraint. In vivo, heart rate and blood pressure were registered. In vitro, in aortic rings, vascular reactivity was analyzed. Additionally, plasma corticosterone concentration was quantified. RESULTS In vivo, subchronic stress did not produce changes on heart rate either on blood pressure. In vitro, aortic rings with and without endothelium from control group B and experimental group showed: 1) a significant decrease in the maximal tension developed in response to phenylephrine; 2) this decrease was reverted by L-NAME. However, aortic rings from all groups, developed the same tension in response to high K+ solution. In aortic rings from animals of the experimental group, an increase in the maximal relaxation induced by carbachol was observed. This relaxation was prevented and/or reversed by L-NAME. Plasma corticosterone concentration was higher in the experimental group than that in the control group A. CONCLUSIONS Exposition to subchronic movement restraint did not produce alterations in neurovegetative responses in this strain mice. But according to vasomotor responses observed, the results suggest that this subchronic stress model induces an increase in the synthesis/release of nitric oxide, both from endothelial cells and vascular smooth muscle. In accordance with the aforementioned results, we propose that C57BL/6 mice strain is sensitive to subchronic movement restraint stress model.
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Chen H, Zhang B, Xue W, Li J, Li Y, Fu K, Chen X, Sun M, Shi H, Tian L, Teng W. Anger, hostility and risk of stroke: a meta-analysis of cohort studies. J Neurol 2019; 266:1016-1026. [PMID: 30756170 DOI: 10.1007/s00415-019-09231-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A growing number of studies have been conducted on the relationship between anger and hostility and the risk of stroke, and their conclusions are not consistent. Accordingly, we performed a meta-analysis to evaluate the relationship between anger and hostility and the risk of stroke. METHODS We searched the PubMed and Embase databases for cohort studies, focusing on the relationship between anger and hostility and risk of stroke. Then studies were selected according to the inclusion and exclusion criteria. Study results were pooled using a random effects model. RESULTS Ten studies from seven articles involving 52,277 participants were included in this meta-analysis. No significant association was found between anger and hostility level and risk of stroke (hazard ratio 1.08; 95% confidence interval 0.79-1.47). However, a positive association was seen when people with high socioeconomic status were excluded (hazard ratio 1.30; 95% confidence interval 1.06-1.59). CONCLUSION A higher level of anger and hostility is not associated with elevated risk of stroke. However, the association is positive among people with lower socioeconomic status.
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Affiliation(s)
- Hanze Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Beidi Zhang
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Weishuang Xue
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jinwei Li
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yuru Li
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Kailei Fu
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinxin Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Miao Sun
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Han Shi
- Clinical Department One, China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital, China Medical University, Shenyang, China.
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China.
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Sun T, Widmer RJ, Matsuzawa Y, Lennon RJ, Park KH, Lerman LO, Lerman A. Pain-induced peripheral artery tonometry scores in the control arm are impaired in patients with apical ballooning syndrome. Medicine (Baltimore) 2019; 98:e13841. [PMID: 30608400 PMCID: PMC6344204 DOI: 10.1097/md.0000000000013841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mental and physical stress is thought to play an important causative factor in apical ballooning syndrome (ABS) likely secondary to the vasomotor dysfunction. However, there are currently few data related to the impact of physical stress in this unique cardiomyopathy.A total 18 patients, including 8 females with history of ABS and 10 post-menopausal controls, underwent physical and mental tests. Assessments included the pain-induced peripheral artery tonometry scores (PIPATs) and mental stress peripheral artery tonometry scores (PATs).Compared with control group, PIPATs were significantly attenuated in patients with ABS in both baseline and post-mental stress (0.94 ± 0.08 vs1.30 ± 0.54, P <.05 and 0.87 ± 0.19 vs1.24 ± 0.21 P = .01, respectively); mental stress PATs were significantly lower in patients with ABS, both in Stroop test (0.79 ± 0.30 vs 1.24 ± 0.43, P = .01) and arithmetic test (0.91 ± 0.27 vs 1.36 ± 0.57, P = .01). PIPATs correlated significantly with mental stress PATs, both in arithmetic and Stroop test (P <.05).The PIPATs were attenuated in female with history of ABS and the vascular response to pain may provide a different pathogenesis mechanism on detecting patients with ABS.
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Affiliation(s)
- Tao Sun
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Division of Cardiology, Anzhen Hospital Capital Medical University, Beijing, China
| | - R. Jay Widmer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Kyoung H. Park
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Yoshikawa Y, Ohmaki E, Kawahata H, Maekawa Y, Ogihara T, Morishita R, Aoki M. Beneficial effect of laughter therapy on physiological and psychological function in elders. Nurs Open 2019; 6:93-99. [PMID: 30534398 PMCID: PMC6279721 DOI: 10.1002/nop2.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022] Open
Abstract
AIM In the present study we investigated the effect of laughter therapy on physiological and psychological function in older people. DESIGN An open-label trial. METHODS Seventeen older people who regularly attended an elderly day care centre were recruited. Stand-up comedy as laughter therapy was performed once a week for 4 weeks. Parameters of physiological and psychological function were evaluated before and after laughter therapy. RESULTS Laughter therapy intervention resulted in a significant reduction in systolic blood pressure and heart rate, accompanied by a significant increase in plasma concentration of serotonin and a significant decrease in salivary concentration of chromogranin A. Questionnaire surveys of SF-8, GDS-15, and Vitality Index demonstrated alleviation of depression and improvement of sociability and activity in older people. Laughter therapy could be expected to become a practical treatment to improve quality of life of older people in an elderly day care centre.
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Affiliation(s)
- Yuki Yoshikawa
- Graduate School of Health SciencesMorinomiya University of Medical SciencesSuminoe‐kuJapan
- Present address:
Faculty of NursingSetsunan UniversityHirakata CityJapan
| | - Etsuko Ohmaki
- Graduate School of Health SciencesMorinomiya University of Medical SciencesSuminoe‐kuJapan
| | - Hirohisa Kawahata
- Graduate School of Health SciencesMorinomiya University of Medical SciencesSuminoe‐kuJapan
| | - Yoshihiro Maekawa
- Graduate School of Health SciencesMorinomiya University of Medical SciencesSuminoe‐kuJapan
| | - Toshio Ogihara
- Graduate School of Health SciencesMorinomiya University of Medical SciencesSuminoe‐kuJapan
| | - Ryuichi Morishita
- Department of Clinical Gene Therapy, Graduate School of MedicineOsaka UniversitySuitaJapan
| | - Motokuni Aoki
- Graduate School of Health SciencesMorinomiya University of Medical SciencesSuminoe‐kuJapan
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Spicer J, Shimbo D, Johnston N, Harlapur M, Purdie-Vaughns V, Cook J, Fu J, Burg MM, Wager TD. Prevention of Stress-Provoked Endothelial Injury by Values Affirmation: a Proof of Principle Study. Ann Behav Med 2018; 50:471-9. [PMID: 26608279 DOI: 10.1007/s12160-015-9756-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Julie Spicer
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, NY, USA
| | - Natalie Johnston
- Department of Psychology, Columbia University, New York, NY, USA
| | | | | | - Jonathan Cook
- Department of Psychology, Columbia University, New York, NY, USA
| | - Jie Fu
- Department of Medicine, Columbia University, New York, NY, USA
| | - Matthew M Burg
- Department of Medicine, Columbia University, New York, NY, USA
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado, 345 UCB, Boulder, CO, 80305, USA.
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Golbidi S, Li H, Laher I. Oxidative Stress: A Unifying Mechanism for Cell Damage Induced by Noise, (Water-Pipe) Smoking, and Emotional Stress-Therapeutic Strategies Targeting Redox Imbalance. Antioxid Redox Signal 2018; 28:741-759. [PMID: 29212347 DOI: 10.1089/ars.2017.7257] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SIGNIFICANCE Modern technologies have eased our lives but these conveniences can impact our lifestyles in destructive ways. Noise pollution, mental stresses, and smoking (as a stress-relieving solution) are some environmental hazards that affect our well-being and healthcare budgets. Scrutinizing their pathophysiology could lead to solutions to reduce their harmful effects. Recent Advances: Oxidative stress plays an important role in initiating local and systemic inflammation after noise pollution, mental stress, and smoking. Lipid peroxidation and release of lysolipid by-products, disturbance in activation and function of nuclear factor erythroid 2-related factor 2 (Nrf2), induction of stress hormones and their secondary effects on intracellular kinases, and dysregulation of intracellular Ca2+ can all potentially trigger other vicious cycles. Recent clinical data suggest that boosting the antioxidant system through nonpharmacological measures, for example, lifestyle changes that include exercise have benefits that cannot easily be achieved with pharmacological interventions alone. CRITICAL ISSUES Indiscriminate manipulation of the cellular redox network could lead to a new series of ailments. An ideal approach requires meticulous scrutiny of redox balance mechanisms for individual pathologies so as to create new treatment strategies that target key pathways while minimizing side effects. FUTURE DIRECTIONS Extrapolating our understanding of redox balance to other debilitating conditions such as diabetes and the metabolic syndrome could potentially lead to devising a unifying therapeutic strategy. Antioxid. Redox Signal. 28, 741-759.
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Affiliation(s)
- Saeid Golbidi
- 1 Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia , Vancouver, Canada
| | - Huige Li
- 2 Department of Pharmacology, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Ismail Laher
- 1 Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia , Vancouver, Canada
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Mehta PK, Hermel M, Nelson MD, Cook-Wiens G, Martin EA, Alkhoder AA, Wei J, Minissian M, Shufelt CL, Marpuri S, Hermel D, Shah A, Irwin MR, Krantz DS, Lerman A, Noel Bairey Merz C. Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction: Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study. Int J Cardiol 2018; 251:8-13. [PMID: 29103858 PMCID: PMC5870901 DOI: 10.1016/j.ijcard.2017.10.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/26/2017] [Accepted: 10/17/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. METHODS 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. RESULTS Mean age of CVaD and control groups was 58±9 and 55±10years (p=0.73). Baseline RHI correlated with coronary endothelial function (r=0.36, p=0.03) and inversely with RHI change post-MST (r=-0.51, p<0.001). During MST, 10% of controls reported chest pain vs. 41% of CVaD subjects (p=0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p=0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r=-3.4, p=0.03), frustration (r=-0.37, p=0.02), and feeling challenged (r=-0.37, p=0.02) in CVaD but not controls. CONCLUSIONS Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.
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Affiliation(s)
- Puja K Mehta
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States.
| | - Melody Hermel
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Michael D Nelson
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Galen Cook-Wiens
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Elizabeth A Martin
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Ayman A Alkhoder
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Margo Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Sailaja Marpuri
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - David Hermel
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, David Geffen SOM at UCLA, United States
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, United States
| | - Amir Lerman
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
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Saarenhovi M, Salo P, Scheinin M, Lehto J, Lovró Z, Tiihonen K, Lehtinen MJ, Junnila J, Hasselwander O, Tarpila A, Raitakari OT. The effect of an apple polyphenol extract rich in epicatechin and flavan-3-ol oligomers on brachial artery flow-mediated vasodilatory function in volunteers with elevated blood pressure. Nutr J 2017; 16:73. [PMID: 29078780 PMCID: PMC5660451 DOI: 10.1186/s12937-017-0291-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/27/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The primary aim of this study was to test the hypothesis that an orally ingested apple polyphenol extract rich in epicatechin and flavan-3-ol oligomers improves endothelium-dependent brachial artery flow-mediated vasodilatation (FMD) in volunteers with borderline hypertension. The secondary aim of the study was to test whether the investigational product would improve endothelium-independent nitrate-mediated vasodilatation (NMD). METHODS This was a single centre, repeated-dose, double-blind, placebo-controlled, crossover study in 60 otherwise healthy subjects (26 men, 34 women; aged 40-65 years) with borderline hypertension (blood pressure 130-139/85-89 mmHg) or unmedicated mild hypertension (blood pressure 140-165/90-95 mmHg). The subjects were randomised to receive placebo or the apple polyphenol extract to provide a daily dose of 100 mg epicatechin for 4 weeks, followed by a four to five-week wash-out period, and then 4 weeks intake of the product that they did not receive during the first treatment period. FMD and NMD of the left brachial artery were investigated with ultrasonography at the start and end of both treatment periods, and the per cent increase of the arterial diameter (FMD% and NMD%) was calculated. RESULTS With the apple extract treatment, a significant acute improvement was detected in the mean change of maximum FMD% at the first visit 1.16 (p = 0.04, 95% CI: 0.04; 2.28), last visit 1.37 (p = 0.02, 95% CI: 0.22; 2.52) and for both visits combined 1.29 (p < 0.01, 95% CI: 0.40; 2.18). However, such improvement was not statistically significant when apple extract was compared with placebo. The overall long-term effect of apple extract on FMD% was not different from placebo. No statistically significant differences between the apple extract and placebo treatments were observed for endothelium-independent NMD. CONCLUSIONS A significant acute improvement in maximum FMD% with apple extract administration was found. However, superiority of apple extract over placebo was not statistically significant in our study subjects with borderline hypertension or mild hypertension. The study raised no safety concerns regarding the daily administration of an apple polyphenol extract rich in epicatechin. TRIAL REGISTRATION The trial is registered at http://clinicaltrials.gov (identifier: NCT01690676 ). Registered 25th May 2012.
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Affiliation(s)
- Maria Saarenhovi
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. .,Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, P.O. Box 52, FI-20521, Turku, Finland.
| | - Pia Salo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Mika Scheinin
- Clinical Research Services Turku (CRST), University of Turku, and Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Jussi Lehto
- Clinical Research Services Turku (CRST), University of Turku, and Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Zsófia Lovró
- Clinical Research Services Turku (CRST), University of Turku, and Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | | | | | | | | | | | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, P.O. Box 52, FI-20521, Turku, Finland
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Luo R, Shen J, Zhou Q, Liu Y, Li G. Evaluation of the brachial artery endothelial function in chronic alcohol consumption among males by high-frequency ultrasonography. Echocardiography 2016; 34:226-231. [PMID: 28032358 DOI: 10.1111/echo.13432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE There is evidence suggesting that different volumes of chronic alcohol consumption have different effects on the endothelium. Therefore, using high-frequency ultrasonography, we evaluate the effects of the different volume and duration of alcohol intake on brachial artery endothelial function in chronic drinkers. METHODS Ninety-two male chronic episodic alcoholics were grouped by alcohol intake amount and duration: mild (group B, n=30); ≤90 mg ethanol daily, 3-5 days/wk for 5-8 years; moderate (group C, n=30); 90-150 mg ethanol daily, 3-5 days/wk for 9-20 years; and severe (group D, n=32); ≥150 mg ethanol daily, 6-7 days/wk for more than 10 years. Thirty male nondrinkers were recruited as the control group A. High-frequency ultrasonography was used to measure brachial artery diameter during rest, during reactive hyperemia and following the administration of nitroglycerin. Endothelial-dependent brachial artery flow-mediated dilatation (FMD) and endothelial-independent brachial artery nitrate-mediated dilatation (NMD) were calculated. RESULTS Flow-mediated dilatation values for group C and D were significantly lower than those for group A and B (VC =7.63±0.22, VD =5.85±0.23 vs VA =13.35±0.35, VB =12.81±0.36, P<.01). The FMD of group D was significantly lower than that of group C (P<.01). Meanwhile, the NMD of group D was significantly lower than that of the other groups (VD =17.33±6.21 vs VA =25.35±7.42, VB =24.52±8.30, VC =23.35±7.27, P<.01). CONCLUSIONS Chronic moderate-to-heavy alcohol consumption caused endothelial dysfunction, even damaging vascular smooth muscle cells in cases of heavy alcohol consumption, while abstinence and chronic mild alcoholics caused no effect on endothelial function.
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Affiliation(s)
- Runlan Luo
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiaqi Shen
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiao Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yue Liu
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guangsen Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Pieterse C, Schutte R, Schutte AE. Leptin relates to prolonged cardiovascular recovery after acute stress in Africans: The SABPA study. Nutr Metab Cardiovasc Dis 2016; 26:45-52. [PMID: 26645796 DOI: 10.1016/j.numecd.2015.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/29/2015] [Accepted: 10/27/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Heightened cardiovascular reactivity and delayed recovery to stress are associated with an increased risk of cardiovascular disease. Africans, who are more prone to develop hypertension, show greater cardiovascular reactivity to stress. However, causal factors underlying individual and ethnic differences in stress reactivity and recovery remain largely unexplored. Leptin, which is known for its sympatho-activating effects, is higher in Africans compared to Caucasians for any given body mass index. We compared how cardiovascular reactivity and recovery relate to leptin in African (n = 200) and Caucasian (n = 209) teachers. METHODS AND RESULTS We measured leptin in serum and cardiovascular baseline and reactivity continuously with the Finometer device during the cold pressor test for 1 min, and recovery at intervals of 1, 3 and 5 min. Africans had higher body mass index, leptin and blood pressure (all P < 0.001). After full adjustment in multiple regression analyses, associations were seen mainly at the 5 min recovery interval. In Africans, cardiac output reactivity (β = -0.335; P = 0.0018) and arterial compliance- (β = -0.241; P = 0.048) associated negatively and total peripheral resistance- (β = 0.227; P = 0.047) positively with leptin. In Caucasians, diastolic blood pressure correlated positively with leptin (β = 0.200; P = 0.015). CONCLUSION In Africans, higher circulating leptin levels associated with prolonged cardiovascular recovery after exposure to stress which could explain their increased vulnerability to hypertension development.
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Affiliation(s)
- C Pieterse
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Karraker A, Schoeni RF, Cornman JC. Psychological and cognitive determinants of mortality: Evidence from a nationally representative sample followed over thirty-five years. Soc Sci Med 2015; 144:69-78. [PMID: 26397865 DOI: 10.1016/j.socscimed.2015.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
Growing evidence suggests that psychological factors, such as conscientiousness and anger, as well as cognitive ability are related to mortality. Less is known about 1) the relative importance of each of these factors in predicting mortality, 2) through what social, economic, and behavioral mechanisms these factors influence mortality, and 3) how these processes unfold over long periods of time in nationally-representative samples. We use 35 years (1972-2007) of data from men (ages 20-40) in the Panel Study of Income Dynamics (PSID), a nationally representative sample in the United States, and discrete time event history analysis (n = 27,373 person-years) to examine the importance of measures of follow-through (a dimension of conscientiousness), anger, and cognitive ability in predicting mortality. We also assess the extent to which income, marriage, and smoking explain the relationship between psychological and cognitive factors with mortality. We find that while follow-through, anger, and cognitive ability are all associated with subsequent mortality when modeled separately, when they are modeled together and baseline demographic characteristics are controlled, only anger remains associated with mortality: being in the top quartile for anger is associated with a 1.57 fold increase in the risk of dying at follow-up compared with those in the bottom quartile. This relationship is robust to the inclusion of income, marriage, and smoking as mediators.
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Affiliation(s)
- Amelia Karraker
- Human Development and Family Studies, Iowa State University, USA.
| | - Robert F Schoeni
- Institute for Social Research, Ford School of Public Policy, and Department of Economics, University of Michigan, USA
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Golbidi S, Frisbee JC, Laher I. Chronic stress impacts the cardiovascular system: animal models and clinical outcomes. Am J Physiol Heart Circ Physiol 2015; 308:H1476-98. [DOI: 10.1152/ajpheart.00859.2014] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/03/2015] [Indexed: 01/01/2023]
Abstract
Psychological stresses are associated with cardiovascular diseases to the extent that cardiovascular diseases are among the most important group of psychosomatic diseases. The longstanding association between stress and cardiovascular disease exists despite a large ambiguity about the underlying mechanisms. An array of possibilities have been proposed including overactivity of the autonomic nervous system and humoral changes, which then converge on endothelial dysfunction that initiates unwanted cardiovascular consequences. We review some of the features of the two most important stress-activated systems, i.e., the humoral and nervous systems, and focus on alterations in endothelial function that could ensue as a result of these changes. Cardiac and hematologic consequences of stress are also addressed briefly. It is likely that activation of the inflammatory cascade in association with oxidative imbalance represents key pathophysiological components of stress-induced cardiovascular changes. We also review some of the commonly used animal models of stress and discuss the cardiovascular outcomes reported in these models of stress. The unique ability of animals for adaptation under stressful conditions lessens the extrapolation of laboratory findings to conditions of human stress. An animal model of unpredictable chronic stress, which applies various stress modules in a random fashion, might be a useful solution to this predicament. The use of stress markers as indicators of stress intensity is also discussed in various models of animal stress and in clinical studies.
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Affiliation(s)
- Saeid Golbidi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; and
| | - Jefferson C. Frisbee
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Ismail Laher
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; and
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Yao X, Wu B, Xu Y, Siwila-Sackman E, Selim M. Day-Night Variability of Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage. J Biol Rhythms 2015; 30:242-50. [PMID: 25994102 DOI: 10.1177/0748730415581489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The levels of several coagulation factors, able to influence hemostatic balance, display circadian variations. We hypothesized that the onset and extent of hematoma expansion (HE) following intracerebral hemorrhage (ICH) also display diurnal patterns. We reviewed clinical, laboratory, and radiological data from 111 consecutive patients with spontaneous ICH who had baseline head computed tomography (CT) scans within 3 h of ICH onset and follow-up CT during the following 72 h. We defined any HE (AHE) as any increase in hematoma volume from baseline to follow-up CT and significant HE (SHE) as an absolute increase in hematoma volume >6 mL or relative increase >33%. We categorized the patients into 2 groups based on the timing of the initial CT scans—day group (from 0800 to 2000 h) and night group (from 2000 to 0800 h)—and performed logistic regression analyses. We also analyzed the differences in the rates of HE between the groups during six 4-h periods spanning 24 h, using χ2 tests. We found that the rates of AHE and SHE were higher in the day versus night group (75% vs. 48%; p = 0.009 for AHE and 47.6% vs. 25.9%; p = 0.047 for SHE). On multivariable logistic regression, day group assignment was independently associated with AHE (adjusted odds ratio = 3.53; p = 0.008) but not with SHE. Both AHE and SHE peaked in the early afternoon (1200-1600 h) and reached a nadir during the 2000 to 2400 h time period, and they were significantly different between the time periods (0000-0400, 0400-0800, 0800-1200, 1200-1600, 1600-2000, and 2000-2400 h); p = 0.002 and 0.029, respectively. These exploratory findings support the presence of a daily pattern in the occurrence of HE, with a higher risk during the day hours. Our results could have implications for future therapeutic efforts targeting HE in ICH and for the triage of ICH patients. They require further validation.
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Affiliation(s)
- Xiaoying Yao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bo Wu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ye Xu
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Erica Siwila-Sackman
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Jiang W, Boyle SH, Ortel TL, Samad Z, Velazquez EJ, Harrison RW, Wilson J, Kuhn C, Williams RB, O’Connor CM, Becker RC. Platelet aggregation and mental stress induced myocardial ischemia: Results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J 2015; 169:496-507.e1. [PMID: 25819856 PMCID: PMC4382806 DOI: 10.1016/j.ahj.2014.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/15/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is common in patients with ischemic heart disease (IHD) and associated with a poorer cardiovascular prognosis. Platelet hyperactivity is an important factor in acute coronary syndrome. This study examined associations between MSIMI and resting and mental stress-induced platelet activity. METHODS Eligible patients with clinically stable IHD underwent a battery of 3 mental stress tests during the recruitment phase of REMIT study. MSIMI was assessed by echocardiography and electrocardiography. Ex vivo platelet aggregation in response to ADP, epinephrine, collagen, serotonin, and combinations of serotonin plus ADP, epinephrine, and collagen were evaluated as was platelet serotonin transporter expression. RESULTS Of the 270 participants who completed mental stress testing, and had both resting and post-stress platelet aggregation evaluation , 43.33% (n=117) met criteria for MSIMI and 18.15% (n=49) had normal left ventricular response to stress (NLVR). The MSIMI group, relative to the NLVR groups, demonstrated heightened mental stress-induced aggregation responses, as measured by area under the curve, to collagen 10μM (6.95[5.54] vs. -14.23[8.75].; P=0.045), epinephrine 10μM (12.84[4.84] vs. -6.40[7.61].; P=0.037) and to serotonin 10 μM plus ADP 1 μM (6.64[5.29] vs. -27.34[8.34]; P<.001). The resting platelet aggregation and serotonin transporter expression, however, were not different between the two groups. CONCLUSIONS These findings suggest that the dynamic change of platelet aggregation caused by mental stress may underlie MSIMI. While the importance of these findings requires additional investigation, they raise concern given the recognized relationship between mental stress-induced platelet hyperactivity and cardiovascular events in patients with IHD.
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Xue YT, Tan QW, Li P, Mou SF, Liu SJ, Bao Y, Jiao HC, Su WG. Investigating the role of acute mental stress on endothelial dysfunction: a systematic review and meta-analysis. Clin Res Cardiol 2014; 104:310-9. [PMID: 25391292 DOI: 10.1007/s00392-014-0782-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/21/2014] [Indexed: 12/16/2022]
Abstract
Chronic stress is a known risk factor for both endothelial dysfunction and cardiovascular disease (CVD), but less is known of how acute mental stress affects the vasculature. In this systematic review and meta-analysis, we analyzed the impact of acute mental stress on flow-mediated dilation (FMD), an indicator of endothelial function. We searched the Medline, Cochrane, EMBASE, and ISI Web of Knowledge databases through May 2014, to identify publications in English-language journals. The primary outcome was the change in FMD from baseline to the time of measurement. We also assessed the risk of bias and the heterogeneity of included studies. Our search identified eight prospective studies, which displayed significant heterogeneity. Four studies measured FMD while the subject was performing the task; six measured FMD after the task had been completed. The total number of participants was 164. The pooled results indicate that FMD did not change significantly while the task was being performed (pooled difference in means: -0.853; 95 % confidence interval (CI), -3.926/2.220; P = 0.586); however, FMD measured after the task was completed was significantly less than baseline (pooled difference in means: -2.450; 95 %CI, -3.925/-0.975; P = 0.001). In conclusions, our findings provide evidence that an acute stressful experience has a delayed, negative impact on the function of the endothelium. Repeated exposure to short-term stress may lead to permanent injury of the vasculature. Therefore, assessment of patients' exposure to both repeated acute mental stress and chronic stress may be useful in determining their risk of developing CVD.
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Affiliation(s)
- Yi-Tao Xue
- Department of Cardiology, Shandong University School of Medicine Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42 West Wenhua Road, Jinan, 250011, Shandong Province, China,
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Sararoudi RB, Kheirabadi GR, Kousha M, Toghani F, Hashemi M, Maracy MR. Is there any association of personality traits with vascular endothelial function or systemic inflammation? Adv Biomed Res 2014; 3:210. [PMID: 25371867 PMCID: PMC4219206 DOI: 10.4103/2277-9175.143254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/15/2013] [Indexed: 11/19/2022] Open
Abstract
Background: Evidences showed association of some personality traits with increased risk of cardiovascular diseases, but mediated mechanisms are not entirely described. In this study, we investigated the association of different personality traits with systemic inflammation and endothelial function as probable mediators. Methods: This cross-sectional study was conducted in 2011 on 40-60 years old employees of an industrial company located in Isfahan city (central Iran). Participants were selected through simple random sampling. Personality types were evaluated using the neuroticism-extroversion-openness personality inventory and systemic inflammatory status was determined with high sensitive C-reactive protein (hs-CRP) level. To evaluate endothelial function flow mediated dilation (FMD) were measured. The obtained data were analyzed with univariate correlation and multiple linear regression tests. Results: A total of 254 cases with mean age of 51.4 ± 6.1 years were evaluated. There was no significant relationship between hs-CRP level and FMD with the personality traits in univariate analysis. In multivariate analysis, no association was found between the scores of personality traits and FMD with controlling the factors such as age, body mass index dyslipidemia, hypertension and diabetes. Only there was an inverse association between conscientiousness score and hs-CRP (β = −0.241, P = 0.013). Conclusions: In our population who were the employees of an industrial company, no relationship was found between specific personality trait and endothelial dysfunction. However, we found that the personality trait of responsibility (conscientiousness) is negatively associated with inflammation. Further multi-center studies and also cohort studies are recommended in this regard.
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Affiliation(s)
- Reza Bagherian Sararoudi
- Department of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Reza Kheirabadi
- Department of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Kousha
- Department of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Toghani
- Department of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hashemi
- Department of Internal Medicine, Cardiovascular Disease Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Poitras VJ, Slattery DJ, Gurd BJ, Pyke KE. Evidence that meal fat content does not impact hemodynamic reactivity to or recovery from repeated mental stress tasks. Appl Physiol Nutr Metab 2014; 39:1314-21. [PMID: 25238201 DOI: 10.1139/apnm-2014-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The magnitude (reactivity) and duration (recovery) of hemodynamic stress responses are predictive of cardiovascular risk, and fat intake has been shown to enhance hemodynamic reactivity to psychological stress tasks. The objective of this study was to determine the impact of a high-fat meal (HFM) on the magnitude and stability of hemodynamic stress reactivity and recovery. This was assessed by: (i) the peak changes from baseline to during stress for heart rate (HR); mean, systolic, and diastolic blood pressure; cardiac output; and total peripheral resistance; and (ii) the residual arousal in hemodynamic parameters at 2 points post-stress ("early" and "late" recovery). On different days, 10 healthy males (aged 23.2 ± 3.3 years) consumed either a HFM (54 g fat) or low-fat meal (LFM; 0 g fat) (∼1000 calories each), followed by 4 hourly 10-min stress tasks (mental arithmetic and speech tasks). Pre-stress (baseline) parameters did not differ between HFM and LFM conditions (all P > 0.05). Plasma triglycerides were greater following the HFM versus the LFM (P = 0.023). No reactivity or recovery parameters differed between meals (all P > 0.05). Stress reactivity and recovery parameters were stable over the 4 stress tasks (main effects of time, all P > 0.05), with the exception of HR (P < 0.05). Contrary to previous reports, meal fat content did not impact hemodynamic reactivity to laboratory stressors. These data also provide the first evidence that meal fat content does not impact hemodynamic recovery from repeated mental stress tasks.
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Affiliation(s)
- Veronica J Poitras
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
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Bastrikov OY, Belov VV, Tseilikman VE, Sumerkina VA. Indices of endothelial function and their relationships with psychoemotional factors in practically healthy people. NEUROCHEM J+ 2014. [DOI: 10.1134/s1819712414020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Poitras VJ, Slattery DJ, Levac BM, Fergus S, Gurd BJ, Pyke KE. The combined influence of fat consumption and repeated mental stress on brachial artery flow-mediated dilatation: a preliminary study. Exp Physiol 2014; 99:715-28. [DOI: 10.1113/expphysiol.2013.077131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Veronica J. Poitras
- School of Kinesiology and Health Studies; Queen's University; Kingston Ontario Canada
| | - David J. Slattery
- School of Kinesiology and Health Studies; Queen's University; Kingston Ontario Canada
| | - Brendan M. Levac
- School of Kinesiology and Health Studies; Queen's University; Kingston Ontario Canada
| | - Stevenson Fergus
- School of Kinesiology and Health Studies; Queen's University; Kingston Ontario Canada
| | - Brendon J. Gurd
- School of Kinesiology and Health Studies; Queen's University; Kingston Ontario Canada
| | - Kyra E. Pyke
- School of Kinesiology and Health Studies; Queen's University; Kingston Ontario Canada
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Bujarborua D, Borooah S, Dhillon B. The stress response as a target for treatment of central serous chorioretinopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/17469899.2013.837298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wagner JA, Tennen H, Finan PH, Ghuman N, Burg MM. Self-reported racial discrimination and endothelial reactivity to acute stress in women. Stress Health 2013; 29:214-21. [PMID: 22962001 DOI: 10.1002/smi.2449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 11/10/2022]
Abstract
This study investigated the effect of self-reported racial discrimination on endothelial responses to acute laboratory mental stress among post-menopausal women. One-hundred thirteen women (n = 94 self-identified as White and n = 19 self-identified as racial/ethnic minority), 43% with type 2 diabetes, reported lifetime experiences of racial/ethnic discrimination. Repeated assessments of flow-mediated dilation were performed at baseline, immediately after 5 min of mental arithmetic and at 20-min recovery. Both White and racial/ethnic minority women reported lifetime discrimination, with rates significantly higher among minorities. Self-reported lifetime discrimination was associated with attenuated flow-mediated dilation at recovery. Confounding variables, including clinical characteristics, mood, personality traits, other life stressors and general distress, did not better account for the effect of racial discrimination. Neither race/ethnicity nor diabetes status moderated the effect. The perceived stressfulness of the mental arithmetic was not associated with the endothelial response. In conclusion, self-reported lifetime discrimination is associated with attenuated endothelial recovery from acute mental stress. Elucidating the effects of discrimination and the biological mechanisms through which it affects the vasculature may suggest interventions to improve health.
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Affiliation(s)
- Julie A Wagner
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Mostofsky E, Maclure M, Tofler GH, Muller JE, Mittleman MA. Relation of outbursts of anger and risk of acute myocardial infarction. Am J Cardiol 2013; 112:343-8. [PMID: 23642509 DOI: 10.1016/j.amjcard.2013.03.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/16/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to explore the association between outbursts of anger and acute myocardial infarction (AMI) risk. Outbursts of anger are associated with an abrupt increase in cardiovascular events; however, it remains unknown whether greater levels of anger intensity are associated with greater levels of AMI risk or whether potentially modifiable factors can mitigate the short-term risk of AMI. We conducted a case-crossover analysis of 3,886 participants from the multicenter Determinants of Myocardial Infarction Onset Study, who were interviewed during the index hospitalization for AMI from 1989 to 1996. We compared the observed number and intensity of anger outbursts in the 2 hours preceding AMI symptom onset with its expected frequency according to each patient's control information, defined as the number of anger outbursts in the previous year. Of the 3,886 participants in the Determinants of Myocardial Infarction Onset Study, 1,484 (38%) reported outbursts of anger in the previous year. The incidence rate of AMI onset was elevated 2.43-fold (95% confidence interval 2.01 to 2.90) within 2 hours of an outburst of anger. The association was consistently stronger with increasing anger intensities (p trend <0.001). In conclusion, the risk of experiencing AMI was more than twofold greater after outbursts of anger compared with at other times, and greater intensities of anger were associated with greater relative risks. Compared with nonusers, regular β-blocker users had a lower susceptibility to heart attacks triggered by anger, suggesting that some drugs might lower the risk from each anger episode.
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Paine NJ, Ring C, Bosch JA, McIntyre D, Veldhuijzen van Zanten JJCS. The effect of acute mental stress on limb vasodilation is unrelated to total peripheral resistance. Psychophysiology 2013; 50:680-90. [PMID: 23656692 DOI: 10.1111/psyp.12054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/26/2013] [Indexed: 01/01/2023]
Abstract
Mental stress can trigger myocardial infarction, with poor vascular responses to stress implicated as a pathway. Vascular stress reactivity can be assessed by different methods, such as total peripheral resistance (TPR) and forearm blood flow (FBF). Little is known about how these vascular assessments are linked. This was examined in two separate studies. Healthy men (Study 1: N = 29, Study 2: N = 23) completed rest and mental arithmetic (Study 1: 8 min, Study 2: 16 min). In both studies, heart rate, mean arterial pressure, and FBF increased in response to stress. In Study 1, no changes in TPR were seen, but Study 2 found stress-induced increases in TPR. FBF was not linked to TPR at any time (all ps > .05). It appears that limb vasculature and TPR responses to stress do not give the same information about impairments of the vasculature. These findings are relevant to the interpretation of prior research findings and the design of future studies on stress and vascular responses.
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Affiliation(s)
- Nicola J Paine
- School of Sport and Exercise Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK, B15 2TT.
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Szijgyarto IC, King TJ, Ku J, Poitras VJ, Gurd BJ, Pyke KE. The impact of acute mental stress on brachial artery flow-mediated dilation differs when shear stress is elevated by reactive hyperemia versus handgrip exercise. Appl Physiol Nutr Metab 2013; 38:498-506. [DOI: 10.1139/apnm-2012-0328] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute mental stress can impair brachial artery (BA) flow-mediated dilation (FMD) in response to reactive hyperemia (RH) induced increases in shear stress. Handgrip exercise (HGEX) is emerging as a useful tool to increase shear stress for FMD assessment; however, the impact of acute mental stress on HGEX-FMD is unknown. The purpose of this study was to determine whether acute mental stress attenuates RH- and HGEX-induced BA-FMD to a similar extent. In 2 counterbalanced visits, 16 healthy males (19–27 years of age) performed RH-FMD or HGEX-FMD tests after a counting control task (prestress FMD) and a speech and arithmetic stress task (poststress FMD). BA diameter and mean blood velocity were assessed with echo and Doppler ultrasound, respectively. Shear stress was estimated using shear rate (SR = BA blood velocity/BA diameter). Mean arterial pressure (MAP), heart rate (HR), and salivary cortisol were used to assess stress reactivity. Results are expressed as mean ± SE. The stress task elevated MAP (Δ24.0 ± 2.6 mm Hg) and HR (Δ15.5 ± 1.9 beats·min–1), but not cortisol (prestress vs. poststress: 4.4 ± 0.7 nmol·L–1 vs. 4.7 ± 0.7 nmol·L–1; p = 0.625). There was no difference between the pre- and poststress SR stimulus for RH (p = 0.115) or HGEX (p = 0.664). RH-FMD decreased from 5.2% ± 0.6% prestress to 4.1% ± 0.5% poststress (p = 0.071); however, stress did not attenuate HGEX-FMD (prestress vs. poststress: 4.1% ± 0.6% vs. 5.3% ± 0.6%; p = 0.154). The pre- to poststress change in FMD was significantly different in the RH-FMD vs. the HGEX-FMD test (–1.1% ± 0.6% vs. +1.1% ± 0.8%; p = 0.015). In conclusion, acute mental stress appears to have a disparate impact on FMD stimulated by RH vs. HGEX induced increases in shear stress.
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Affiliation(s)
- Ingrid C. Szijgyarto
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Trevor J. King
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Jennifer Ku
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Veronica J. Poitras
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Brendon J. Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Kyra E. Pyke
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada
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Poitras VJ, Pyke KE. The impact of acute mental stress on vascular endothelial function: evidence, mechanisms and importance. Int J Psychophysiol 2013; 88:124-35. [PMID: 23562766 DOI: 10.1016/j.ijpsycho.2013.03.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/21/2013] [Accepted: 03/26/2013] [Indexed: 01/23/2023]
Abstract
Cardiovascular disease is a principle cause of morbidity and mortality worldwide, and it has a complex etiology that involves lifestyle factors such as psychosocial stress. Recent evidence suggests that temporary impairments in vascular endothelial cell function may contribute to the relationship between stress and cardiovascular disease. Indeed, impaired endothelial function has been observed to occur transiently (lasting up to 1.5h) following mental stress, and such periods of impairment could accumulate to become clinically relevant over the long term. The finding of acute stress induced endothelial dysfunction is not universal however, and both physiological (e.g. sympathetic nervous system and hypothalamic-pituitary-adrenal axis reactivity), and methodological factors contribute to the conflicting results. A clear understanding of the interaction between stress response activation and endothelial function is critical to elucidating the complexities of the relationship between psychosocial stress and cardiovascular disease. Therefore, the purpose of this review is: 1) to briefly describe the importance of vascular endothelial function and how it is assessed, 2) to review the literature investigating the impact of acute mental stress on endothelial function in humans, identifying factors that may explain contradictory results, and 3) to summarize our current understanding of the mechanisms that may mediate an acute mental stress-endothelial function interaction.
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Affiliation(s)
- Veronica J Poitras
- Queen's University School of Kinesiology and Health Studies, 28 Division St. Kingston, Ontario, Canada
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Finding EJT, Jones ID, Fuentes VL, Menzies-Gow NJ. Evaluation of a technique for measurement of flow-mediated vasodilation in healthy ponies. Am J Vet Res 2012; 73:755-61. [PMID: 22620687 DOI: 10.2460/ajvr.73.6.755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine between-pony and within-pony variations and interobserver and intraobserver agreements of a technique for measurement of flow-mediated vasodilation (FMD) in healthy ponies. ANIMALS 6 healthy pony mares (weight range, 236 to 406 kg; body condition score range, 3/9 to 7/9; age range, 14 to 25 years). PROCEDURES In each pony, the left median artery was occluded with a blood pressure cuff (inflated to > 300 mm Hg for 5 minutes). Two-dimensional ultrasonographic images of the artery were recorded for 30 seconds before cuff inflation and for 2 minutes after cuff deflation. Maximum luminal diameters of arteries were compared with their baseline diameters to calculate FMD (relative percentage increase in luminal size). Images were obtained from 6 ponies 1 time and from 1 pony 6 times. Independent analysis of images was performed by 2 investigators, 1 of whom analyzed images on 2 occasions. RESULTS Mean ± SD FMD in 6 ponies (1 time) was 12.57 ± 4.28% and in 1 pony (6 times) was 7.30 ± 2.11%. Between-pony and within-pony coefficients of variation were 34.09% and 28.84%, respectively. Interobserver agreement was fair (intraclass correlation coefficient, 0.47); intraobserver agreement was poor (intraclass correlation coefficient, 0.30). CONCLUSIONS AND CLINICAL RELEVANCE FMD was identified and measured in ponies. Measurement of FMD is used to assess endothelial function in humans and has been investigated in dogs. Measurement of FMD in ponies appeared to be feasible and could be used to assess endothelial function (to determine predisposition for development of laminitis or cardiovascular diseases).
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Affiliation(s)
- Elizabeth J T Finding
- Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, North Mymms, Hatfield, Hertfordshire, AL9 7TA, England.
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Mental stress-induced ischemia in patients with coronary artery disease: echocardiographic characteristics and relation to exercise-induced ischemia. Psychosom Med 2012; 74:766-72. [PMID: 22923698 DOI: 10.1097/psy.0b013e3182689441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to investigate the incidence and parameters associated with myocardial ischemia during mental stress (MS) as measured by echocardiography and to evaluate the relation between MS-induced and exercise-induced myocardial ischemia. METHODS Study participants were 79 patients (63 men; mean [M] [standard deviation {SD}] age = 52 [8] years) with angiographically confirmed coronary artery disease and previous positive exercise test result. The MS protocol consisted of mental arithmetic and anger recall task. The patients performed a treadmill exercise test 15 to 20 minutes after the MS task. Data of post-MS exercise were compared with previous exercise stress test results. RESULTS The frequency of echocardiographic abnormalities was 35% in response to the mental arithmetic task, compared with 61% with anger recall and 96% with exercise (p < .001, exercise versus MS). Electrocardiogram abnormalities and chest pain were substantially less common during MS than were echocardiographic abnormalities. Independent predictors of MS-induced myocardial ischemia were: wall motion score index at rest (p = .02), peak systolic blood pressure (p = .005), and increase in rate-pressure product (p = .004) during MS. The duration of exercise stress test was significantly shorter (p < .001) when MS preceded the exercise and in the case of earlier exercise (M [SD] = 4.4 [1.9] versus 6.7 [2.2] minutes for patients positive on MS and 5.7 [1.9] versus 8.0 [2.3] minutes for patients negative on MS). CONCLUSIONS Echocardiography can be successfully used to document myocardial ischemia induced by MS. MS-induced ischemia was associated with an increase in hemodynamic parameters during MS and worse function of the left ventricle. MS may shorten the duration of subsequent exercise stress testing and can potentiate exercise-induced ischemia in susceptible patients with coronary artery disease.
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Toda N, Nakanishi-Toda M. How mental stress affects endothelial function. Pflugers Arch 2011; 462:779-94. [PMID: 21947555 DOI: 10.1007/s00424-011-1022-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 01/23/2023]
Abstract
Mental stress is an important factor contributing to recognized mechanisms underlying cardiovascular events. Among these, stress-related endothelial dysfunction is an early risk factor that predicts future development of severe cardiovascular disorders. Acute mental stress by a variety of tests impairs endothelial function in humans, although the opposite results have been reported by some investigators. Chronic stress always deteriorates endothelial function in humans and experimental animals. Stress hormones, such as glucocorticoids and pro-inflammatory cytokines, and endothelin-1 liberated in response to mental stress participate in endothelial dysfunction possibly via downregulation of endothelial nitric oxide synthase (eNOS) expression, eNOS inactivation, decreased nitric oxide (NO) actions, and increased NO degradation, together with vasoconstriction counteracting against NO-induced vasodilatation. Catecholamines do not directly affect endothelial function but impair its function when blood pressure elevation by the amines is sustained. Endogenous opioids favorably affect endothelial function, which counteract deteriorating effects of other stress hormones and mediators. Inhibition of cortisol and endothelin-1 production, prevention of pro-inflammatory mediator accumulation, hypnotics, mirthful laughter, humor orientation, and lifestyle modification would contribute to the prevention and treatment for stress-related endothelial dysfunction and future serious cardiovascular disease.
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Affiliation(s)
- Noboru Toda
- Toyama Institute for Cardiovascular Pharmacology Research, 7-13, 1-Chome, Azuchi-machi, Chuo-ku, Osaka 541-0052, Japan.
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Roemmich JN, Feda DM, Seelbinder AM, Lambiase MJ, Kala GK, Dorn J. Stress-induced cardiovascular reactivity and atherogenesis in adolescents. Atherosclerosis 2011; 215:465-70. [PMID: 21296350 PMCID: PMC3072778 DOI: 10.1016/j.atherosclerosis.2010.12.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/11/2010] [Accepted: 12/25/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the association between cardiovascular reactivity to a set of psychological stressors and carotid artery intima-media thickness, a marker of subclinical cardiovascular disease in healthy adolescents. METHODS Participants were 25 boys and 23 girls age 14.2 ± 0.9 years who were measured for heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure reactivity to mirror-tracing, reaction time, speech preparation and ad lib speech tasks and for common carotid artery intima-media thickness. Sequential regression analyses were used to establish the incremental increase in R(2)(R(inc)(2)) for the prediction of intima-media thickness due to cardiovascular reactivity independent of age, BMI percentile, sex, socioeconomic status, and resting HR or BP. RESULTS SBP reactivity while preparing (β=0.0019, R(inc)(2)=0.09) and giving the speech (β=0.0014, R(inc)(2)=0.10) and an aggregate reactivity score based on all 4 tasks (β=0.0026, R(inc)(2)=0.11) independently predicted (p ≤ 0.05) mean carotid artery intima-media thickness. Neither DBP reactivity nor HR reactivity during any task were independent predictors of intima-media thickness. CONCLUSION Stress-induced cardiovascular reactivity, and especially SBP reactivity, is associated with carotid intima-media thickness and the early pathogenesis of cardiovascular disease. The use of an aggregate stress reactivity index provides a more reliable reflection of trait SBP reactivity to psychological stress and increases the confidence that youth with greater cardiovascular stress reactivity may indeed have greater progression of subclinical cardiovascular disease.
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Affiliation(s)
- James N Roemmich
- Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA.
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Endothelial function: the impact of objective and subjective socioeconomic status on flow-mediated dilation. Ann Behav Med 2010; 39:222-31. [PMID: 20376585 PMCID: PMC2908439 DOI: 10.1007/s12160-010-9181-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although objective and subjective indicators of socioeconomic status (SES) are linked to cardiovascular disease (CVD), little is known about their relationship to endothelial dysfunction, which often precedes CVD. PURPOSE This study examined how objective and subjective SES relate to brachial artery flow-mediated dilation (FMD). METHODS FMD was assessed in 72 healthy adults (mean age 36 years). The MacArthur Scale of Subjective Social Status assessed perceived social standing in the USA (SSS-USA) and local community (SSS-Community). Objective SES measures included income and the Hollingshead Two-Factor Index of Social Position (education, occupation). RESULTS Adjusted regressions revealed that SSS-Community positively correlated with FMD (p < 0.05) and explained 8% of the variance. No other SES measures were significant for FMD. The association between FMD and SSS-Community remained significant (p < 0.01) after adjustment for objective SES and other covariates. CONCLUSIONS Lower subjective social status in one's community may be linked to CVD via impaired vasodilation.
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Assessment of endothelial function in patients with fibromyalgia—cardiac ultrasound study. Clin Rheumatol 2010; 30:647-54. [DOI: 10.1007/s10067-010-1599-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/24/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
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Dedert EA, Calhoun PS, Watkins LL, Sherwood A, Beckham JC. Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence. Ann Behav Med 2010; 39:61-78. [PMID: 20174903 DOI: 10.1007/s12160-010-9165-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. PURPOSE The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. METHODS A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. RESULTS The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. CONCLUSIONS Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.
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Affiliation(s)
- Eric A Dedert
- VA Research Service, Department of Psychiatry and Behavioral Sciences, Durham Veterans Affairs and Duke University Medical Centers, Durham, NC, USA.
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Abstract
OBJECTIVE To evaluate the extent to which music may affect endothelial function. In previous research, a link between music and physiologic parameters such as heart rate and blood pressure has been observed. METHODS Randomized four-phase crossover and counterbalanced trial in ten healthy, nonsmoking volunteers (70% male; mean age, 35.6 years) that included self-selections of music evoking joy or provoking anxiety. Two additional phases included watching video clips to induce laughter and listening to audio tapes to promote relaxation. To minimize emotional desensitization, subjects were asked to refrain from using self-selected tapes and images for at least 2 weeks before the assigned study phase. Endothelial function was assessed by brachial artery flow-mediated dilation (FMD) and measured as percent diameter change after an overnight fast. After baseline FMD measurements, subjects were randomized to a 30-minute phase of the testing stimulus followed by poststudy FMD; they returned a minimum of 1 week later for the subsequent task. A total of 160 FMD measurements were obtained. RESULTS Compared with baseline, music that evoked joy was associated with increases in mean upper arm FMD (2.7% absolute increase; p < .001), whereas reductions in FMD were observed after listening to music that elicited anxiety (0.6% absolute decrease; p = .005 difference between joyful and anxiety-provoking music). Self-selected joyful music was associated with increased FMD to a magnitude previously observed with aerobic activity or statin therapy. CONCLUSION Listening to joyful music may be an adjunctive life-style intervention for the promotion of vascular health.
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Chumaeva N, Hintsanen M, Hintsa T, Ravaja N, Juonala M, Raitakari OT, Keltikangas-Järvinen L. Early atherosclerosis and cardiac autonomic responses to mental stress: a population-based study of the moderating influence of impaired endothelial function. BMC Cardiovasc Disord 2010; 10:16. [PMID: 20350311 PMCID: PMC2862016 DOI: 10.1186/1471-2261-10-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 03/29/2010] [Indexed: 12/29/2022] Open
Abstract
Background Acute mental stress may contribute to the cardiovascular disease progression via autonomic nervous system controlled negative effects on the endothelium. The joint effects of stress-induced sympathetic or parasympathetic activity and endothelial function on atherosclerosis development have not been investigated. The present study aims to examine the interactive effect of acute mental stress-induced cardiac reactivity/recovery and endothelial function on the prevalence of carotid atherosclerosis. Methods Participants were 81 healthy young adults aged 24-39 years. Preclinical atherosclerosis was assessed by carotid intima-media thickness (IMT) and endothelial function was measured as flow-mediated dilatation (FMD) using ultrasound techniques. We also measured heart rate, respiratory sinus arrhythmia (RSA), and pre-ejection period (PEP) in response to the mental arithmetic and speech tasks. Results We found a significant interaction of FMD and cardiac RSA recovery for IMT (p = 0.037), and a significant interaction of FMD and PEP recovery for IMT (p = 0.006). Among participants with low FMD, slower PEP recovery was related to higher IMT. Among individuals with high FMD, slow RSA recovery predicted higher IMT. No significant interactions of FMD and cardiac reactivity for IMT were found. Conclusions Cardiac recovery plays a role in atherosclerosis development in persons with high and low FMD. The role of sympathetically mediated cardiac activity seems to be more important in those with impaired FMD, and parasympathetically mediated in those with relatively high FMD. The development of endothelial dysfunction may be one possible mechanism linking slow cardiac recovery and atherosclerosis via autonomic nervous system mediated effect.
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Affiliation(s)
- Nadja Chumaeva
- Institute of Behavioural Sciences, University of Helsinki, PO Box 9, FIN-00014 Helsinki, Finland
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Abstract
OBJECTIVE To examine the impact of mood states on endothelial function, as measured noninvasively by brachial artery flow-mediated dilation (FMD). Substantial literature indicates that negative mood is linked to cardiovascular disease (CVD). However, the mechanisms underlying this relationship are not well defined. CVD is often preceded by dysfunction of the endothelium. METHODS Healthy adults (n = 70; mean age, 36 years) completed the Profile of Mood States (POMS), which contains six subscales (depression/dejection; tension/anxiety; anger/hostility; confusion/bewilderment; fatigue/inertia; vigor/activity) that are used to compute a total mood disturbance score for overall psychological distress. FMD was calculated (maximum percentage change in brachial artery diameter) from ultrasound assessment of arterial diameter at baseline and for 10 minutes after occlusion. RESULTS Regressions showed that increases in POMS total mood disturbance scores were associated with decreases in endothelial function. Mood disturbance explained 10% of the variance in FMD (p < .01), after controlling for age, sex, mean arterial pressure, body mass index, and socially desirable response bias. An exploratory set of separate regressions conducted to decompose the link between FMD and total mood disturbance revealed that the following POMS subscales were inversely correlated with FMD: depression/dejection, tension/anxiety, anger/hostility, fatigue/inertia (p's < .05), and confusion/bewilderment (p < .01). CONCLUSIONS Mood disturbance could contribute to CVD via impaired vasodilation. These preliminary results show that even mild levels of adverse psychological states, particularly depressed, anxious, angry, confused, and fatigued states, might be linked to increased cardiovascular risk.
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Babyak MA, Blumenthal JA, Hinderliter A, Hoffman B, Waugh RA, Coleman RE, Sherwood A. Prognosis after change in left ventricular ejection fraction during mental stress testing in patients with stable coronary artery disease. Am J Cardiol 2010; 105:25-8. [PMID: 20102885 DOI: 10.1016/j.amjcard.2009.08.647] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 08/07/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
Abstract
Previous studies of patients with stable coronary artery disease have demonstrated that decreases in the left ventricular ejection fraction (LVEF) during acute mental stress are predictive of adverse clinical outcomes. The aim of the present study was to examine the prospective relation of mental stress on clinical outcomes in a sample of 138 patients with stable coronary artery disease. Patients underwent mental stress testing and were followed for a median of 5.9 years to assess the occurrence of the combined end point of myocardial infarction or all-cause mortality. There were 32 events (17 nonfatal myocardial infarctions and 15 deaths) over the follow-up period. Of the 26 patients who exhibited myocardial ischemia during mental stress testing, 11 (42%) sustained subsequent clinical events, compared to 21 of the 112 patients (19%) who showed no mental stress-induced ischemia. LVEF change during mental stress was also related to the clinical events in a graded, continuous fashion, with each 4% decrease from the LVEF at rest associated with an adjusted hazard ratio of 1.7, (95% confidence interval 1.1 to 2.6, p = 0.011). In conclusion, reductions in the LVEF during mental stress are prospectively associated with adverse clinical outcomes.
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Abstract
BACKGROUND Trait negative affect has been implicated as a risk marker for cardiovascular disease, but the mechanisms underlying this association are uncertain. PURPOSE Our aim was to examine associations between trait measures of anger, hostility, depression, and anxiety with endothelial dysfunction via brachial artery flow-mediated dilation (FMD), an early indicator of cardiovascular disease. METHOD FMD was examined in 332 healthy older adults. Measures included Beck Anxiety and Depression Inventories, Cook-Medley Hostility Scale, and Spielberger State-Trait Anger Expression Inventory (Anger In, Anger Out, and Trait Anger). RESULTS Mean age was 60.5 +/- 4.8 years; 83% of participants were Caucasian and 49% were female. FMD was greater in women compared to men (6.17% vs. 4.07%, p < 0.001). Women reported significantly greater Anxiety (p < 0.001), and men reported greater Hostility (p = 0.004). In separate multivariable linear regression models controlling for cardiovascular risk factors, plus current hormone therapy for women, smaller FMD was associated with higher Anger In for women (beta = -0.222, p = 0.04) and showed a trend with higher Hostility for men (beta = -0.082, p = 0.09). CONCLUSION Endothelial dysfunction, as indicated by less vasodilatation of the brachial artery, is positively associated with measures of hostility and anger suppression in healthy older adults. Thus, associations between negative affect and cardiovascular health may be apparent early in the disease process.
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Manfredini R, Boari B, Smolensky MH, Salmi R, la Cecilia O, Maria Malagoni A, Haus E, Manfredini F. Circadian Variation in Stroke Onset: Identical Temporal Pattern in Ischemic and Hemorrhagic Events. Chronobiol Int 2009; 22:417-53. [PMID: 16076646 DOI: 10.1081/cbi-200062927] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Stroke is the culmination of a heterogeneous group of cerebrovascular diseases that is manifested as ischemia or hemorrhage of one or more blood vessels of the brain. The occurrence of many acute cardiovascular events--such as myocardial infarction, sudden cardiac death, pulmonary embolism, critical limb ischemia, and aortic aneurysm rupture--exhibits prominent 24 h patterning, with a major morning peak and secondary early evening peak. The incidence of stroke exhibits the same 24 h pattern. Although ischemic and hemorrhagic strokes are different entities and are characterized by different pathophysiological mechanisms, they share an identical double-peak 24 h pattern. A constellation of endogenous circadian rhythms and exogenous cyclic factors are involved. The staging of the circadian rhythms in vascular tone, coagulative balance, and blood pressure plus temporal patterns in posture, physical activity, emotional stress, and medication effects play central and/or triggering roles. Features of the circadian rhythm of blood pressure, in terms of their chronic and acute effects on cerebral vessels, and of coagulation are especially important. Clinical medicine has been most concerned with the prevention of stroke in the morning, when population-based studies show it is of greatest risk during the 24 h; however, improved protection of at-risk patients against stroke in the early evening, the second most vulnerable time of cerebrovascular accidents, has received relatively little attention thus far.
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Affiliation(s)
- Roberto Manfredini
- Vascular Diseases Center, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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Greeson JM, Lewis JG, Achanzar K, Zimmerman E, Young KH, Suarez EC. Stress-induced changes in the expression of monocytic beta2-integrins: the impact of arousal of negative affect and adrenergic responses to the Anger Recall Interview. Brain Behav Immun 2009; 23:251-6. [PMID: 18955128 PMCID: PMC3683970 DOI: 10.1016/j.bbi.2008.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 09/22/2008] [Accepted: 09/30/2008] [Indexed: 01/04/2023] Open
Abstract
Adhesion of circulating monocytes to the vascular endothelium is one of the earliest steps in the development of atherosclerosis. This leukocyte-to-endothelium interaction is mediated in part by beta2-integrins, a group of cell adhesion molecules that bind to endothelial ligands. Given the significance of this interaction to atherogenesis, we examined the effects of stress, operationalized as the arousal of negative affect (NA) and cardiovascular and catecholamine responses to the Anger Recall Interview (ARI), on the expression of LFA-1 (CD11a), Mac-1 (CD11b) and p150/95 (CD11c) on circulating monocytes (CD14+). Subjects were 173 healthy, nonsmoking men and women (60% men, 40% minorities, aged 18-49 year). Arousal of NA, cardiovascular responses (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP]), circulating catecholamines (epinephrine [Epi], norepinephrine [Ne]) and beta2-integrin (CD11/CD18) expression were determined prior to and following the ARI. The principal findings were that the ARI, on average, induced a decrease in monocyte expression of beta2-integrins. However, after adjusting for age, sex, body mass index, exercise status, and baseline level of beta2-integrin expression, those individuals who showed the largest increases in NA, Ne and DBP during the ARI showed an increase in monocyte beta2-integrin expression. Thus, heightened psychological and physiological stress responses induced phenotypic changes in monocytic expression of beta2-integrins that are consistent with the role of monocytes/macrophages in vascular inflammation and increased risk of atherosclerotic cardiovascular disease.
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Affiliation(s)
- Jeffrey M. Greeson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - James G. Lewis
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Karen Achanzar
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Eugene Zimmerman
- Department of Pharmacology, Duke University Medical Center, Durham, NC, USA
| | - Kenneth H. Young
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Edward C. Suarez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA,Corresponding author. Fax: + 919 668 6419. (E.C. Suarez)
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Hostility trait and vascular dilatory functions in healthy Taiwanese. J Behav Med 2008; 31:517-24. [DOI: 10.1007/s10865-008-9177-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 08/29/2008] [Indexed: 11/26/2022]
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Hamer M, Owen G, Kloek J. The role of functional foods in the psychobiology of health and disease. Nutr Res Rev 2007; 18:77-88. [DOI: 10.1079/nrr2005103] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractThe effect of psychological stress on health is becoming a serious concern, with figures from the World Health Organization showing that stress-related disorders affect nearly 450 million individuals worldwide. Heightened physiological stress responses and psychosocial factors have been linked to disease pathways such as hypertension and CVD. This has prompted significant interest within the scientific community, public health bodies and industry to employ interventions to control and reduce the impact of stress on health. There is now strong potential for functional foods to offer stress management benefits. Various physiological pathways have been targeted by specific dietary supplements for stress reduction, including the hypothalamic–pituitary–adrenal axis and sympathetic nervous system. Presently there are a number of ingredients, which include vitamin C, milk proteins, a number of herbal extracts (ginkgo biloba, ginseng, kava, valerian and lemon balm), andn-3 fatty acids, that have demonstrated potential stress reactivity-lowering and mood-enhancing effects, although further work is required to substantiate the efficacy in human subjects. Dietary supplements that can alleviate excessive stress responses may play an increasingly important role for the maintenance of health in a stressful environment. However, future research should employ a greater range of measures that will provide stronger evidence to substantiate functional food claims for stress relief.
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