Acute Psychological Stress as a Precipitant of Acute Coronary Syndromes in Patients With Undiagnosed Ischemic Heart Disease

Zupancic, Melanie

doi:10.4088/pcc.08r00623

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…Atherosclerosis represents one of the key factors of cardiovascular and cerebrovascular diseases: the inflammation-related predominant Th1 response has also been implicated in the pathophysiology of chronic heart failure [ 137 , 138 ] and heart failure after acute myocardial infarction [ 139 ]. The stress-related Th2 predominant response seems to be associated with acute coronary syndromes: acute exogenous or endogenous stress factors can trigger unstable angina, sudden cardiac death and acute myocardial infarction [ 140 , 141 ], condition in which was found, in relation to sympathetic system activation and catecholamines release, an increase of IL-6 [ 142 , 143 ] and IL-10 [ 144 , 145 ]. Th2 polarized response also promotes fibrosis in general, and cardiac fibrosis in particular [ 146 ].…”

Section: Human Chronic Diseases and Th1/th2 Balancementioning

confidence: 99%

Immunomodulation Mechanism of Antidepressants: Interactions between Serotonin/Norepinephrine Balance and Th1/Th2 Balance

Martino

Rocchi

Escelsior

et al. 2012

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Neurotransmitters and hormones regulate major immune functions, including the selection of T helper (Th)1 or Th2 cytokine responses, related to cell-mediated and humoral immunity, respectively. A role of imbalance and dynamic switching of Th1/Th2 system has been proposed, with relative displacement of the immune reserve in relation to complex interaction between Th1/Th2 and neuro-hormonal balance fluctuations, in the pathogenesis of various chronic human diseases, probably also including psychiatric disorders. Components of the stress system such as norepinephrine (NE) and glucocorticoids appear to mediate a Th2 shift, while serotonin (5-HT) and melatonin might mediate a Th1 shift. Some antidepressants would occur affecting these systems, acting on neurotransmitter balance (especially the 5-HT/NE balance) and expression levels of receptor subtypes, which in turn affect cytokine production and relative Th1/Th2 balance. It could be therefore hypothesized that the antidepressant-related increase in NE tone enhances the Th2 response, while the decrease in NE tone or the increase in 5-HT tone enhances the Th1 response. However, the neurotransmitter and Th1/Th2 balance modulation could be relative, aiming to restore physiological levels a previous imbalance in receptor sensitivity and cytokine production. The considerations on neuro-immunomodulation could represent an additional aid in the study of pathophysiology of psychiatric disorders and in the choice of specific antidepressants in specific clusters of symptoms, especially in comorbidity with internal pathologies. Furthermore limited data, reviewed here, have shown the effectiveness of some antidepressants as pure immunomodulators. However, these considerations are tentative and require experimental confirmation or refutation by future studies.

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Section: Human Chronic Diseases and Th1/th2 Balancementioning

confidence: 99%

Immunomodulation Mechanism of Antidepressants: Interactions between Serotonin/Norepinephrine Balance and Th1/Th2 Balance

Martino

Rocchi

Escelsior

et al. 2012

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“…In our investigation, sBDNF levels were measured within 2 weeks of ACS onset. Because ACS is associated with acute psychosocial stress ( 26 ), and the sBDNF level rises in response to acute psychosocial stress ( 27 ), the sBDNF level may not have had an effect on long-term cardiovascular outcomes in ACS patients due to overall elevated sBDNF levels. However, because we did not assess the concentration of sBDNF in relation to numerous CVDs in our study, more research is needed to corroborate this.…”

Section: Discussionmentioning

confidence: 99%

Modifying effect of the serum level of brain-derived neurotrophic factor (BDNF) on the association between BDNF methylation and long-term cardiovascular outcomes in patients with acute coronary syndrome

Choi

Kang

Kim

et al. 2023

Front. Cardiovasc. Med.

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IntroductionThis study investigated the potential modifying effects of the serum brain-derived neurotrophic factor (sBDNF) level on the association between BDNF methylation status and long-term cardiovascular outcomes in acute coronary syndrome (ACS) patients.MethodsFrom 2006 to 2012, hospitalized ACS patients were consecutively recruited. The sBDNF level and BDNF methylation status were assessed at baseline in 969 patients who were followed up for major adverse cardiac events (MACEs) over 5–12 years, until 2017 or death. Cox proportional hazards models were utilized to compare the time to first composite or individual MACEs between individuals with lower and those with higher average BDNF methylation levels in the low and high sBDNF groups, respectively. The modifying effects of the sBDNF and average BDNF methylation levels on first composite and individual MACEs were analyzed using Cox proportional hazards models after adjusting for potential covariates.ResultsIn the low sBDNF group, a higher average BDNF methylation level was linked to an increase in composite MACEs independent of confounding variables, but not in the high sBDNF group [HR (95 percent CI) = 1.04 (0.76–1.44)]. The interaction effect between the sBDNF and average BDNF methylation levels on composite MACEs was significant after adjusting for covariates (P = 0.008).ConclusionCombining the BDNF methylation status and sBDNF levels may help identify ACS patients who are likely to have unfavorable clinical outcomes.

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“…Accelerated platelet aggregation triggered by mental stress is a key element in the underlying pathological process, especially in individuals who are under chronic stress 24–28 . Heightened platelet activation in acute coronary syndrome (ACS) has been well supported in literature and is the reason that Aspirin and other anti-platelet activity agents are used in patients with acute coronary syndrome and other forms of CHD.…”

Section: Discussionmentioning

confidence: 99%

Responses of mental stress–induced myocardial ischemia to escitalopram treatment: Background, design, and method for the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment trial

Jiang

Velázquez

Samad

et al. 2012

American Heart Journal

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Background Mental stress induced myocardial ischemia (MSIMI) is common in patients with clinically stable coronary heart disease (CHD) and is associated with poor outcomes. Depression is a risk factor of MSIMI. The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) trial investigates whether selective serotonin reuptake inhibitor (SSRI) treatment can improve MSIMI. The rationale and outline of the study are described. Method In this single center randomized clinical trial, adult patients with clinically stable CHD are recruited for baseline mental and exercise stress testing assessed by echocardiography. Additionally, psychometric questionnaires are administered and blood samples are collected for platelet activity analysis. Patients who demonstrate MSIMI, defined by new abnormal wall motion, ejection fraction reduction ≥8%, and/or development of ischemic ST change in electrocardiogram during mental stress testing, are randomized at a 1:1 ratio to escitalopram or placebo for 6 weeks. Approximately 120 patients with MSIMI are enrolled in the trial. The stress testing, platelet activity assessment and psychometric questionnaires are repeated at the end of the 6-week intervention. The hypothesis of the study is that SSRI treatment improves MSIMI via mood regulation and modification of platelet activity. Conclusion The REMIT study examines the effect of SSRI on MSIMI in vulnerable CHD patients and probes some potential underlying mechanisms.

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Acute Psychological Stress as a Precipitant of Acute Coronary Syndromes in Patients With Undiagnosed Ischemic Heart Disease

Cited by 5 publications

References 26 publications

Immunomodulation Mechanism of Antidepressants: Interactions between Serotonin/Norepinephrine Balance and Th1/Th2 Balance

Immunomodulation Mechanism of Antidepressants: Interactions between Serotonin/Norepinephrine Balance and Th1/Th2 Balance

Modifying effect of the serum level of brain-derived neurotrophic factor (BDNF) on the association between BDNF methylation and long-term cardiovascular outcomes in patients with acute coronary syndrome

Responses of mental stress–induced myocardial ischemia to escitalopram treatment: Background, design, and method for the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment trial

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