Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease.

Krantz, David S.; Helmers, Karin F.; Bairey, C N; Nebel, Linda E.; Hedges, Susan M.; Rozanski, Alan

doi:10.1097/00006842-199101000-00001

Cited by 142 publications

(61 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among females, social subordination, ovarian impairment, hypercortisolemia, and exaggerated heart rate responses to stress seem to occur concurrently, dramatically accelerating atherogenesis in affected individuals. 172 Other studies have linked sympathetic hyperresponsivity to the induction of ischemia during exercise 254 and mental stress, 255 and to the development of hypertension. 256 -258 Combined, these recent animal and human studies raise the possibility that sympathetic hyperresponsivity may constitute a risk factor for the development or progression of CAD.…”

Section: Sympathetic Nervous System Hyperresponsivitymentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

View full text Add to dashboard Cite

Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

show abstract

Section: Sympathetic Nervous System Hyperresponsivitymentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

View full text Add to dashboard Cite

show abstract

“…Stress and negative emotions increase heart rate and contractile force in both healthy and CHD populations (Brownley, Hurwitz, & Schneiderman, 2000;Goldberg et al, 1996), thereby increasing oxygen demand. CHD patients with greater CVR to laboratory mental stressors are more likely to display ischemia during exercise testing (Kral et al, 1997), laboratory mental stressors Krantz et al, 1991), and ambulatory monitoring (Blumenthal, Jiang, et al, 1995). Of interest, CVR to mental stress has also been found to predict recurrent events in post-MI patients (Manuck, Olsson, Hjemdahl, & Renqvist, 1992).…”

Section: Effects Of Psychophysiological Reactivity On Cadmentioning

confidence: 99%

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Smith¹,

Ruiz²

2002

Journal of Consulting and Clinical Psychology

292

208

View full text Add to dashboard Cite

Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.Coronary heart disease (CHD) is the leading cause of death in the United States; each year about 450,000 people die from CHD, and 1,000,000 experience an initial or recurrent coronary event (American Heart Association, 2001). Among healthy 40-year olds, between 40% and 50% of men and between 25% and 35% of women will later develop CHD (Lloyd-Jones, Larson, Beiser, & Levy, 1999). Over $100 billion is spent on CHD each year in the United States in direct medical costs, disability payments, and lost productivity (American Heart Association, 2001). This disease involves the three major topics composing behavioral medicine and health psychology, making it a central focus throughout their 30-year history. In the first (i.e., health behavior and prevention), modifiable behavioral risk factors (e.g., smoking, activity level, diet) are important risk factors for the development of CHD (Stamler et al., 1999;Wannamethee, Shaper, Walker, & Ebrahim, 1998), and behavior change is an essential component of prevention. In the second topic (i.e., stress and disease or psychosomatics), other psychological and social factors have more direct effects on the development and course of CHD through the intervening psychobiological effects of stress and negative emotions. In the third (i.e., psychosocial aspects of medical illness and care), established CHD has extensive emotional and social impacts on patients and their families, behavior is a key element of standard care (e.g., medication adherence, dietary change, exercise), and psychosocial interventions are useful additions to traditional medical and surgical treatment.Like the article on CHD in the previous special issue on behavioral medicine in this journal (Thoresen & Powell, 1992), we focused primarily on the second major topic-psychosocial influences on the development and course of CHD. We also reviewed one aspect of the third topic-interventions targeting psychosocial risk factors and their underlying psychophysiological mechanisms. Perhaps the most important implication of research on psychosocial risk factors for coronary disease is that interventions targeting these factors could reduce cardiac morb...

show abstract

“…Post-MI patients with exaggerated cardiovascular reactivity to mental stress were at a higher risk for development of new clinical events (re-infarction or stroke) during the 39 to 64 months after acute MI in comparison to post-MI patients with normal cardiovascular reactivity (Manuck, Olsson, Hjemdahl, & Rehnqvist, 1992). In another study, the relationships between hemodynamic reactivity and myocardial ischemia during laboratory mental stress were evaluated in 39 CAD patients and 12 controls (Krantz et al, 1991). Results revealed that SBP levels during metal task and SBP reactivity (increases) were highest for the severely ischemic group and lowest for controls (Krantz et al, 1991).…”

Section: Stress Reactivity In Chd Patientsmentioning

confidence: 99%

Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

Ghambaryan¹

2007

View full text Add to dashboard Cite

Altered cardiac autonomic balance has been shown to be a predictor of adverse cardiac events in patients with cardiovascular decease (CAD). Alteration of the sympatho-vagal balance of heart regulation may be more evident during periods of mental stress. The high frequency (HF) component of heart rate variability (HRV) is a marker of the parasympathetic regulation of the heart. The meaning of the low frequency (LF) component of HRV is controversial, but it may represent the sympathetic modulation of heart regulation. Plasma catecholamine levels (epinephrine and norepinephrine) are markers of sympathetic nervous system action. Increases in hemodynamic (blood pressure and heart rate) responses to stress are predominantly regulated by the sympathetic branch of the autonomic nervous system (ANS). The relationships among the frequency domains of HRV, hemodynamics, and catecholamine level were examined at rest and during speech mental stress in 147 CAD patients from the Psychophysiological Investigations of Myocardial Ischemia (PIMI) study. At rest, there were no significant associations between HRV measures, hemodynamic responses, and plasma catecholamine levels. However, at peak stress levels, analyses of variance revealed a significant inverse relation between HF levels and epinephrine (Epi), (univariate F (3, 132) = 2.9; p= .037); and a significant inverse relation between LF and catecholamine levels, (multivariate F (6, 258) = 3.7; p =.001). At peak stress levels, HF levels were inversely related to systolic blood pressure (SBP) and heart rate (HR) (F SBP (3, 141) = 3.9; p =0.01; and F HR (3, 141) = 7.2; p < 0.001). At peak stress levels LF was inversely related to SBP and HR, (F SBP (3, 140) = 8.9; p < 0.001; and F HR (3, 140) = 4.0; p = 0.009). These findings suggest that associations of the vagal components (HF) of HRV with sympathetic markers in CAD patients are only revealed under conditions of mental stress. In addition, based on the data,

show abstract

Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease.

Cited by 142 publications

References 23 publications

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

Contact Info

Product

Resources

About