Stress-induced release of matrix metalloproteinase-9 in patients with coronary artery disease: The possible influence of cortisol

Lundberg, Anna; Jonsson, Sofi; Stenmark, Jonathan; Kristenson, Margareta; Jonasson, Lena

doi:10.1016/j.psyneuen.2016.07.219

Cited by 18 publications

(11 citation statements)

References 48 publications

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“…The psychological stress test included two parts with different stressors, an anger recall test and an arithmetic test, with a pause of 2 minutes in-between 16 , 23 . In the first part, the participant was instructed to recall an event that made him/her angry, frustrated or upset, and to discuss for 6 min what had happened and how that made him/her feel.…”

Section: Methodsmentioning

confidence: 99%

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Stress-induced release of the S100A8/A9 alarmin is elevated in coronary artery disease patients with impaired cortisol response

Jonasson

Larsen

Lundberg

et al. 2017

Sci Rep

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Psychological stress is thought to be an important trigger of cardiovascular events, yet the involved pathways and mediators are largely unknown. Elevated systemic levels of the pro-inflammatory alarmin S100A8/A9 correlate with poor prognosis in coronary artery disease (CAD) patients. Here, we investigated the links between S100A8/A9 release and parameters of anti-inflammatory glucocorticoid secretion in two different cohorts subjected to a psychological stress test. In the first cohort of 60 CAD patients, psychological stress induced a rapid increase of circulating S100A8/A9. This rapid S100A8/A9 response strongly correlated with elevated evening saliva cortisol levels, suggesting an association with a dysregulated hypothalamic–pituitary–adrenal (HPA) axis. In the second cohort of 27 CAD patients and 28 controls, elevated S100A8/A9 levels were still detectable 24 h after stress in 40% of patients and 36% of controls, with a tendency for higher levels in patients. The sustained S100A8/A9 response was associated with a poor rapid cortisol release after stress in patients, but not in the control group. Our findings reveal for the first time that acute psychological stress induces elevated levels of S100A8/A9. We also provide hypothesis-generating evidence that dysregulated cortisol secretion in CAD patients might be associated with an exaggerated pro-inflammatory S100A8/A9 response.

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Section: Methodsmentioning

confidence: 99%

“…Acute psychological stress triggers the release of inflammatory mediators in humans 15 , 16 and may thereby increase the risk for CV disease 17 , 18 . Glucocorticoids regulate immune and inflammatory pathways, and are essential for dampening the inflammatory response associated with acute stress 19 , 20 .…”

Section: Introductionmentioning

confidence: 99%

Stress-induced release of the S100A8/A9 alarmin is elevated in coronary artery disease patients with impaired cortisol response

Jonasson

Larsen

Lundberg

et al. 2017

Sci Rep

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“…So far, we can only speculate that the stress-induced level of MMP-9 is a marker of residual inflammatory risk. However, the association between stress-induced release of MMP-9 and shorter leukocyte telomere length as well as increased plaque burden support the hypothesis that recurring bouts of inflammation in response to exogenous challenges contribute to a gradual progression in CAD [12].…”

Section: Discussionmentioning

confidence: 95%

“…E.g., neutrophils from patients with coronary artery disease (CAD) are more prone to release these mediators, in particular MMP-9, upon in vitro stimulation compared with neutrophils from healthy subjects [11]. Moreover, patients with CAD who exhibit a significant and early increase in plasma MMP-9 after a laboratory stress test show signs of more advanced disease, including premature cellular aging and larger atherosclerotic burden [12].…”

Section: Introductionmentioning

confidence: 99%

Salivary and plasma levels of matrix metalloproteinase-9 and myeloperoxidase at rest and after acute physical exercise in patients with coronary artery disease

Mahmood

Enocsson

Bäck

et al. 2018

Preprint

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22 Background 23 Low-grade systemic inflammation is a predictor of recurrent cardiac events in patients with coronary 24 artery disease (CAD). Plasma proteins such as matrix metalloproteinase (MMP)-9 and 25 myeloperoxidase (MPO) have been shown to reflect basal as well as stress-induced inflammation in 26 CAD. Measurements of MMP-9 and MPO in saliva might pose several advantages. Therefore, we 27 investigated whether salivary levels of MMP-9 and MPO corresponded to plasma levels in patients 28 with CAD, both at rest and after acute physical exercise. 29 Methods 30 An acute bout of physical exercise on a bicycle ergometer was used as a model for stress-induced 31 inflammation. Twenty-three CAD patients performed the test on two occasions 3-6 months apart. 32 Whole unstimulated saliva was collected before, directly after and 30 min after exercise while plasma 33 was collected before and after 30 min. MMP-9 and MPO in saliva and plasma were determined by 34 Luminex. 35 Results 36 MMP-9 and MPO levels were 2-to 4-fold higher in saliva than in plasma. Within the saliva 37 compartment, and also to a great extent within the plasma compartments, MMP-9 and MPO showed 38 strong intercorrelations at all time points. However, there were no (or weak) correlations between 39 salivary and plasma MMP-9 and none between salivary and plasma MPO. 40 Conclusion 41 We conclude that salivary diagnostics cannot be used to assess systemic levels of MMP-9 and MPO in 42 CAD patients, neither at rest nor after acute physical exercise. 43 44 Key words 45 Coronary artery disease; inflammation; matrix metalloproteinase-9; myeloperoxidase; saliva 46 3 47 Introduction 48 49 Inflammation is an important component of atherosclerosis, from the formation of atherosclerotic 50 plaques to plaque destabilization eventually leading to plaque rupture and atherothrombotic events, 51 such as myocardial infarction [1]. Systemic levels of inflammatory markers can be useful to assess 52 cardiovascular risk and monitor disease activity and over the years, great efforts have been made to 53 identify relevant and easily available markers. The predictive value of markers like C-reactive protein 54 (CRP) and interleukin (IL)-6 in determining the risk of myocardial infarction is well-documented [2].55 Moreover, a number of epidemiological and clinical studies have shown that neutrophil-associated 56 proteins in plasma, such as matrix metalloproteinase (MMP)-9 and myeloperoxidase (MPO), predict 57 cardiovascular outcome [3, 4] and also relate to the extent and severity of atherosclerosis [5]. Overall, 58 there is emerging evidence that the presence of low-grade systemic inflammation should be considered 59 in clinical praxis when assessing a patient´s risk of recurrent cardiovascular events. 60 61 Low-grade inflammation is however not always detectable in plasma measures taken at rest. As has 62 been shown in various settings, stress provocation tests may add important information on the 63 individual´s susceptibility to inflammatory response [6][7][8][9]. A gr...

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“…4 – 7 Chronic stress is a well-documented risk factor for various medical disorders, diseases, and symptoms. 8 – 20 A particular demographic group with a high stress level is corporate executives.…”

Section: Introductionmentioning

confidence: 99%

The Stressed Executive: Sources and Predictors of Stress Among Participants in an Executive Health Program

Ganesh

Mahapatra

Fuehrer

et al. 2018

Glob Adv Health Med

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BackgroundStress is highly prevalent in the U.S. society, especially in executives, and is a well-documented risk factor for a wide range of medical disorders. Knowledge of common sources of stress and predictive factors may help identify executives at risk of high stress and allow us to appropriately refer them for stress management treatment.ObjectiveThe primary aim of this study was to identify common sources of stress, predictors of high stress, and other correlates among executives.MethodsThis was a cross-sectional survey of executives who requested a stress management consult at our institution. We abstracted the data from a 14-item intake survey as well as from the patient interview.ResultsOf the 839 executives, 827 executives (98.6%) who were referred for individual stress management consults completed the stress-related questions of the survey; 51.3% of these executives reported having a high stress level. Study participants mostly struggled with the well-being measures of sleep, anxiety, energy level, and diet. The majority reported that their main stressor was work related (n = 540, 64.4%) followed by family related (n = 371, 44.2%), health related (n = 170, 20.3%), and work–life balance (n = 62, 7.4%). In unadjusted analysis, high stress was associated with younger age (P = .006), lower quality-of-life scores (P < .001), and less physical activity (P < .001). In multivariable analyses, the strongest predictors for high stress level were younger age (odds ratios [OR] = 0.84, P = .045) and worse quality-of-life indicators such as anxiety (OR = 2.72, P < .001), diet (OR = 0.78, P = .02), and sleep (OR = 0.74, P < .003).ConclusionThese findings suggest that executives with a high level of stress might be best helped through a multimodality stress management program. Our findings merit replication in larger studies and more definitive confirmation with prospective clinical trials.

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Stress-induced release of matrix metalloproteinase-9 in patients with coronary artery disease: The possible influence of cortisol

Cited by 18 publications

References 48 publications

Stress-induced release of the S100A8/A9 alarmin is elevated in coronary artery disease patients with impaired cortisol response

Stress-induced release of the S100A8/A9 alarmin is elevated in coronary artery disease patients with impaired cortisol response

Salivary and plasma levels of matrix metalloproteinase-9 and myeloperoxidase at rest and after acute physical exercise in patients with coronary artery disease

The Stressed Executive: Sources and Predictors of Stress Among Participants in an Executive Health Program

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