Exaggerated platelet and hemodynamic reactivity to mental stress in men with coronary artery disease.
OBJECTIVE
This study compared the effects of acute mental stress on cardiovascular and subjective responses and platelet activation in male patients with established coronary artery disease (CAD) and age-matched controls.


METHODS
We assessed 17 male CAD patients aged 44 to 59 years and 22 healthy male controls. Blood pressure, heart rate, and hemodynamics were assessed before, during, and up to 2 hours after administration of color/word and mirror tracing tasks. Blood was sampled at baseline, after tasks, and at 30 and 75 minutes after stress, and platelet activation was assessed by measuring platelet-leukocyte aggregates (PLAs) using flow cytometry.


RESULTS
CAD patients showed significantly greater systolic blood pressure stress responses than controls (mean increases of 43.9 and 28.3 mm Hg, adjusted for income, body mass index, waist/hip ratio, and medication), together with larger increases in heart rate (14.1 and 4.7 bpm) and cardiac index. Total peripheral resistance increased during the poststress recovery period in CAD patients but not in controls. PLAs increased with stress in both groups, but remained elevated at 75 minutes in CAD patients, returning to baseline in controls. Heart rate and cardiac index responses were correlated with increases in subjective stress and with depression ratings, whereas PLA responses were associated with ratings of task difficulty.


CONCLUSIONS
Acute mental stress stimulated heightened cardiovascular responses in CAD patients, coupled with more prolonged platelet activation. These factors may contribute to plaque rupture and thrombogenesis, and partly mediate stress-induced triggering of acute coronary syndromes.
Psychobiology Group, Department of Epidemiology and Public Health, University College London, London, UK. p.strike@public-health.ucl.ac.uk
Philip C
PC
Strike
Kesson
K
Magid
Lena
L
Brydon
Susan
S
Edwards
Jean R
JR
McEwan
Andrew
A
Steptoe
D000208:Acute Disease; D000328:Adult; D001792:Blood Platelets / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D003328:Coronary Thrombosis / Q000097:blood / Q000209:etiology; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology; D012737:Sex Factors; D013315:Stress, Psychological / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D014655:Vascular Resistance / Q000502:physiology