Molecular Medicine

, Volume 12, Issue 11–12, pp 269–274 | Cite as

C-Reactive Protein and Vulnerability to Mental Stress-Induced Myocardial Ischemia

  • Rahman Shah
  • Matthew M Burg
  • Aseem Vashist
  • Dorothea Collins
  • Joyce Liu
  • Farid Jadbabaie
  • Brendon Graeber
  • Christine Earley
  • Rachel Lampert
  • Robert Soufer
Research Article


Myocardial ischemia provoked in the laboratory during mental stress (MSI) in patients with stable coronary artery disease (CAD) predicts subsequent clinical events. The pathophysiology of MSI differs from that of exercise ischemia, and the mechanisms tying MSI to poor prognosis are not known. C-reactive protein (CRP) is a risk marker for cardiovascular events in patients with CAD, but little is known regarding the relationship of CRP to MSI. The purpose of this study was to examine the association of CRP to risk of MSI in CAD patients. Eighty-three patients with stable CAD underwent simultaneous single-photon emission computed tomography (SPECT) imaging with technetium-99m tetrofosmin myocardial perfusion imaging (MPI) and transthoracic echocardiography (TTE), at rest and during MS induced by laboratory mental stress. Serum CRP levels were measured 24 h after MS. MSI was defined by the presence of a new perfusion defect on SPECT and/or new regional wall motion abnormality on TTE during MS. Of the 83 patients, 30 (36%) developed MSI. There was no difference in gender, sex, BMI, histories of diabetes, hypertension, smoking, lipid profile, medications used (including statins, β-blockers, ACE inhibitors, and aspirin), or hemodynamic response during MS between those with and without MSI. In univariate logistic regression analysis, each unit (1 mg/L) increase in CRP level was associated with 20% higher risk of MSI (OR 1.2, 95% CI 1.01–1.39, P =.04). This relationship remained in multivariate models. These data suggest that levels of CRP may be a risk marker for MSI in patients with CAD.



We thank Dr. William C. Sessa, Professor of Pharmacology, Yale University School of Medicine, for his contribution to the conceptual construct.

This work was supported by R01 awards (HL59619-01 and HL071116-01) from the National Heart, Lung, and Blood Institute, and by a Merit Review award from the Department of Veterans Affairs to Dr. Soufer.


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Copyright information

© Feinstein Institute for Medical Research 2006

Authors and Affiliations

  • Rahman Shah
    • 1
    • 2
  • Matthew M Burg
    • 1
    • 2
    • 3
  • Aseem Vashist
    • 1
    • 2
  • Dorothea Collins
    • 1
    • 2
  • Joyce Liu
    • 1
    • 2
  • Farid Jadbabaie
    • 1
    • 2
  • Brendon Graeber
    • 1
  • Christine Earley
    • 1
    • 2
  • Rachel Lampert
    • 1
  • Robert Soufer
    • 1
    • 2
  1. 1.Section of Cardiovascular MedicineYale University School of MedicineNew HavenUSA
  2. 2.VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.Columbia University School of MedicineNew York CityUSA

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