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Investigating the role of acute mental stress on endothelial dysfunction: a systematic review and meta-analysis

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Abstract

Chronic stress is a known risk factor for both endothelial dysfunction and cardiovascular disease (CVD), but less is known of how acute mental stress affects the vasculature. In this systematic review and meta-analysis, we analyzed the impact of acute mental stress on flow-mediated dilation (FMD), an indicator of endothelial function. We searched the Medline, Cochrane, EMBASE, and ISI Web of Knowledge databases through May 2014, to identify publications in English-language journals. The primary outcome was the change in FMD from baseline to the time of measurement. We also assessed the risk of bias and the heterogeneity of included studies. Our search identified eight prospective studies, which displayed significant heterogeneity. Four studies measured FMD while the subject was performing the task; six measured FMD after the task had been completed. The total number of participants was 164. The pooled results indicate that FMD did not change significantly while the task was being performed (pooled difference in means: −0.853; 95 % confidence interval (CI), −3.926/2.220; P = 0.586); however, FMD measured after the task was completed was significantly less than baseline (pooled difference in means: −2.450; 95 %CI, −3.925/−0.975; P = 0.001). In conclusions, our findings provide evidence that an acute stressful experience has a delayed, negative impact on the function of the endothelium. Repeated exposure to short-term stress may lead to permanent injury of the vasculature. Therefore, assessment of patients’ exposure to both repeated acute mental stress and chronic stress may be useful in determining their risk of developing CVD.

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References

  1. Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2095–2128

    Article  PubMed  Google Scholar 

  2. Go AS, Mozaffarian D, Roger VL et al (2014) Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation 129:e28–e292

    Article  PubMed  Google Scholar 

  3. Xi B, Liu F, Hao Y, Dong H, Mi J (2014) The growing burden of cardiovascular diseases in China. Int J Cardiol 174:736–737

    Article  PubMed  Google Scholar 

  4. World Health Organization Health Statistics and Information Systems: Estimates for 2000–2012.

  5. Esser S, Gelbrich G, Brockmeyer N, Goehler A, Schadendorf D, Erbel R, Neumann T, Reinsch N (2013) Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study. Clin Res Cardiol 102:203–213

    Article  PubMed  Google Scholar 

  6. Santoro F, Tarantino N, Pellegrino PL, Caivano M, Lopizzo A, Di Biase M, Brunetti ND (2014) Cardiovascular sequelae of radiation therapy. Clin Res Cardiol [Epub ahead of print] PMID: 24803132

  7. Gremmel T, Fruhwirth K, Kopp CW, Kaider A, Steiner S, Bakchoul T, Sachs UJ, Koppensteiner R, Panzer S (2012) Frequency of heparin/platelet factor 4-dependent platelet antibodies in patients undergoing angioplasty and stenting for cardiovascular disease and their role for on-clopidogrel platelet reactivity. Clin Res Cardiol 101:445–452

    Article  CAS  PubMed  Google Scholar 

  8. Kleijn L, Westenbrink BD, van Deursen VM, Damman K, de Boer RA, Hillege HL, van Veldhuisen DJ, Voors AA, van der Meer P (2014) Anemia is associated with an increased central venous pressure and mortality in a broad spectrum of cardiovascular patients. Clin Res Cardiol 103:467–476

    Article  PubMed  Google Scholar 

  9. Petrie CJ, Voors AA, Robertson M, van Veldhuisen DJ, Dargie HJ (2012) A low pulse pressure predicts mortality in subjects with heart failure after an acute myocardial infarction: a post hoc analysis of the CAPRICORN study. Clin Res Cardiol 101:29–35

    Article  PubMed  Google Scholar 

  10. Otaki Y, Takahashi H, Watanabe T et al (2014) Electrocardiographic left ventricular hypertrophy Cornell product is a feasible predictor of cardiac prognosis in patients with chronic heart failure. Clin Res Cardiol 103:275–284

    Article  PubMed  Google Scholar 

  11. Siegerink B, Maas R, Vossen CY, Schwedhelm E, Koenig W, Boger R, Rothenbacher D, Brenner H, Breitling LP (2013) Asymmetric and symmetric dimethylarginine and risk of secondary cardiovascular disease events and mortality in patients with stable coronary heart disease: the KAROLA follow-up study. Clin Res Cardiol 102:193–202

    Article  CAS  PubMed  Google Scholar 

  12. Jespersen L, Abildstrom SZ, Hvelplund A, Prescott E (2013) Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris. Clin Res Cardiol 102:571–581

    Article  PubMed  Google Scholar 

  13. Nicolai MP, Both S, Liem SS, Pelger RC, Putter H, Schalij MJ, Elzevier HW (2013) Discussing sexual function in the cardiology practice. Clin Res Cardiol 102:329–336

    Article  CAS  PubMed  Google Scholar 

  14. Bloom DE, Cafiero ET, Jané-Llopis E et al (2011) The global economic burden of noncommunicable diseases. World Economic Forum, Geneva

    Google Scholar 

  15. Nichols M, Townsend N, Scarborough P, Rayner M (2013) Cardiovascular disease in Europe: epidemiological update. Eur Heart J 34:3028–3034

    Article  PubMed  Google Scholar 

  16. Kara K, Mahabadi AA, Geisel MH et al (2014) B-type natriuretic peptide: distribution in the general population and the association with major cardiovascular and coronary events—the Heinz Nixdorf Recall Study. Clin Res Cardiol 103:125–132

    Article  CAS  PubMed  Google Scholar 

  17. Mahabadi AA, Lehmann N, Mohlenkamp S et al (2014) Association of bilirubin with coronary artery calcification and cardiovascular events in the general population without known liver disease: the Heinz Nixdorf Recall study. Clin Res Cardiol 103:647–653

    Article  CAS  PubMed  Google Scholar 

  18. Mahfoud F, Ukena C, Poss J, Bramlage P, Volpe M, Thoenes M, Schmieder R, Bohm M (2012) Microalbuminuria independently correlates to cardiovascular comorbidity burden in patients with hypertension. Clin Res Cardiol 101:761–766

    Article  CAS  PubMed  Google Scholar 

  19. Sinning C, Keller T, Zeller T et al (2014) Association of high-sensitivity assayed troponin I with cardiovascular phenotypes in the general population: the population-based Gutenberg health study. Clin Res Cardiol 103:211–222

    Article  CAS  PubMed  Google Scholar 

  20. Hoefer IE, Sels JW, Jukema JW et al (2013) Circulating cells as predictors of secondary manifestations of cardiovascular disease: design of the CIRCULATING CELLS study. Clin Res Cardiol 102:847–856

    Article  CAS  PubMed  Google Scholar 

  21. Balin M, Celik A, Kobat MA (2012) Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 levels are associated with proximal/middle segment of the LAD lesions in patients with stable coronary artery disease. Clin Res Cardiol 101:247–253

    Article  CAS  PubMed  Google Scholar 

  22. Ng M, Fleming T, Robinson M, et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781

  23. Ng SW, Norton EC, Popkin BM (2009) Why have physical activity levels declined among Chinese adults? Findings from the 1991–2006 China Health and Nutrition Surveys. Soc Sci Med 68:1305–1314

    Article  PubMed Central  PubMed  Google Scholar 

  24. Sliwa K, Ojji D, Bachelier K, Bohm M, Damasceno A, Stewart S (2014) Hypertension and hypertensive heart disease in African women. Clin Res Cardiol 103:515–523

    Article  PubMed  Google Scholar 

  25. Iso H, Date C, Yamamoto A et al (2002) Perceived mental stress and mortality from cardiovascular disease among Japanese men and women: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study). Circulation 106:1229–1236

    Article  PubMed  Google Scholar 

  26. Yusuf S, Hawken S, Ounpuu S et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:937–952

    Article  PubMed  Google Scholar 

  27. Richardson S, Shaffer JA, Falzon L, Krupka D, Davidson KW, Edmondson D (2012) Meta-analysis of perceived stress and its association with incident coronary heart disease. Am J Cardiol 110:1711–1716

    Article  PubMed Central  PubMed  Google Scholar 

  28. Lonn EM, Rambihar S, Gao P, Custodis FF, Sliwa K, Teo KK, Yusuf S, Bohm M (2014) Heart rate is associated with increased risk of major cardiovascular events, cardiovascular and all-cause death in patients with stable chronic cardiovascular disease: an analysis of ONTARGET/TRANSCEND. Clin Res Cardiol 103:149–159

    Article  PubMed  Google Scholar 

  29. Hirata Y, Nagata D, Suzuki E, Nishimatsu H, Suzuki J, Nagai R (2010) Diagnosis and treatment of endothelial dysfunction in cardiovascular disease. Int Heart J 51:1–6

    Article  CAS  PubMed  Google Scholar 

  30. Poitras VJ, Pyke KE (2013) The impact of acute mental stress on vascular endothelial function: evidence, mechanisms and importance. Int J Psychophysiol 88:124–135

    Article  PubMed  Google Scholar 

  31. Pereira VH, Cerqueira JJ, Palha JA, Sousa N (2013) Stressed brain, diseased heart: a review on the pathophysiologic mechanisms of neurocardiology. Int J Cardiol 166:30–37

    Article  PubMed  Google Scholar 

  32. Gimbrone MA Jr (1989) Endothelial dysfunction and atherosclerosis. J Card Surg 4:180–183

    Article  PubMed  Google Scholar 

  33. Mudau M, Genis A, Lochner A, Strijdom H (2012) Endothelial dysfunction: the early predictor of atherosclerosis. Cardiovasc J Afr 23:222–231

    Article  PubMed Central  PubMed  Google Scholar 

  34. Kim HS, Cho KI (2013) Impact of chronic emotional stress on myocardial function in postmenopausal women and its relationship with endothelial dysfunction. Korean Circ J 43:295–302

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Mausbach BT, Roepke SK, Ziegler MG et al (2010) Association between chronic caregiving stress and impaired endothelial function in the elderly. J Am Coll Cardiol 55:2599–2606

    Article  PubMed Central  PubMed  Google Scholar 

  36. Non AL, Rimm EB, Kawachi I, Rewak MA, Kubzansky LD (2014) The effects of stress at work and at home on inflammation and endothelial dysfunction. PLoS One 9:e94474

    Article  PubMed Central  PubMed  Google Scholar 

  37. Takase B, Akima T, Uehata A, Ohsuzu F, Kurita A (2004) Effect of chronic stress and sleep deprivation on both flow-mediated dilation in the brachial artery and the intracellular magnesium level in humans. Clin Cardiol 27:223–227

    Article  PubMed  Google Scholar 

  38. Yao F, Liu L, Zhang Y et al (2013) Erectile dysfunction may be the first clinical sign of insulin resistance and endothelial dysfunction in young men. Clin Res Cardiol 102:645–651

    Article  CAS  PubMed  Google Scholar 

  39. Lisi M, Oelze M, Dragoni S et al (2012) Chronic protection against ischemia and reperfusion-induced endothelial dysfunction during therapy with different organic nitrates. Clin Res Cardiol 101:453–459

    Article  CAS  PubMed  Google Scholar 

  40. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3:e123–130

    PubMed Central  PubMed  Google Scholar 

  41. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  42. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Gottdiener JS, Kop WJ, Hausner E, McCeney MK, Herrington D, Krantz DS (2003) Effects of mental stress on flow-mediated brachial arterial dilation and influence of behavioral factors and hypercholesterolemia in subjects without cardiovascular disease. Am J Cardiol 92:687–691

    Article  PubMed  Google Scholar 

  44. Harris CW, Edwards JL, Baruch A, Riley WA, Pusser BE, Rejeski WJ, Herrington DM (2000) Effects of mental stress on brachial artery flow-mediated vasodilation in healthy normal individuals. Am Heart J 139:405–411

    CAS  PubMed  Google Scholar 

  45. Jambrik Z, Santarcangelo EL, Ghelarducci B, Picano E, Sebastiani L (2004) Does hypnotizability modulate the stress-related endothelial dysfunction? Brain Res Bull 63:213–216

    Article  PubMed  Google Scholar 

  46. Jambrik Z, Sebastiani L, Picano E, Ghelarducci B, Santarcangelo EL (2005) Hypnotic modulation of flow-mediated endothelial response to mental stress. Int J Psychophysiol 55:221–227

    Article  PubMed  Google Scholar 

  47. Ghiadoni L, Donald AE, Cropley M et al (2000) Mental stress induces transient endothelial dysfunction in humans. Circulation 102:2473–2478

    Article  CAS  PubMed  Google Scholar 

  48. Lind L, Johansson K, Hall J (2002) The effects of mental stress and the cold pressure test on flow-mediated vasodilation. Blood Press 11:22–27

    Article  PubMed  Google Scholar 

  49. Spieker LE, Hurlimann D, Ruschitzka F et al (2002) Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation 105:2817–2820

    Article  CAS  PubMed  Google Scholar 

  50. Szijgyarto IC, King TJ, Ku J, Poitras VJ, Gurd BJ, Pyke KE (2013) The impact of acute mental stress on brachial artery flow-mediated dilation differs when shear stress is elevated by reactive hyperemia versus handgrip exercise. Appl Physiol Nutr Metab 38:498–506

    Article  CAS  PubMed  Google Scholar 

  51. Corretti MC, Anderson TJ, Benjamin EJ et al (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 39:257–265

    Article  PubMed  Google Scholar 

  52. Inaba Y, Chen JA, Bergmann SR (2010) Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. Int J Cardiovasc Imaging 26:631–640

    Article  PubMed  Google Scholar 

  53. Ras RT, Streppel MT, Draijer R, Zock PL (2013) Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol 168:344–351

    Article  PubMed  Google Scholar 

  54. de Waha A, Cassese S, Park DW, Burzotta F et al (2012) Everolimus-eluting versus sirolimus-eluting stents: an updated meta-analysis of randomized trials. Clin Res Cardiol 101:461–467

    Article  CAS  PubMed  Google Scholar 

  55. Navarese EP, Austin D, Gurbel PA et al (2013) Drug-coated balloons in treatment of in-stent restenosis: a meta-analysis of randomised controlled trials. Clin Res Cardiol 102:279–287

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Piccolo R, Cassese S, Galasso G, Niglio T, De Rosa R, De Biase C, Piscione F (2012) Long-term clinical outcomes following sirolimus-eluting stent implantation in patients with acute myocardial infarction. A meta-analysis of randomized trials. Clin Res Cardiol 101:885–893

    Article  CAS  PubMed  Google Scholar 

  57. Sedaghat-Hamedani F, Zitron E, Kayvanpour E, Lorenz HM, Katus HA, Meder B (2014) Post cardiac injury syndrome after initially uncomplicated CRT-D implantation: a case report and a systematic review. Clin Res Cardiol [Epub ahead of print] PMID: 24777392

  58. Silvetti S, Greco T, Di Prima AL, Mucchetti M, de Lurdes CM, Pasin L, Scandroglio M, Landoni G, Zangrillo A (2014) Intermittent levosimendan improves mid-term survival in chronic heart failure patients: meta-analysis of randomised trials. Clin Res Cardiol 103:505–513

    Article  CAS  PubMed  Google Scholar 

  59. Yue Z, Cai C, Ai-Fang Y, Feng-Min T, Li C, Bin W (2014) The effect of placebo adherence on reducing cardiovascular mortality: a meta-analysis. Clin Res Cardiol 103:229–235

    Article  PubMed  Google Scholar 

  60. Alvarez PA, Schwarz ER, Ramineni R, Myatt P, Barbin C, Boissonnet C, Phan A, Maggioni A, Barbagelata A (2013) Periprocedural adverse events in cell therapy trials in myocardial infarction and cardiomyopathy: a systematic review. Clin Res Cardiol 102:1–10

    Article  PubMed  Google Scholar 

  61. Nichols RB, McIntyre WF, Chan S, Scogstad-Stubbs D, Hopman WM, Baranchuk A (2012) Snow-shoveling and the risk of acute coronary syndromes. Clin Res Cardiol 101:11–15

    Article  PubMed  Google Scholar 

  62. Manchanda SC, Madan K (2014) Yoga and meditation in cardiovascular disease. Clin Res Cardiol 103:675–680

    Article  CAS  PubMed  Google Scholar 

  63. Manchanda SC, Madan K (2014) Erratum to: Yoga and meditation in cardiovascular disease. Clin Res Cardiol 103:763

    Article  Google Scholar 

  64. Volaklis KA, Tokmakidis SP, Halle M (2013) Acute and chronic effects of exercise on circulating endothelial progenitor cells in healthy and diseased patients. Clin Res Cardiol 102:249–257

    Article  PubMed  Google Scholar 

  65. Haussig S, Schuler G, Linke A (2014) Worldwide TAVI registries: what have we learned? Clin Res Cardiol 103:603–612

    Article  PubMed  Google Scholar 

  66. Schymik G, Heimeshoff M, Bramlage P, et al (2014) Ruptures of the device landing zone in patients undergoing transcatheter aortic valve implantation: an analysis of TAVI Karlsruhe (TAVIK) patients. Clin Res Cardiol [Epub ahead of print] PMID: 24908338

  67. Yammine L, Kang DH, Baun MM, Meininger JC (2014) Endothelin-1 and psychosocial risk factors for cardiovascular disease: a systematic review. Psychosom Med 76:109–121

    Article  CAS  PubMed  Google Scholar 

  68. Ohkita M, Tawa M, Kitada K, Matsumura Y (2012) Pathophysiological roles of endothelin receptors in cardiovascular diseases. J Pharmacol Sci 119:302–313

    Article  CAS  PubMed  Google Scholar 

  69. Chai SB, Li XM, Pang YZ, Qi YF, Tang CS (2010) Increased plasma levels of endothelin-1 and urotensin-II in patients with coronary heart disease. Heart Vessels 25:138–143

    Article  PubMed  Google Scholar 

  70. Miyauchi T, Yanagisawa M, Tomizawa T, Sugishita Y, Suzuki N, Fujino M, Ajisaka R, Goto K, Masaki T (1989) Increased plasma concentrations of endothelin-1 and big endothelin-1 in acute myocardial infarction. Lancet 2:53–54

    Article  CAS  PubMed  Google Scholar 

  71. Schneider MP, Hilgers KF, Klingbeil AU, John S, Veelken R, Schmieder RE (2000) Plasma endothelin is increased in early essential hypertension. Am J Hypertens 13:579–585

    Article  CAS  PubMed  Google Scholar 

  72. Schmidt FP, Basner M, Kroger G et al (2013) Effect of nighttime aircraft noise exposure on endothelial function and stress hormone release in healthy adults. Eur Heart J 34:3508–3514a

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Shandong University School of Medicine Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42 West Wenhua Road, Jinan, 250011, Shandong Province, China

    Yi-Tao Xue

  2. Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China

    Qi-wen Tan, Ping Li, Shan-fang Mou, Shu-juan Liu, Yue Bao, Hua-chen Jiao & Wen-Ge Su

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  1. Yi-Tao Xue
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Xue, YT., Tan, Qw., Li, P. et al. Investigating the role of acute mental stress on endothelial dysfunction: a systematic review and meta-analysis. Clin Res Cardiol 104, 310–319 (2015). https://doi.org/10.1007/s00392-014-0782-3

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