Effects of a cognitive stress challenge on myocardial perfusion and plasma cortisol in coronary heart disease patients with depression

• Type of Material: Article
• Authors: James Bremner, Emory University; Faiz A Cheema, Emory University; Ali Ashraf, Emory University; Nadeem Afzal, Emory University; Negar Fani, Emory University; Lai Reed, Emory University; Dominique L Musselman, Emory University; James Ritchie, Emory University; Tracy Faber, Emory University; John Votaw, Emory University; Charles B Nemeroff, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2009-08-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2008 John Wiley & Sons, Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1002/smi.1246
• Title of Journal or Parent Work: STRESS AND HEALTH
• Volume: 25
• Issue: 3
• Start Page: 267
• End Page: 278
• Grant/Funding Information: This study was supported by the Charles A. Dana Foundation. J. D. Bremner receives research funding support from NIH R01 MH56120, VA, DOD, Dreyfus Health Foundation, private donations, and GlaxoSmithKline Inc.; V. Vaccarino receives research funding support from NIH R01 HL66287-01 and Aetna Health Foundation. C. B. Nemeroff receives research funding support from NIH Conte MH-58922 and R01 MH-39415, MH-56946, MH-42088, and research funding and/or payment as a consultant or speaker for Abbott Laboratories, Acadia, AFSP, Astra-Zeneca, Bristol-Myers-Squibb, Corcept, Cypress Biosciences, Cyberonics, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceuticals, Merck, NARSAD, Neurocrine Biosciences, Novadel Pharm, Novartis, Organon, Otsuka, Pfizer Pharmaceuticals, Sanofi, Scirex, Somerset, Stanley Foundation/NAMI, Wyeth-Ayerst; is a stockholder in Acadia, Corcept, Neurocrine Biosciences and Novadel Pharm; and patents US 6,375,990 B1.
• Keywords: Life Sciences & Biomedicine; LEFT-VENTRICULAR DYSFUNCTION; BLOOD-FLOW; VASOMOTOR RESPONSE; Psychology, Applied; single photon emission computed tomography; Psychiatry; depression; Psychology; MENTAL STRESS; DAILY-LIFE; ISCHEMIA; PSYCHOLOGICAL-FACTORS; ARTERY-DISEASE; DISORDER; cortisol; stress; Social Sciences; Science & Technology; CARDIOVASCULAR-DISEASE; cardiovascular disease

Abstract

Although it is well established that coronary heart disease (CHD) patients with depression exhibit increased mortality compared with equally ill cardiac patients without depression, the mechanisms mediating this effect remain obscure. Depression is characterized by vulnerability to stress and heightened stress responsiveness, and stress can theoretically act through several biological pathways to contribute to excess mortality from CHD. Mechanisms connecting stress, depression and cardiovascular mortality have not been previously explored in detail. The purpose of this study was to assess the effects of stress and depression on myocardial perfusion and plasma cortisol concentrations in CHD patients. Patients with CHD with and without depression (n = 28) underwent single photon emission computed tomography imaging of myocardial perfusion at rest and during a stressful cognitive challenge. Severity of ischaemia was measured by summing perfusion defect scores across myocardial segments and subtracting out rest from stress scores. Plasma cortisol concentrations were measured at baseline and in response to the stressful challenge. There were no differences in stress-induced myocardial ischaemia or plasma cortisol response to stress between CHD patients with and without depression. Depressed CHD patients with a history of psychological trauma (n = 5) had an increase in stress-induced ischaemia scores [7; standard deviation (SD) = 5] compared with CHD patients with depression without a history of psychological trauma (2 SD = 2) and CHD patients without depression or psychological trauma (1; SD = 2) (F = 8.51; degree of freedom = 2,23; p = 0.007). Eighty per cent of CHD/depression trauma-exposed subjects had stress-induced ischaemia as opposed to 38 per cent of CHD/depression subjects without trauma exposure and 23 per cent of subjects with CHD without depression or trauma. Self-reported nervousness during the cognitive stressor was correlated with stress-induced ischaemia. These preliminary findings suggest that depression with a history of prior exposure to traumatic stress is associated with increased risk for stress-induced cardiovascular ischaemia. Copyright © 2009 John Wiley & Sons, Ltd.