Inflammatory response to mental stress and mental stress induced myocardial ischemia

• Authors: Muhammad Hammadah, Emory University; Samaah Sullivan, Emory University; Bradley Pearce, Emory University; Ibhar Al Mheid, Emory University; Kobina Wilmot, Emory University; Ronnie Ramadan, Emory University; Ayman Samman Tahhan, Emory University; Wesley T. O'Neal, Emory University; Malik Obideen, Emory University; Ayman Alkhoder, Emory University; Naser Abdelhadi, Emory University; Heval Mohamed Kelli, Emory University; Mohamad Mazen Ghafeer, Emory University; Pratik Pimple, Emory University; Pratik Sandesara, Emory University; Amit Shah, Emory University; Kareem Mohammed Hosny, Emory University; Laura Ward, Emory University; Yi-An Ko, Emory University; Yan Sun, Emory University; Lei Weng, Emory University; Michael Kutner, Emory University; J. Douglas Bremner, Emory University; David S. Sheps, University of Florida; Fabio Esteves, Emory University; Paolo Raggi, Emory University; Laura Vaccarino, Emory University; Arshed Quyyumi, Emory University
• Journal Title: Brain, Behavior, and Immunity
• Volume: Volume 68
• Publisher: Elsevier: 12 months | 2018-02-01, Pages 90-97
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.bbi.2017.10.004
• Subjects: Health Sciences, Immunology; Biology, Neuroscience; Psychology, Behavioral
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Neurosciences; Psychiatry; Neurosciences & Neurology; Inflammation; Mental stress; Myocardial ischemia; C reactive protein; Interleukin 6; Matrix metallopeptidase 9; Monocyte chemoattractant protein-1; CORONARY-ARTERY-DISEASE; C-REACTIVE PROTEIN; ACUTE PSYCHOLOGICAL STRESS; MAJOR DEPRESSIVE DISORDER; ENDOTHELIAL DYSFUNCTION; CARDIOVASCULAR-DISEASE; UNSTABLE ANGINA; OLDER MEN; INTERLEUKIN-6; INFARCTION

Abstract

Background: Mental stress-induced myocardial ischemia (MSIMI) is associated with increased risk of adverse cardiovascular outcomes, yet the underlying mechanisms are not well understood. We measured the inflammatory response to acute laboratory mental stress in patients with coronary artery disease (CAD) and its association with MSIMI. We hypothesized that patients with MSIMI would have a higher inflammatory response to mental stress in comparison to those without ischemia. Methods: Patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during mental stress testing using a public speaking stressor. MSIMI was determined as impaired myocardial perfusion using a 17-segment model. Inflammatory markers including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), matrix metallopeptidase 9 (MMP-9) and high-sensitivity C reactive protein (hsCRP) were measured at rest and 90 min after mental stress. Results were validated in an independent sample of 228 post-myocardial infarction patients. Results: Of 607 patients analyzed in this study, (mean age 63 ± 9 years, 76% male), 99 (16.3%) developed MSIMI. Mental stress resulted in a significant increase in IL-6, MCP-1, and MMP-9 (all p <0.0001), but not hsCRP. However, the changes in these markers were similar in those with and without MSIMI. Neither resting levels of these biomarkers, nor their changes with mental stress were significantly associated with MSIMI. Results in the replication sample were similar. Conclusion: Mental stress is associated with acute increases in several inflammatory markers. However, neither the baseline inflammatory status nor the magnitude of the inflammatory response to mental stress over 90 min were significantly associated with MSIMI.