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Exaggerated Platelet and Hemodynamic Reactivity to Mental Stress in Men With Coronary Artery Disease

From the Psychobiology Group, Department of Epidemiology and Public Health (P.C.S., K.M., L.B., S.E., A.S.) and the Department of Medicine (J.R.M.), University College London, London, UK.

Address correspondence and reprint requests to Dr. Philip Strike, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London, WC1E 6BT, UK. E-mail p.strike{at}public-health.ucl.ac.uk

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.

CONCLUSION: 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.

Key Words: coronary artery disease, • mental stress, • platelet activation, • blood pressure, • depression.

Abbreviations: ACS = acute coronary syndromes;; ADP = adenosine diphosphate;; BMI = body mass index;; CAD = coronary artery disease;; HAD = Hospital Anxiety and Depression Scale;; PLAs = platelet-leukocyte aggregates.

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