CORRESPONDENCE: LETTER TO THE EDITOR
Psychological Stress and Cardiovascular Disease With Emphasis on Acute Coronary Syndromes
Stephen K. Williams, MD* and
Karina W. Davidson, PhD
* Division of Cardiology, Emory University School of Medicine, 1639 Pierce Drive, Suite 319, Atlanta, Georgia 30322 (Email: Stephen.K.Williams.DMS01{at}Alum.Dartmouth.org).
We read with great interest the state-of-the-art report regarding psychological stress and cardiovascular disease by Dimsdale (1). The study did an excellent job of addressing the role of microvascular dysfunction in response to psychological stressors, and the concomitant impact this has on perfusion of the cardiovascular system.
Nonetheless, we were disappointed that there was no emphasis on the clinical consequences that stress has in actually triggering an overt acute coronary syndrome (ACS) (2,3). As we are all aware, the burden of ACS results in significant hospitalizations and mortality in our communities (4,5). We would like to emphasize that there are multiple excellent articles that lend credence to the high likelihood that stress leads to metabolic derangements that, in turn, serve as possible trigger(s) for an ACS (6–12).
Once again, we applaud a very concise summary on the importance of psychological stress and cardiovascular disease, but we hope that this letter provides a valuable addition to this article.
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1. Dimsdale JE. Psychological stress and cardiovascular disease J Am Coll Cardiol 2008;51:1237-1246.[Abstract/Free Full Text]2. Culic V, Eterovic D, Miric D. Meta-analysis of possible external triggers of acute myocardial infarction Int J Cardiol 2005;99:1-8.[CrossRef][Web of Science][Medline] 3. Kloner RA. Natural and unnatural triggers of myocardial infarction Prog Cardiovasc Dis 2006;48:285-300.[CrossRef][Web of Science][Medline] 4. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update J Am Coll Cardiol 2007;49:1230-1250.[Free Full Text] 5. Smith Jr. SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute J Am Coll Cardiol 2006;47:2130-2139.[Free Full Text] 6. Bhattacharyya MR, Steptoe A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications Prog Cardiovasc Dis 2007;49:353-365.[CrossRef][Web of Science][Medline] 7. Davidson KW. Emotional predictors and behavioral triggers of acute coronary syndrome Cleve Clin J Med 2008;75(Suppl 2):S15-S19.[Abstract/Free Full Text] 8. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology J Am Coll Cardiol 2005;45:637-651.[Abstract/Free Full Text] 9. Strike PC, Steptoe A. Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique Psychosom Med 2005;67:179-186.[Abstract/Free Full Text] 10. Strike PC, Magid K, Whitehead DL, Brydon L, Bhattachatyya MR, Steptoe A. Pathophysiological processes underlying emotional triggering of acute cardiac events Proc Natl Acad Sci U S A 2006;103:4322-4327.[Abstract/Free Full Text] 11. Thrall G, Lane D, Carroll D, Lip GY. A systematic review of the effects of acute psychological stress and physical activity on haemorheology, coagulation, fibrinolysis and platelet reactivity: implications for the pathogenesis of acute coronary syndromes Thromb Res 2007;120:819-847.[CrossRef][Web of Science][Medline] 12. Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies Circulation 2006;114:1863-1872.[Free Full Text]
Related Article
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Reply
- Joel E. Dimsdale
J. Am. Coll. Cardiol. 2009 53: 1339.
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