This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kral, B. G. Articles by Becker, D. M. Search for Related Content PubMed PubMed Citation Articles by Kral, B. G. Articles by Becker, D. M. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Exercise for Children Exercise and Physical Fitness Stress Hazardous Substances DB THALLIUM, ELEMENTAL

(Circulation. 1997;96:4246-4253.)
© 1997 American Heart Association, Inc.

Articles

Exaggerated Reactivity to Mental Stress Is Associated With Exercise-Induced Myocardial Ischemia in an Asymptomatic High-Risk Population

Brian G. Kral, BA; Lewis C. Becker, MD; Roger S. Blumenthal, MD; Thomas Aversano, MD; Lee A. Fleisher, MD; Raphael M. Yook, MSPH; ; Diane M. Becker, ScD, MPH

From the Division of Cardiology and the Center for Health Promotion, the Johns Hopkins Medical Institutions, Baltimore, Md.

Correspondence to Diane M. Becker, Johns Hopkins Medical Institutions, Center for Health Promotion, 1830 E Monument St, Room 8033, Baltimore, MD 21205. E-mail dbecker{at}welchlink.welch.jhu.edu

Background This study was done to determine whether cardiovascular reactivity to mental stress is associated with exercise-induced occult ischemia in an asymptomatic population at high risk for premature coronary heart disease (CHD).

Methods and Results One hundred fifty-two siblings of persons with premature CHD underwent mental stress testing. Exercise thallium tomography and 24-hour Holter monitoring were also performed. Hemodynamic changes were monitored during both stressors. Siblings positive for exercise-induced ischemia were offered cardiac catheterization. During mental stress, siblings with an abnormal exercise ECG and/or thallium scan (n=15) had greater maximal increases in systolic blood pressure (SBP, P=.0004) and diastolic blood pressure (DBP, P=.05) and had greater heart rate variability in the normalized low frequency domain of an analysis of Holter monitor recordings, compared with siblings without exercise-induced ischemia. Coronary arteriography confirmed coronary atherosclerosis in 85% of siblings with exercise-induced ischemia. Regression analyses showed that occult ischemia during exercise was a strong independent predictor of maximal change in SBP and DBP during mental stress. A multivariate logistic model demonstrated that siblings with exercise-induced occult ischemia were 21 times more likely to be "hot" responders (top quartile of change in SBP and DBP) during mental stress.

Conclusions An exaggerated cardiovascular response to mental stress is associated with exercise-induced myocardial ischemia in persons with preclinical coronary heart disease.

Key Words: stress • ischemia • blood pressure • nervous system, autonomic

This article has been cited by other articles:

				R. Lampert, V. Shusterman, M. Burg, C. McPherson, W. Batsford, A. Goldberg, and R. Soufer Anger-induced T-wave alternans predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators. J. Am. Coll. Cardiol., March 3, 2009; 53(9): 774 - 778. [Abstract] [Full Text] [PDF]

				S. D. Holmes, D. S. Krantz, W. J. Kop, A. Del Negro, P. Karasik, and J. S. Gottdiener Mental Stress Hemodynamic Responses and Myocardial Ischemia: Does Left Ventricular Dysfunction Alter These Relationships? Psychosom Med, July 1, 2007; 69(6): 495 - 500. [Abstract] [Full Text] [PDF]

				P.C Strike and A Steptoe Systematic review of mental stress-induced myocardial ischaemia Eur. Heart J., April 2, 2003; 24(8): 690 - 703. [Full Text] [PDF]

				R. S. Blumenthal, D. M. Becker, L. R. Yanek, T. R. Aversano, T. F. Moy, B. G. Kral, and L. C. Becker Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population Circulation, February 11, 2003; 107(5): 702 - 707. [Abstract] [Full Text] [PDF]

				S. S. Knox, J. Hausdorff, and J. H. Markovitz Reactivity as a Predictor of Subsequent Blood Pressure: Racial Differences in the Coronary Artery Risk Development in Young Adults (CARDIA) Study Hypertension, December 1, 2002; 40(6): 914 - 919. [Abstract] [Full Text] [PDF]

				R. D. Lipman, P. Grossman, S. E. Bridges, J.W. Hamner, and J. A. Taylor Mental Stress Response, Arterial Stiffness, and Baroreflex Sensitivity in Healthy Aging J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2002; 57(7): B279 - 284. [Abstract] [Full Text]

				A. C. King, K. Baumann, P. O'Sullivan, S. Wilcox, and C. Castro Effects of Moderate-Intensity Exercise on Physiological, Behavioral, and Emotional Responses to Family Caregiving: A Randomized Controlled Trial J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2002; 57(1): M26 - 36. [Abstract] [Full Text] [PDF]

				B. M. Curtis and J. H. O'Keefe Jr Autonomic Tone as a Cardiovascular Risk Factor: The Dangers of Chronic Fight or Flight Mayo Clin. Proc., January 1, 2002; 77(1): 45 - 54. [Abstract] [PDF]

				K J Paavonen, H Swan, K Piippo, L Hokkanen, P Laitinen, M Viitasalo, L Toivonen, and K Kontula Response of the QT interval to mental and physical stress in types LQT1 and LQT2 of the long QT syndrome Heart, July 1, 2001; 86(1): 39 - 44. [Abstract] [Full Text] [PDF]

				A. W. Siegman, S. T. Townsend, A. C. Civelek, and R. S. Blumenthal Antagonistic Behavior, Dominance, Hostility, and Coronary Heart Disease Psychosom Med, March 1, 2000; 62(2): 248 - 257. [Abstract] [Full Text] [PDF]

				H. Schoder, D. H. Silverman, R. Campisi, J. W. Sayre, M. E. Phelps, H. R. Schelbert, and J. Czernin Regulation of myocardial blood flow response to mental stress in healthy individuals Am J Physiol Heart Circ Physiol, February 1, 2000; 278(2): H360 - H366. [Abstract] [Full Text] [PDF]

				A. Rozanski, J. A. Blumenthal, and J. Kaplan Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy Circulation, April 27, 1999; 99(16): 2192 - 2217. [Abstract] [Full Text] [PDF]