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(Circulation. 2000;102:2473.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Mental Stress Induces Transient Endothelial Dysfunction in Humans
From the Vascular Physiology Unit (L.G., A.E.D., M.J.M., G. Oakley, M.T., G. O’Connor, N.K., J.E.D.), Great Ormond Street Hospital for Children NHS Trust, the Department of Psychology (M.C., A.S.), St Georges Hospital, and the Department of Medicine (J.B.), Middlesex Hospital, London, UK.
Correspondence to Prof John E. Deanfield, Vascular Physiology Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1 3JH, UK.
Background—Mental stress has been linked to increased morbidity and mortality in coronary artery disease and to atherosclerosis progression. Experimental studies have suggested that damage to the endothelium may be an important mechanism.
Methods and Results—Endothelial function was studied in 10 healthy men (aged 50.4±9.6 years) and in 8 non–insulin-dependent diabetic men (aged 52.0±7.2 years). Brachial artery flow-mediated dilation (FMD, endothelium dependent) and response to 50 µg of sublingual glyceryl trinitrate (GTN, endothelium independent) were measured noninvasively by use of high-resolution ultrasound before and after (30, 90, and 240 minutes) a standardized mental stress test. The same protocol without mental stress was repeated on a separate occasion in the healthy men. In healthy subjects, FMD (5.0±2.1%) was significantly (P<0.01) reduced at 30 and 90 minutes after mental stress (2.8±2.3% and 2.3±2.4%, respectively) and returned toward normal after 4 hours (4.1±2.0%). Mental stress had no effect on the response to GTN. In the repeated studies without mental stress, FMD did not change. The diabetic subjects had lower FMD than did the control subjects (3.0±1.5% versus 5.0±2.1%, respectively; P=0.02) but showed no changes in FMD (2.7±1.1% after 30 minutes, 2.8±1.9% after 90 minutes, and 3.1±2.3% after 240 minutes) or GTN responses after mental stress.
Conclusions—These findings suggest that brief episodes of mental stress, similar to those encountered in everyday life, may cause transient (up to 4 hours) endothelial dysfunction in healthy young individuals. This might represent a mechanistic link between mental stress and atherogenesis.
Key Words: endothelium • atherosclerosis • mental stress • diabetes mellitus
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