Inflammatory response to mental stress and mental stress induced myocardial ischemia

Muhammad Hammadah, Samaah Sullivan, Brad Pearce, Ibhar Al Mheid, Kobina Wilmot, Ronnie Ramadan, Ayman Samman Tahhan, Wesley T. O'Neal, Malik Obideen, Ayman Alkhoder, Naser Abdelhadi, Heval Mohamed Kelli, Mohamad Mazen Ghafeer, Pratik Pimple, Pratik Sandesara, Amit J. Shah, Kareem Mohammed Hosny, Laura Ward, Yi An Ko, Yan V. SunLei Weng, Michael Kutner, J. Douglas Bremner, David S. Sheps, Fabio Esteves, Paolo Raggi, Viola Vaccarino, Arshed A. Quyyumi

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)90-97
Number of pages8
JournalBrain, Behavior, and Immunity
StatePublished - Feb 2018
Externally publishedYes


  • C reactive protein
  • Inflammation
  • Interleukin 6
  • Matrix metallopeptidase 9
  • Mental stress
  • Monocyte chemoattractant protein-1
  • Myocardial ischemia

ASJC Scopus subject areas

  • Immunology
  • Endocrine and Autonomic Systems
  • Behavioral Neuroscience


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