Viola Vaccarino, MD, PhD Professor and Chair, Department of Epidemiology Rollins School of Public Health Professor, Division of Cardiology Emory School of Medicine

Emotional Distress Stresses Cardiac Blood Vessels in Patients with Coronary Artery Disease Interview with:

Viola Vaccarino, MD, PhD Professor and Chair, Department of Epidemiology Rollins School of Public Health Professor, Division of Cardiology Emory School of Medicine

Dr. Vaccarino

Viola Vaccarino, MD, PhD
Wilton Looney Professor and Chair in Cardiovascular Research
Dept. of Epidemiology, Rollins School of Public Health
Professor, Dept. of Medicine, School of Medicine
Emory University What is the background for this study?

Response: Psychological stress has been linked to increased risk for cardiovascular disease. The mechanisms have not been clear. One hypothesis has been that chronic or repeated exposure to psychological stress can cause a phenomenon of “wear-and-tear” of the vascular system due to activation of the neuroendocrine stress systems, eventually leading to accelerated plaque formation and adverse cardiovascular events. However, this has never been demonstrated in humans.

In some individuals, psychological stress can induce a transitory impairment of the endothelium, a phenomenon known as endothelial dysfunction. A healthy endothelium is essential in blood flow regulation and in maintaining cardiovascular health. What are the main findings?

Response: Our study found that patients with coronary artery disease who develop endothelial dysfunction when exposed to an acute psychological stressor, have a higher risk of future adverse cardiovascular events. This is the first study to show that endothelial dysfunction induced by psychological stress is linked to adverse outcomes. What should readers take away from your report?

Response: Our results point to endothelial responses to psychological stress as a potential mechanism linking stress to adverse outcomes and disease progression in coronary disease patients. Although previous studies have examined endothelial dysfunction in the resting state as a prognostic factor, this is the first study to show  that the dynamic changes in endothelial function when exposed to stress are even more prognostic than the resting state. These data suggest that coronary endothelial function could represent an important mechanism linking daily emotional stress to cardiovascular outcomes, and could be the target for intervention in this vulnerable group of patients. What recommendations do you have for future research as a result of this work?

Response: We used a laboratory stressor; while this has allowed us to use a standardized protocol, we do not know for sure that mental stress testing in the lab captures physiological changes of stress in daily life. Future studies should address this.  Also, future studies should develop methods for mental stress testing that could be applied in the clinical care environment, and assess interventions that may ameliorate endothelial responses to stress or their adverse consequences.

I do not have disclosures. 


Lima BB, Hammadah M, Kim JH, et al. Association of Transient Endothelial Dysfunction Induced by Mental Stress With Major Adverse Cardiovascular Events in Men and Women With Coronary Artery Disease. JAMA Cardiol. Published online September 11, 2019. doi:10.1001/jamacardio.2019.3252


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Last Updated on September 13, 2019 by Marie Benz MD FAAD