In this review Roger Ho and colleagues discuss how stress hormones through affecting different components of the immune/inflammatory reaction may in turn contribute to the development of coronary artery disease (CAD).
Recent evidence indicates that acute and chronic psychological stress, such as intense anger, low socioeconomic status, work stress, social isolation, depression, anxiety and hostility are associated with the development of CAD.
Ho et al. outline the following mechanisms that may play a significant role in the pathogenesis of CAD:
- Effect of stress hormones on leukocytes circulation and trafficking , chemotaxis, endothelial dysfunction and expression of cell adhesion molecules
- Effect of stress on the production of proinﬂammatory cytokines
- The link between depression, infection and coronary artery disease
The authors explore some future directions, such as the possibility of modulating immunity through coping with stress and reducing the psychosocial risk for cardiac conditions, or through interventions such as cognitive therapy, relaxation training and behavioral modiﬁcations.
This may also include C-reactive protein monitoring that may identify the depressed or anxious patients who would most beneﬁt from a strategy of early prevention of cardiovascular disease, or the need for prospective studies of depressed patients, measuring a wide array of inﬂammatory markers in order to identify those which are superior to the others in predicting CAD.
SOURCE: Ann Acad Med Singapore 2010, 39(3): 191