Cardiac vagal control and dynamic responses to psychological stress among patients with coronary artery disease

doi:10.1016/S0002-9149(97)89295-8

The American Journal of Cardiology

Volume 78, Issue 12, 15 December 1996, Pages 1424-1427

https://doi.org/10.1016/S0002-9149(97)89295-8 Get rights and content

Abstract

This study indicates that variations in cardiac vagal control among coronary patients are related to cardiovascular responses to behavioral stress. With impaired vagal control, repeated demands of everyday life may produce exaggerated pressor and myocardial metabolic states that presage enhanced cardiovascular risk.

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Cited by (27)

An investigation of vago-regulatory and health-behavior accounts for increased inflammation in posttraumatic stress disorder
2016, Journal of Psychosomatic Research
Citation Excerpt :
For each 60-s segment, 256 points were analyzed, which included 240 sampled points with zero padding. Consistent with prior research [47–49], RSA was estimated from the R-R interval power summed across the high-frequency 0.13- to 0.50-Hz respiratory band. Raw RSA was log-transformed before analysis in order to normalize values.
Posttraumatic stress disorder (PTSD) has been linked to chronic inflammation, a condition that poses a risk for cardiovascular disease. Attenuated vagal activity has been proposed as a potential mediator of PTSD and inflammation, although associated behavioral health risks—namely cigarette smoking and alcohol dependence—might also account for that link.
Inflammation was quantified by fasting serum concentrations of C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-10, and thymus- and activation-regulated chemokine (TARC)/CCL17 collected from 85 participants with PTSD and 82 without PTSD. Latent variable modeling was used to assess the relationship between PTSD symptom severity and inflammation along with potential mediators vagal activity (respiratory sinus arrhythmia; RSA), smoking status, and lifetime alcohol dependence.
PTSD symptom severity was associated with increased inflammation (β = .18, p = .02). However, this association was reduced in models that adjusted for RSA, smoking status, and lifetime alcohol dependence. Independent mediation effects were deemed significant via bootstrapping analyses. Together, RSA, smoking status, and lifetime alcohol dependence accounted for 95% of the effect of PTSD symptom severity on inflammation.
Although RSA accounted for a modest proportion of the association between posttraumatic stress and pro-inflammatory responses, behavioral factors—specifically cigarette smoking and alcohol dependence—proved to be larger mediators. The benefits of PTSD treatment may be enhanced by additional interventions aimed at modifying these health behaviors.
Effects of lifestyle modification on the progression of coronary atherosclerosis, autonomic function, and angina - The role of GNB3 C825T polymorphism
2006, American Heart Journal
Citation Excerpt :
After a 5-minute adaptation phase, the protocol included a 30-minute supine deep resting period followed by metronomic breathing (at 9, 12, and 15 cpm). High-frequency heart rate variability (HF-HRV) and spectral analysis of baroreflex sensitivity (BRS) were calculated from the different paced breathing conditions, as previously described.14 Baseline heart rate was calculated from the mean of the supine electrocardiogram recordings at deep rest.
Given the multimodal medical and interventional treatment options in coronary artery disease, the additional value of intensified lifestyle modification is unclear. We have therefore examined the effects of lifestyle modification on top of current treatment and also associated with the GNB3 C825T polymorphism, which has established association to sympathetic activation and the precipitation of angina.
One hundred one patients with established coronary artery disease were randomized to a 1-year lifestyle modification group (lifestyle group [LG]) or an advice group. Risk factors, coronary calcification (electron beam tomography), heart rate variability, baroreflex sensitivity, anginal symptoms, and quality of life (QOL) were assessed on entry and after 1 year.
Patients in LG had excellent program adherence, but lifestyle modification had no impact on metabolic risk factors and coronary calcification. Changes in heart rate, heart rate variability, and blood pressure were only slightly favoring LG. Baroreflex sensitivity increased by 2 (0.79-3.13) ms/mm Hg in the LG but decreased by −0.10 (−1.11 to 0.92) in the advice group (P = .013). Lifestyle modification led to improved physical QOL, reductions of anginal attacks (−54% vs 11%, P = .01), and dose reductions in 30% of anti-ischemic medications (P = .004). *825T allele carriers had a more pronounced reduction of heart rate and improvement of angina and QOL. The beneficial effect on reduction of medication was seen in *825T allele carriers only.
In the presence of modern treatments, comprehensive lifestyle modification provides no additional benefits on progression of atherosclerosis but improves autonomic function, angina, and QOL with concomitant reduced need of medication. These responses are more pronounced in GNB3*825T allele carriers.
Effects of daily stress on autonomic cardiac control in patients with coronary artery disease
2004, American Journal of Cardiology
Emotional stress has been implicated in the development and progression of coronary artery disease, with 1 proposed causal pathway being changes in cardiac autonomic tone. One hundred thirty-five patients with coronary artery disease underwent 48 hours of ambulatory electrocardiographic monitoring and completed activity and mood diaries every 20 minutes while awake. Random-effects model analyses associated higher levels of negative emotions (e.g., anger, stress, sadness) with decreases in high- and low-frequency power, whereas higher levels of positive emotion were related to an increase in low-frequency power, independent of age, posture, and medications.
Predicting blood pressure reactivity and heart rate variability from mood state following coronary artery bypass surgery
2003, International Journal of Psychophysiology
Study objectives: Coronary Artery Bypass Graft (CABG) surgery is a common and successful procedure for revascularisation. However, the experience can induce emotional reactions prior to and following surgery. This study aimed to document changes in blood pressure (BP) reactivity and heart rate variability (HRV) following CABG surgery, and to determine the impact of mood state, particularly anxiety and depression upon cardiovascular functioning. Method: Twenty-two patients preparing to receive elective, first time CABG surgery were recruited from The Cardiothoracic Centre, Liverpool, UK and psychologically assessed using the Hospital Anxiety and Depression Scale (HAD), Global Mood Scale (GMS) and the Dispositional Resilience Scale (DRI). BP and heart rate responses were also measured during four conditions: baseline response; laboratory session; ambulatory monitoring; and self-initialised recordings during the ambulatory period. In addition, HRV was measured for 12 h in conjunction with the ambulatory monitoring period. All measures were assessed 1 week prior to surgery and 2 months following surgery. Results: A significant decrease in negative mood and an increase in positive mood were reported following surgery. Forty percent of patients were clinically anxious and depressed prior to surgery although this was reduced to 27% after surgery. Depression was the strongest independent predictor of pre-operative BP and HRV whilst anxiety was most significantly related to follow-up BP reactivity. DBP was most strongly predicted by mood state. Conclusions: These results suggest that patients with higher levels of anxiety and depression are at risk of reduced HRV and increased BP reactivity in response to mental stressors. The study also strongly suggests that current patient services should be expanded to acknowledge the role of psychological factors within clinical prognosis after CABG surgery.
Social anxiety and response to touch: Incongruence between self-evaluative and physiological reactions
2001, Biological Psychology
Touch is an important form of social interaction, and one that can have powerful emotional consequences. Appropriate touch can be calming, while inappropriate touch can be anxiety provoking. To examine the impact of social touching, this study compared socially high-anxious (N=48) and low-anxious (N=47) women's attitudes concerning social touch, as well as their affective and physiological responses to a wrist touch by a male experimenter. Compared to low-anxious participants, high-anxious participants reported greater anxiety to a variety of social situations involving touch. Consistent with these reports, socially anxious participants reacted to the experimenter's touch with markedly greater increases in self-reported anxiety, self-consciousness, and embarrassment. Physiologically, low-anxious and high-anxious participants showed a distinct pattern of sympathetic-parasympathetic coactivation, as reflected by decreased heart rate and tidal volume, and increased respiratory sinus arrhythmia, skin conductance, systolic/diastolic blood pressure, stroke volume, and respiratory rate. Interestingly, physiological responses were comparable in low and high-anxious groups. These findings indicate that social anxiety is accompanied by heightened aversion towards social situations that involve touch, but this enhanced aversion and negative-emotion report is not reflected in differential physiological responding.
The somatic symptom paradox in DSM-IV anxiety disorders: Suggestions for a clinical focus in psychophysiology
2001, Biological Psychology
Although DSM-IV criteria for anxiety disorders include physiological symptoms, these symptoms are evaluated exclusively by verbal report. The current review explores the background for this paradox and tries to demonstrate on theoretical and empirical grounds how it could be resolved, providing new insights about the role of psychophysiological measures in the clinic. The three-systems approach to evaluating anxiety argues that somatic measures as well as verbal and behavioral ones are indispensable. However, the low concordance between these domains of measurement impugns their reliability and validity. We argue that concordance can be improved by examining the relationship of variables less global than anxiety and by restriction to specific anxiety disorders. For example, recent evidence from our and other laboratories indicate a prominent role of self-reported and physiologically measured breathing irregularities in panic disorder. Nonetheless, even within a diagnosis, anxiety patients vary radically in which somatic variables are deviant. Thus, in clinical practice, individual profiles of psychological and physiological anxiety responses may be essential to indicate distinct therapeutic approaches and ways of tracking improvement. Laboratory provocations specific to certain anxiety disorders and advances in ambulatory monitoring vastly expand the scope of self-report and physiological measurement and will likely contribute to a refined assessment of anxiety disorders.

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¹: Dr. Grossman's address is: Lown Cardiovascular Research Laboratory, 21 Longwood Ave., Brookline, Massachusetts 02146.

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Brief reportCardiac vagal control and dynamic responses to psychological stress among patients with coronary artery disease

Abstract

Am J Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

The ability of several short-term measures of RR variability to predict mortality after myocardial infarction

Circulation

Reduced heart rate variability and mortality risk in an elderly cohort: The Framingham Heart Study

Circulation

Experimental studies of psychophysiological factors in sudden cardiac death

Acta Med Scand Suppl

Cardiac autonomic mechanisms associated with borderline hypertension under varying behavioral demands: evidence for attenuated parasympathetic tone but not for enhanced beta-adrenergic activity

Psychophysiology

Brief report
Cardiac vagal control and dynamic responses to psychological stress among patients with coronary artery disease