Mental and physical stresses induce higher-than-normal levels of inflammatory markers in patients with coronary artery disease, according to study results published in the March 15th issue of the American Journal of Cardiology.

"The acute responses of inflammatory markers to challenges that are known triggers for acute coronary syndromes have not been investigated in patients with coronary artery disease," Dr. Willem J. Kop, of the University of Maryland Medical Center, Baltimore, and colleagues write. "The pathophysiologic mechanisms accounting for these adverse cardiovascular effects may involve autonomic nervous system and neurohormonally mediated immune system responses."

To investigate, the researchers studied 36 CAD patients (59 years, 33 per cent women) and 28 controls (54 years, 36 per cent women). Increases in inflammatory markers -- C-reactive protein (CRP), interleukin-6 (IL-6), and soluble intercellular adhesion molecule-1 (sICAM-1) -- in response to mental challenge tasks (anger recall and mental arithmetic) and treadmill exercise were measured. The team used stress echocardiography to rule out stress-induced ischemia as a possible confounding factor.

CRP responses were higher in the patients with CAD (0.19 mg/L) than control subjects (0.01 mg/L) with the mental arithmetic challenge (p = 0.003) and with exercise (0.57 versus 0.08 mg/L; p = 0.001).

An association was found between increased norepinephrine responses and larger CRP and IL-6 increases on mental challenge tasks.

"Exercise provoked significant responses in CRP, IL-6, and sICAM-1 (p < 0.005)," Dr. Kop and colleagues report. "Exercise induced substantially greater inflammatory increases than mental tasks."

The investigators conclude that mental stress and exercise induce larger increases in inflammatory markers related to a neurohormonal response in CAD patients than in healthy subjects. "Further research is needed," they say, "to examine whether increased inflammatory responsiveness to exogenous challenges is associated with increased risk of incident and recurrent cardiac events."

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