Highlights
- •The incidence of coronary artery disease in younger subjects is increasing in China.
- •Young adults, especially males, have faced increasing psychological stress in China.
- •Perceived stress is associated with activation of the sympathetic nervous system.
- •Perceived stress is a risk factor for coronary artery disease in young Chinese males.
Abstract
Background and purpose
Young Chinese male adults have faced increasing psychological stress. Whether this
is associated with the increased risk of coronary artery disease (CAD) in young Chinese
males remains unclear. This study aimed to evaluate the correlation and underlying
mechanisms of perceived stress and CAD in young male patients.
Methods
A total of 178 male patients diagnosed as young CAD (aged ≤55 years) by coronary angiography (CAG) were enrolled, and 181 age-matched non-CAD individuals
were set as control group. Traditional cardiovascular risk factors and levels of epinephrine
and norepinephrine were measured, and perceived stress status was accessed by Perceived
Stress Scale (PSS).
Results
The PSS score was correlated with levels of epinephrine (r = 0.45), norepinephrine (r = 0.41), high-sensitivity C-reactive protein (hs-CRP) (r = 0.38, p < 0.01), and current smoking (r = 0.32) (all p < 0.05). Multivariate logistic regression analysis showed that smoking (OR, 3.12; 95%CI,
1.23–7.91), triglycerides (OR, 1.42; 95%CI, 1.04–1.94), hs-CRP (OR, 3.57; 95%CI, 1.65–7.72),
and PSS score (OR, 1.81; 95%CI, 1.23–2.66) were independently correlated with CAD
in young patients. The association between PSS score and risk of CAD become insignificant
(OR, 1.43; 95%CI, 0.96–2.13) when further adjusted for the levels of epinephrine and
norepinephrine.
Conclusions
After adjustment for multiple cardiovascular risk factors, high perceived stress was
an independent risk factor for CAD in young Chinese male patients. Abnormal activation
of the sympathetic nervous system may play an important role linking perceived stress
with the risk of CAD.
Keywords
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References
- Global perspective on acute coronary syndrome: a burden on the young and poor.Circ Res. 2014; 114: 1959-1975
- Plasma oxidized low-density lipoprotein is an independent risk factor in young patients with coronary artery disease.Dis Markers. 2011; 31: 295-301
- Prevalence of metabolic syndrome in young patients with acute MI: does the Framingham Risk Score underestimate cardiovascular risk in this population?.Diab Vasc Dis Res. 2006; 3: 103-107
- Cardiovascular risk factors in young adults: a literature review.J Cardiovasc Nurs. 2014; https://doi.org/10.1097/JCN.0000000000000150
- Psychosocial risk factors for coronary heart disease.Med J Aust. 2013; 199: 179-180
- Perceived stress is associated with incident coronary heart disease and all-cause mortality in low- but not high-income participants in the Reasons for Geographic and Racial Differences in Stroke study.J Am Heart Assoc. 2013; 2: e447
- Meta-analysis of perceived stress and its association with incident coronary heart disease.Am J Cardiol. 2012; 110: 1711-1716
- Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study.J Intern Med. 2007; 261: 245-254
- Psychological factors and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong.Maturitas. 2010; 67: 186-191
- Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men.BMJ. 2002; 324: 1247-1251
- Perceived stress and risk of ischemic heart disease: causation or bias?.Epidemiology. 2006; 17: 391-397
- Poor sleep quality, stress status, and sympathetic nervous system activation in nondipping hypertension.Blood Press Monit. 2011; 16: 117-123
- Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality.Am Heart J. 2008; 156: 277-283
- Cardiac computed tomography and myocardial perfusion scintigraphy for risk stratification in asymptomatic individuals without known cardiovascular disease: a position statement of the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology.Eur Heart J. 2011; 32 (1986-1993, 93a, 93b.)
- Can CT angiography replace catheter coronary angiography?.EuroIntervention. 2010; 6: G65-G71
- Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke.BMC Public Health. 2010; 10: 513
- Patterns and correlates of stress among rural Chinese males: a four-region study.Public Health. 2009; 123: 694-698
- Hyperhomocysteinemia is an independent risk factor in young patients with coronary artery disease in southern China.Herz. 2013; 38: 779-784
- Angiotensin II plays an important role in maintaining blood pressure in postmenopausal women receiving hormone replacement therapy.Am J Hypertens. 2005; 18: 1340-1346
- The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.JAMA. 2003; 289: 2560-2572
- Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus.Diabetes Care. 2003; 26: S5-S20
- Joint Committee for Developing Chinese guidelines on Prevention and Treatment of Dyslipidemia in Adults. [Chinese guidelines on prevention and treatment of dyslipidemia in adults].Zhonghua Xin Xue Guan Bing Za Zhi. 2007; 35: 390-419
- Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population.Zhonghua Liu Xing Bing Xue Za Zhi. 2002; 23: 5-10
- Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease.J Am Soc Nephrol. 2006; 17: 2937-2944
- Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy.Circulation. 1999; 99: 2192-2217
- Stress and lipoprotein metabolism: modulators and mechanisms.Metabolism. 1993; 42: 3-15
- Exaggerated blood pressure responses during mental stress are prospectively related to enhanced carotid atherosclerosis in middle-aged Finnish men.Circulation. 2004; 110: 2198-2203
- Delayed blood pressure recovery after psychological stress is associated with carotid intima-media thickness: Whitehall psychobiology study.Arterioscler Thromb Vasc Biol. 2006; 26: 2547-2551
- Stress, inflammation and cardiovascular disease.J Psychosom Res. 2002; 52: 1-23
- Mental stress induces transient endothelial dysfunction in humans.Circulation. 2000; 102: 2473-2478
- Association of a serotonin transporter polymorphism (5-HTTLPR) with depression, perceived stress, and norepinephrine in patients with coronary disease: the Heart and Soul Study.Am J Psychiatry. 2007; 164: 1379-1384
- Panic disorder, anxiety, and cardiovascular diseases.Clin Neuropsychiatry. 2014; 11: 130-144
- An epidemiological study on stress among urban residents in social transition period.Zhonghua Liu Xing Bing Xue Za Zhi. 2003; 24: 760-764
- The benefits of interventions for work-related stress.Am J Public Health. 2001; 91: 270-276
Article info
Publication history
Published online: August 18, 2015
Accepted:
August 6,
2015
Received in revised form:
August 5,
2015
Received:
February 2,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
