Mental Stress-Induced Change in Plasma Stromal Cell-Derived Factor-1 and Adverse Cardiovascular Outcomes: A Cohort
Jeong Hwan Kim1, Zakaria Almuwaqqat1, Afif Martini1
1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
An increase in Stromal cell-derived factor 1 (SDF1) after mental stress predicts adverse outcomes in coronary artery disease (CAD) patients. This rise in SDF1 indicates a higher risk for death and myocardial infarction, independent of ischemia.
Area of Science:
- Cardiology
- Biomarkers
- Psychocardiology
Background:
- Acute psychological stress can trigger myocardial ischemia in coronary artery disease (CAD) patients.
- Stromal cell-derived factor 1 (SDF1), released during hypoxia, is linked to adverse outcomes.
- The study investigates SDF1's predictive value for adverse events in CAD patients under mental stress.
Purpose of the Study:
- To determine if elevated SDF1 levels following mental stress predict adverse cardiovascular events in patients with stable CAD.
- To assess the association between changes in SDF1 levels and the risk of death, myocardial infarction, and heart failure hospitalization.
Main Methods:
- 554 stable CAD patients underwent standardized mental stress testing.
- Plasma SDF1 levels were measured at rest and 90 minutes post-stress.
- Outcomes (death, MI, heart failure hospitalization) were tracked over 5 years using Cox hazard models.
Main Results:
- A one standard deviation increase in SDF1 post-stress correlated with a 32% higher risk of death and MI.
- This association remained significant regardless of resting SDF1, clinical factors, or ischemia.
- A similar SDF1 rise also increased the risk of the secondary composite endpoint by 33%.
Conclusions:
- Increased SDF1 levels in response to mental stress are an independent predictor of adverse cardiovascular events in stable CAD.
- The findings highlight SDF1 as a potential biomarker for risk stratification in CAD patients experiencing psychological stress.
Background:
Acute psychological stress can provoke mental stress-induced myocardial ischemia (MSIMI) in coronary artery disease (CAD). Stromal cell-derived factor 1 (SDF1) is released in response to hypoxia, and higher levels of SDF1 are associated with adverse outcomes. We examined whether an increase in SDF1 level in response to mental stress predicts adverse outcomes in CAD patients.
Methods:
A total of 554 patients with stable CAD (mean age 63 years; 76% male; 26% Black) underwent standardized mental stress testing. Plasma SDF1 levels were measured at rest and 90 minutes after mental stress, and MSIMI was evaluated by 99mTc-sestamibi perfusion imaging. Participants were followed for 5 years for the primary endpoint of composite of death and myocardial infarction (MI) and the secondary endpoint of composite of death, MI, and heart failure hospitalization. Cox hazard models were used to assess the association between SDF1 change and incident adverse events.
Results:
Mean (standard deviation) SDF1 change with mental stress was +56.0 (230) pg/mL. During follow-up, a rise of 1 standard deviation in SDF1 with mental stress was associated with a 32% higher risk for the primary endpoint of death and MI (95% confidence interval, 6%-64%), independent of the resting SDF1 level, demographic and clinical risk factors, and presence of ischemia. A rise of 1 standard deviation in SDF1 was associated with a 33% (95% confidence interval, 11%-59%) increase in the risk for the secondary endpoint, independent of the resting SDF1 level, demographic, and clinical risk factors and presence of ischemia.
Conclusions:
An increase in SDF1 level in response to mental stress is associated with a higher risk of adverse events in stable CAD, independent of MSIMI.
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