Purpose of Review
In this review, we summarize evidence on the risk factor psychological stress in the context of coronary heart disease (CHD) in humans and explore the role of inflammation as a ...potential underlying mechanism.
Recent Findings
While chronic stress increases the risk of incident CHD and poor cardiovascular prognosis, acute emotional stress can trigger acute CHD events in vulnerable patients. Evidence supporting a potential role for inflammation as a promising biological mechanism comes from population-based studies showing associations between chronic stress and increased inflammation. Similarly, experimental studies demonstrate acute stress-induced increases in inflammatory markers and suggest modulatory potential for pharmacological and biobehavioral interventions. So far, studies investigating patients with cardiovascular disease are few and the full sequence of events from stress to inflammation to CHD remains to be established.
Summary
Psychological stress is an independent CHD risk factor associated with increased inflammation. Although promising, causality needs to be further explored.
The investigation of collective stress experiences, including collective stressors and the psychophysiological reactivity of a collective to these stressors, has been widely neglected so far. Here, ...we examined public non-professional orchestra concerts as collective naturalistic, real-life stressors of psychosocial nature and the resulting psychophysiological reactivity in a collective of non-professional orchestra musicians.
The members of two non-professional music orchestras (N = 54) were accompanied during a public concert (stress condition) and a rehearsal (control condition). We repeatedly assessed heart rate, salivary cortisol, and excitement levels before, during, and after the concert/rehearsal in addition to the anticipatory cognitive stress appraisal.
We observed greater physiological reactivity to the concert compared to the rehearsal (p’s ≤.017), with higher increases in heart rate levels in anticipation of and in reaction to the concert and in cortisol levels in reaction to the concert compared to the rehearsal. Moreover, orchestra members reported greater psychological reactivity to the concert than to the rehearsal (p’s ≤.024) in terms of higher cognitive stress appraisal in anticipation and increased excitement levels before and during the concert compared to the rehearsal.
Our findings indicate that orchestra concerts by non-professional musicians constitute collective naturalistic, real-life stressors of psychosocial nature, resulting in significant psychophysiological stress responses with reactivity kinetics differing between the sympathetic-adrenal-medullary axis, the hypothalamic-pituitary-adrenal axis, and the psychological response. Potential implications and modulating factors need to be elucidated in future studies.
•Orchestra concerts induce psychophysiological stress responses in non-professional musicians.•Thus, orchestra concerts constitute collective naturalistic stressors of psychosocial nature.•The reactivity kinetics differs between SAM axis, HPA axis, and psychological responses.•Anticipatory responses to orchestra concerts comprise SAM axis and psychological responses.•Reactive responses to orchestra concerts were observed for SAM axis and HPA axis.
Overweight and obesity have become a major health burden with a higher prevalence of obesity in women than in men. Mental stress has been discussed to play a role in this context.
We investigated ...endocrine mechanisms underlying eating after acute psychosocial stress and potential sex differences therein.
A total of 32 male and 31 female healthy participants underwent the Trier Social Stress Test before they tasted ice cream in a bogus taste test 15 minutes after stress. We repeatedly assessed the stress hormone cortisol and the satiety hormone cholecystokinin (CCK) in saliva as well as perceived hunger before and up to 1 hour after stress.
Lower immediate total cortisol stress reactivity predicted higher hunger (Ps ≤ .004), but was not associated with food intake (Ps ≥ .90) or total CCK release (Ps ≥ .84). As compared to men, women ate less after stress (Ps < .001) and had consistently lower levels of hunger (Ps ≤ .024) and cortisol (Ps ≤ .008) as well as a lower immediate total cortisol stress reactivity (Ps = .002). Further, they differed in the kinetics of CCK over the total experimental procedure (Ps ≤ .011), in immediate reaction to stress (Ps ≤ .038), and after eating (Ps ≤ .072), with women's CCK levels continuously decreasing while men's CCK levels were reactive.
We found evidence for lower immediate total cortisol stress reactivity relating to higher perceived hunger, with lower cortisol levels in women. Unlike in men, CCK levels in women were not reactive to acute stress and eating and decreased continuously. Our results may suggest a higher risk for stress-induced eating in women.
Abstract
Context
The renin-angiotensin-aldosterone system (RAAS) plays an important role in cardiovascular homeostasis and its dysfunction relates to negative health consequences. Acute psychosocial ...stress seems to activate the RAAS in humans, but stress kinetics and interrelations of RAAS parameters compared with a nonstress control group remain inconclusive.
Objective
We systematically investigated in a randomized placebo-controlled design stress kinetics and interrelations of the reactivity of RAAS parameters measured in plasma and saliva to standardized acute psychosocial stress induction.
Methods
58 healthy young men were assigned to either a stress or a placebo control group. The stress group underwent the Trier Social Stress Test (TSST), while the control group underwent the placebo TSST. We repeatedly assessed plasma renin, and plasma and salivary aldosterone before and up to 3 hours after stress/placebo. We simultaneously assessed salivary cortisol to validate successful stress induction and to test for interrelations.
Results
Acute psychosocial stress induced significant increases in all endocrine measures compared with placebo-stress (all P ≤ .041). Highest renin levels were observed 1 minute after stress, and highest aldosterone and cortisol levels 10 and 20 minutes after stress, with salivary aldosterone starting earlier at 1 minute after stress. Renin completed recovery at 10 minutes, cortisol at 60 minutes, salivary aldosterone at 90 minutes, and plasma aldosterone at 180 minutes after stress. Stress increase scores of all endocrine measures related to each other, as did renin and cortisol areas under the curve with respect to increase (AUCi) and salivary and plasma aldosterone AUCi (all P ≤ .047).
Conclusions
Our findings suggest that in humans acute psychosocial stress induces a differential and interrelated RAAS parameter activation pattern. Potential implications for stress-related cardiovascular risk remain to be elucidated.
The mineralocorticoid hormone aldosterone is a key regulator of the sodium–potassium balance and blood pressure. In excess, aldosterone relates to hypertension and cardiovascular disease (CVD). Here, ...we systematically investigated aldosterone secretion during the day in terms of salivary aldosterone awakening response (AldAR) and salivary aldosterone daytime levels (AldDay) under controlled conditions in participants’ natural environment including assessment of potential confounding variables.
In 40 healthy young men, saliva samples for AldAR were collected immediately after awakening and 15, 30, 45, and 60 min thereafter. AldDay levels were measured in 1 h intervals from 9:00–22:00 h. Analyses were complemented by salivary cortisol assessment. Fluid and food intake was standardized and as potential confounders, we assessed awakening time and sleep duration, age, BMI and MAP, as well as chronic stress.
Awakening was followed by significant increases in salivary aldosterone (p = .004, f= 0.31), returning to baseline levels > 60 min later. Longer sleep duration was associated with lower AldAR (p < .001, f= 0.36). Over the course of the day we observed a continuous decrease of AldDay (p < .001, f= 0.45). Longer sleep duration (p = .097, f= .21), later time of awakening (p < .001, f= .29), and higher chronic stress (p = .041, f= .23) were associated with AldDay characteristics. Circadian aldosterone secretion was positively associated with most cortisol measures.
We observed an awakening response in salivary aldosterone and could confirm a decrease in aldosterone levels during the day, comparable to cortisol. Significant confounders were sleep-related variables and chronic stress. Clinical implications of circadian aldosterone secretion with respect to CVD risk remain to be elucidated.
•Salivary aldosterone showed a response to awakening.•Salivary aldosterone levels decreased over the course of the day.•Sleep duration was associated with the salivary aldosterone awakening response.•Sleep duration, awakening time, and chronic stress related to daytime aldosterone.
Summary Physical activity plays a key role in the control of neuroendocrine, autonomic, and behavioral responses to physical and psychosocial stress. However, little is known about how the level of ...physical activity modulates stress responsiveness. Here, we test whether different levels of physical activity are associated with different adrenal, cardiovascular, and psychological responses to psychosocial stress. In addition, competitiveness is assessed as a personality trait that possibly modulates the relationship between physical activity and stress reactivity. Eighteen elite sportsmen, 50 amateur sportsmen, and 24 untrained men were exposed to a standardized psychosocial laboratory stressor (Trier Social Stress Test). Repeated measures of salivary free cortisol, heart rate, and psychological responses to psychosocial stress were compared among the 3 study groups. Elite sportsmen exhibited significantly lower cortisol, heart rate, and state anxiety responses compared with untrained subjects. Amateur sportsmen showed a dissociation between sympathetic and hypothalamic–pituitary–adrenal responsiveness to stress, with significantly reduced heart rate responses but no difference in cortisol responses compared with untrained men. Different levels of competitiveness among groups did not mediate stress reactivity. Our results are in line with previous studies indicating reduced reactivity of the autonomic nervous system to psychosocial stress in trained individuals. More importantly, these findings imply a differential effect of the level of physical activity on different stress-related neurophysiological systems in response to psychosocial stress.
Introduction While the effectiveness of cognitive-behavioral stress management trainings (SMTs) is well-documented, the underlying mechanisms, especially in an occupational context, are not fully ...understood. We tested whether SMT-induced improvements in stress management skills, particularly in the mastery of changing cognitions, may explain beneficial SMT effects. Methods Our non-randomized controlled trial comprised 108 employees of a German health insurance company, with 65 of them participating in a cognitive-behavioral SMT and 43 participating in an alternative control training (AT). As outcome variables, we repeatedly assessed stress-related (functional stress management skills, relaxation, stress reactivity, exhaustion), work-related (job dissatisfaction), and specific-context-related (social support, trait anger) measures at baseline, 2 weeks, and 3 months after the trainings. Functional stress management skills and, in particular, a subscale assessing perceived mastery of changing cognitions (“cognitive-strategies-and-problem-solving”) were tested as mediators of change. Results Repeated measures (M)AN(C)OVAs and complementary multigroup latent difference models confirmed improvements in all outcomes in the SMT-group compared to the AT-group ( p' s ≤ 0.015). Multivariate mediation path analyses revealed that, regarding mechanisms of change, the subscale cognitive-strategies-and-problem-solving was identified as the most important mediator for all outcomes (95% CIs for expected increases in SMT- vs. AT-group = lower limits (LLs) ≥ 0.004; 95% CIs for expected decreases in the SMT- vs. AT-group = upper limits(ULs) ≤ −0.078) except for job dissatisfaction. Discussion Our findings confirm that employees can effectively learn to master stress reduction techniques and consequently lower the resulting burden. Moreover, beneficial SMT effects seem to result from improvements in functional stress management skills, particularly in the ability to change cognitions. This points to the importance of training cognitive techniques.
DNA damage and the capacity to repair damaged DNA have been associated with the pathogenesis of several diseases such as cancer. While it is well known that external mutagenic agents can induce DNA ...damage, less is known about endogenous contributors to genomic instability. The aim of this study was to investigate whether excess body weight as a physiological factor and vital exhaustion as a psychological factor would be associated with basal levels of DNA damage as well as DNA repair capacity.
In a cross-sectional between-subject design we recruited 53 apparently healthy men within the normal to non-obese overweight range (mean BMI: 25.2 ± 0.5) who were either vitally exhausted (VE) (VE-score ≥ 10) or non-exhausted (VE-score ≤ 3). Vital exhaustion was assessed using the Maastricht Vital Exhaustion Questionnaire. We assessed DNA damage and repair in terms of strand breaks in PBMCs by means of the automated Fluorimetric Detection of Alkaline Unwinding (FADU) assay. DNA repair capacity was assessed by repeatedly measuring the amount of intact DNA up to 90 min after standardized X-irradiation of the cells.
General linear models revealed that elevated levels of basal DNA damage (β=−0.34, p=0.013, f=0.33) as well as impaired capacity to repair damaged DNA (F(1/50)=5.40, p=0.024, f=0.33) with increasing BMI, but not with vital exhaustion (p’s ≥ 0.63).
Our findings point to DNA integrity impairments with increasing BMI, already in the overweight range, and suggest impaired DNA repair as a potential underlying molecular mechanism. In contrast, the psychological factor vital exhaustion was not associated with DNA damage or DNA repair capacity.
•Already non-obese overweight (BMI<30) results in genomic instability in PBMCs of men.•Reduced DNA repair capacity might be a potential mechanism underlying the DNA damage with higher BMI.•Vital exhaustion is not associated with basal DNA damage or reduced DNA repair capacity.
Existing research indicates that not only own stress leads to physiological stress reactions, but also observing stress in others. So far, a standardized paradigm to reliably induce physiological ...stress contagion based on direct face-to-face stress observation compared to an active placebo-stress observing control condition is lacking. Here, we tested a standardized randomized placebo-controlled experimental paradigm to investigate physiological reactivity to direct stress observation and characterized the stress contagion response of the major endocrine stress systems, including full reactivity kinetics.
Healthy young male participants were randomly assigned to (1) undergo an adapted version of the Trier Social Stress Test (“TSST participants”, n = 20), (2) observe it (“stress observers”, n = 36), or (3) observe a corresponding placebo-stress control condition (“placebo-stress observers”, n = 30). We repeatedly assessed heart rate, salivary alpha-amylase, salivary cortisol, and salivary aldosterone.
Stress observers exhibited greater physiological reactivity to stress observation as compared to placebo-stress observers to placebo-stress observation in heart rate, salivary alpha-amylase, and cortisol (p’s ≤ .027), but not in aldosterone. We observed similar reactivity kinetics in TSST participants and stress observers but less pronounced in stress observers.
Extending previous literature, our findings indicate that independent of secondary effects of the observation setting, direct observation of stress in other individuals induces activation of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis. Moreover, the physiological stress contagion response resembles the physiological reactivity to first-hand stress but is less pronounced. Potential implications of physiological stress contagion regarding health, cognition, or behavior, as well as modulating factors need to be further elucidated.
•Introduction of a standardized controlled experimental stress contagion paradigm.•Stress observation induces a physiological stress contagion response.•Stress contagion reactivity resembles first-hand stress reactivity but less pronounced.•HPA and SAM axis are stress contagion responsive systems as opposed to the RAAS.
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