ArticleJAMA cardiology2019
Association of Transient Endothelial Dysfunction Induced by Mental Stress With Major Adverse Cardiovascular Events in Men and Women With Coronary Artery Disease.
Article in JAMA cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- Acute Psychological Stress and Pulse Wave Velocity: Meta-Analysis and Recommendations for Future Research.Psychophysiology · 2025Pooled it
- The Effects of Acute Exposure to Prolonged Sitting, With and Without Interruption, on Vascular Function Among Adults: A Meta-analysis.Sports medicine (Auckland, N.Z.) · 2020Pooled it
- The effectiveness of bench step exercise for ameliorating acute mental stress-induced arterial stiffening.European journal of applied physiology · 2022Trial
- From protection to predisposition: A narrative review of sex-specific vascular responses to acute stressors across the lifespan.Physiological reports · 2026Review
- Review
- [Tako-Tsubo syndrome associated with acute carbamate poisoning in Tunisia: a rare, multifactorial cardiac complication].Medecine tropicale et sante internationale · 2026Article
- Advancing Brain and Body Vascular Imaging in Bipolar Disorder: A Report From the International Society for Bipolar Disorders Vascular Task Force.Bipolar disorders · 2026Review
- Mental Disorders as Risk Factors for New Onset Cardiovascular Diseases.Biomedicines · 2026Review
- Dose-dependent association between elevated resting IL-6 levels and severity of mental stress-induced myocardial perfusion defects.Psychological medicine · 2026Article
- Inflammation and the Heart: The Role of Traditional Factors.Cardiology research and practice · 2026Review
- Occupational stress, cardiovascular vulnerability and sudden cardiac death in police officers: mechanisms and the protective role of structured exercise.Frontiers in public health · 2026Review
- Mental stress as a trigger of cardiovascular events: A narrative review.European journal of clinical investigation · 2026Review
- Bidirectional brain-heart communication in coronary heart disease: from coronary plaques to central autonomic networks.Frontiers in neuroscience · 2026Review
- Stress and Acute Coronary Syndrome.Cardiology research · 2025Review
- Mental stress is associated with coronary endothelial dysfunction in women with chest pain and non-obstructive coronary artery disease.International journal of cardiology. Heart & vasculature · 2025Article
- Imaging Findings Associated With Socioenvironmental Exposures Inform Mechanisms of Cardiovascular Disease.Arteriosclerosis, thrombosis, and vascular biology · 2025Review
- The Bidirectional Relationship Between Myocardial Infarction and Depression: Risk Factors, Mechanisms, and Interventions.Biomedicines · 2025Review
- Trigger Factors of Primary Cerebral Hemorrhage Onset: A Case-Crossover Study.Health science reports · 2025Article
- Alteration in epigenetic profile in subclinical atherosclerosis and in high uric acid.Scientific reports · 2025Article
- Psychosocial stress and cardiovascular disease.American journal of preventive cardiology · 2025Review
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Authors and funding
16 authors at 4 institutions in 1 country.
Funding
Abstract
Importance: Acute mental stress can result in transient endothelial dysfunction, but the prognostic relevance of this phenomenon is unknown. Objective: To determine the association between mental stress-induced impairment in endothelium-dependent relaxation as assessed by brachial artery flow-mediated vasodilation and adverse cardiovascular outcomes among individuals with stable coronary artery disease. Design, Setting, and Participants: This cohort study was conducted at a university-affiliated hospital network between June 2011 and August 2014. A cohort of individuals with stable coronary artery disease were included. Data analysis took place from November 2018 to May 2019. Exposures: Study participants were subjected to a laboratory mental stress task (public speaking). Main Outcomes and Measures: Flow-mediated vasodilation was measured before and 30 minutes after a public-speaking mental stress task. We examined the association of the rest (prestress), poststress, and δ flow-mediated vasodilation (poststress minus prestress levels) with an adjudicated composite end point of adverse events, including cardiovascular death, myocardial infarction, unstable angina leading to revascularization, and heart failure hospitalization, after adjusting for sociodemographic factors, medical history, and depression. Results: A total of 569 patients were included (mean [SD] age, 62.6 [9.3] years; 420 men [73.8%]). Flow-mediated vasodilation decreased from a mean (SD) of 4.8% (3.7%) before mental stress to 3.9% (3.6%) after mental stress (a 23% reduction; P < .001), and 360 participants (63.3%) developed transient endothelial dysfunction (a decrease in flow-mediated vasodilation). During a median (interquartile range) follow-up period of 3.0 (2.9-3.1) years, 74 patients experienced a major adverse cardiovascular event. The presence of transient endothelial dysfunction with mental stress was associated with a 78% increase (subdistribution hazard ratio [sHR], 1.78 [95% CI, 1.15-2.76]) in the incidence of major adverse cardiovascular event. Both the δ flow-mediated vasodilation (sHR, 1.15 [95% CI, 1.03-1.27] for each 1% decline) and poststress flow-mediated vasodilation (sHR, 1.14 [95% CI, 1.04-1.24] for each 1% decline) were associated with major adverse cardiovascular event. Risk discrimination statistics demonstrated a significant model improvement after addition of either poststress flow-mediated vasodilation (change in the area under the curve, 0.05 [95% CI, 0.01-0.09]) or prestress plus δ flow-mediated vasodilation (change in the area under the curve, 0.04 [95% CI, 0.00-0.08]) compared with conventional risk factors. Conclusions and Relevance: In this study, transient endothelial dysfunction with mental stress was associated with adverse cardiovascular outcomes in patients with coronary artery disease. Endothelial responses to stress represent a possible mechanism through which psychological stress may affect outcomes in patients with coronary artery disease.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.