Evidence map›Paper›PMID 32522022›Full record

ArticleCirculation2020

Higher Activation of the Rostromedial Prefrontal Cortex During Mental Stress Predicts Major Cardiovascular Disease Events in Individuals With Coronary Artery Disease.

Kasra Moazzami, Matthew T Wittbrodt, Bruno B Lima, Jonathon A Nye, Puja K Mehta, Brad D Pearce, Zakaria Almuwaqqat, Muhammad Hammadah, Oleksiy Levantsevych, Yan V Sun and 7 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed
3.6field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 40 citations in OpenAlex.

  1. Trial
  2. Article
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. Psychosocial stress and cardiovascular disease.American journal of preventive cardiology · 2025
    Review
  10. Article
  11. Stress and cardiovascular disease: an update.Nature reviews. Cardiology · 2024
    Review
  12. Heart-brain axis: Pushing the boundaries of cardiovascular molecular imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2024
    Review
  13. Article
  14. Review
  15. Central stress pathways in the development of cardiovascular disease.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2024
    Review
  16. Article
  17. Article
  18. Article
  19. Review
  20. Mental Stress and Cardiovascular Health-Part I.Journal of clinical medicine · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 3 institutions in 2 countries.

Kasra MoazzamiDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Matthew T WittbrodtDepartment of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA.
Bruno B LimaDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Jonathon A NyeDepartment of Radiology and Imaging Sciences (J.A.N., E.V.G., J.D.B.), Emory University School of Medicine, Atlanta, GA.
Puja K MehtaEmory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology (K.M., B.B.L., P.K.M., Z.A., M.H., O.L., A.A.Q., V.V., A.J.S.), Emory University School of Medicine, Atlanta, GA.
Brad D PearceDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Zakaria AlmuwaqqatDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Muhammad HammadahEmory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology (K.M., B.B.L., P.K.M., Z.A., M.H., O.L., A.A.Q., V.V., A.J.S.), Emory University School of Medicine, Atlanta, GA.
Oleksiy LevantsevychEmory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology (K.M., B.B.L., P.K.M., Z.A., M.H., O.L., A.A.Q., V.V., A.J.S.), Emory University School of Medicine, Atlanta, GA.
Yan V SunDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Paolo RaggiMazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Canada (P.R.).
Ernest V GarciaDepartment of Radiology and Imaging Sciences (J.A.N., E.V.G., J.D.B.), Emory University School of Medicine, Atlanta, GA.
Margarethe GoetzDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Arshed A QuyyumiEmory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology (K.M., B.B.L., P.K.M., Z.A., M.H., O.L., A.A.Q., V.V., A.J.S.), Emory University School of Medicine, Atlanta, GA.
J Douglas BremnerDepartment of Psychiatry and Behavioral Sciences (M.T.W., J.D.B.), Emory University School of Medicine, Atlanta, GA.
Viola VaccarinoDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Amit J ShahDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (K.M., B.B.L., B.D.P., Z.A., Y.V.S., M.G., V.V., A.J.S.).
Emory University · USEmory Healthcare · USUniversity of Alberta · CA

Funding

Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE)UL1TR002378 · NCATS · EMORY UNIVERSITY · PI Andres J Garcia, Elizabeth O. Ofili · 2017 to 2026
$92.1M
Atlanta Clinical and Translational Science Institute (ACTSI) RenewalUL1TR000454 · NCATS · EMORY UNIVERSITY · PI STEPHENS, DAVID S · 2012 to 2016
$25.8M
Vascular Responses During Mental StressP01HL101398 · NHLBI · EMORY UNIVERSITY · PI SHEPS, DAVID SAMUEL · 2010 to 2015
$11.0M
Research Trainng in Academic CardiologyT32HL007745 · NHLBI · EMORY UNIVERSITY · PI TAYLOR, WILLIAM ROBERT · 1994 to 2023
$10.6M
J: NRSA Training CoreTL1TR002382 · NCATS · EMORY UNIVERSITY · PI HENRY M BLUMBERG, Vasiliki Michopoulos · 2017 to 2026
$8.5M
Mental Stress and Myocardial Ischemia after MI: Sex Differences, Mechanisms and PrognosisR01HL109413 · NHLBI · EMORY UNIVERSITY · PI VACCARINO, VIOLA · 2012 to 2023
$6.9M
Multidisciplinary Research Training to Reduce Inequities in Cardiovascular HealthT32HL130025 · NHLBI · EMORY UNIVERSITY · PI Tené T Lewis, Viola Vaccarino · 2016 to 2026
$6.4M
PTSD and Ischemic Heart Disease Progression: A Longitudinal Twin StudyR01HL125246 · NHLBI · EMORY UNIVERSITY · PI VACCARINO, VIOLA · 2015 to 2018
$3.4M
Atlanta Clinical and Translational Science Institute (ACTSI) RenewalKL2TR000455 · NCATS · EMORY UNIVERSITY · PI STEPHENS, DAVID S · 2012 to 2016
$2.9M
Mind-Body Interactions in Cardiovascular DiseaseK24HL077506 · NHLBI · EMORY UNIVERSITY · PI VACCARINO, VIOLA · 2004 to 2013
$1.5M
Biological Correlates of Traumatic StressK24MH076955 · NIMH · EMORY UNIVERSITY · PI BREMNER, JAMES DOUGLAS · 2006 to 2013
$946k
Emotional Stress as a Risk Factor for Arrhythmia: Ischemic and Genetic MechanismsK23HL127251 · NHLBI · EMORY UNIVERSITY · PI SHAH, AMIT JASVANT · 2016 to 2019
$749k
NCATS NIH HHS KL2 TR000455NCATS NIH HHS TL1 TR002382NCATS NIH HHS UL1 TR000454NCATS NIH HHS UL1 TR002378NHLBI NIH HHS K23 HL127251NHLBI NIH HHS K24 HL077506NHLBI NIH HHS P01 HL101398NHLBI NIH HHS R01 HL109413NHLBI NIH HHS R01 HL125246NHLBI NIH HHS R03 HL146879NHLBI NIH HHS T32 HL007745NHLBI NIH HHS T32 HL130025NIMH NIH HHS K24 MH076955
6 · The paper itself

Abstract

backgroundPsychological stress is a risk factor for major adverse cardiovascular events (MACE) in individuals with coronary artery disease. Certain brain regions that control both emotional states and cardiac physiology may be involved in this relationship. The rostromedial prefrontal cortex (rmPFC) is an important brain region that processes stress and regulates immune and autonomic functions. Changes in rmPFC activity with emotional stress (reactivity) may be informative of future risk for MACE.

methodsParticipants with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors and simultaneous brain imaging with high-resolution positron emission tomography brain imaging. We defined high rmPFC activation as a difference between stress and control scans greater than the median value for the entire cohort. Interleukin-6 levels 90 minutes after stress, and high-frequency heart rate variability during stress were also assessed. We defined MACE as a composite of cardiovascular death, myocardial infarction, unstable angina with revascularization, and heart failure hospitalization.

resultsWe studied 148 subjects (69% male) with mean±SD age of 62±8 years. After adjustment for baseline demographics, risk factors, and baseline levels of interleukin-6 and high-frequency heart rate variability, higher rmPFC stress reactivity was independently associated with higher interleukin-6 and lower high-frequency heart rate variability with stress. During a median follow-up of 3 years, 34 subjects (21.3%) experienced a MACE. Each increase of 1 SD in rmPFC activation with mental stress was associated with a 21% increase risk of MACE (hazard ratio, 1.21 [95% CI, 1.08-1.37]). Stress-induced interleukin-6 and high-frequency heart rate variability explained 15.5% and 32.5% of the relationship between rmPFC reactivity and MACE, respectively. Addition of rmPFC reactivity to conventional risk factors improved risk reclassification for MACE prediction, and C-statistic improved from 0.71 to 0.76 (

conclusionsGreater rmPFC stress reactivity is associated with incident MACE. Immune and autonomic responses to mental stress may play a contributory role.

Indexed as

NeuroimagingPositron-Emission TomographyAgedAngina, UnstableComorbidityCoronary Artery DiseaseDefault Mode NetworkEmotionsFemaleHeart Disease Risk FactorsHeart FailureHeart RateHospitalizationHumansInflammationInterleukin-6IL6 protein, humanInterleukin-6coronary artery diseaseheart rateinflammationprefrontal cortexstress, psychologicaltreatment outcome

Identifiers

PMID32522022
PMCPMC7677173
OpenAlexW3033092351

What OpenQuestion holds

Textmetadata
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Read underepoch 390

Registered trials

None linked

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.