Cortisol-Mediated Stress Response and Mortality in Acute Coronary Syndrome

Aladio, José Martín; Costa, Diego; Matsudo, Maia; Hoz, Alejo Pérez de la; González, Diego; Brignoli, A.; Swieszkowski, Sandra; Hoz, Ricardo Pérez de la

doi:10.1016/j.cpcardiol.2020.100623

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…However, this finding must be taken in context of sepsis, also another inflammatory state, but physiopathologically different to ACS [25–26]. Fibrinogen, d -dimer, and hsCRP are acute-phase reactants, so their elevation is expected in ACS as stress response markers [27]. Positive correlations with hsCRP were clearly significant to demonstrate the latter.…”

Section: Discussionmentioning

confidence: 89%

Association of hemostasis and inflammation biomarkers with outcomes in acute coronary syndromes

Matsudo

Aladio

Costa

et al. 2023

Blood Coagulation &Amp; Fibrinolysis

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Plaque rupture triggers a prothrombotic response that is counterbalanced by a fibrinolytic response. D-dimer serves as a marker of both processes. Inflammatory mediators are also released, evidenced with the rise of high-sensitive C reactive protein (hsCRP). Current evidence with these biomarkers has shown conflicting results. Determine an association between D-dimer and hsCRP within hospital and 1-year mortality in patients with acute coronary syndromes. In total, 127 patients were included. In-hospital mortality was 5.7%, and 1-year all-cause and cardiovascular mortality were 14.6 and 9.7%, respectively. The median of admission D-dimer for patients who died during hospital stay was higher than those who survived [4.59 (interquartile ranges (IQR) 1.94-6.05 mg/ml fibrinogen equivalent units (FEU)) vs. 0.56 (IQR 0.31-1.12 mg/ml FEU), P U 0.001]. At 1-year follow-up, the median of admission D-dimer for patients who died was significantly higher than those who survived: 1.55 (IQR 0.91-5.08 mg/ml FEU) vs. 0.53 (IQR 0.29-0.90 mg/ml FEU), P < 0.001. Positive D-dimer vs. negative D-dimer at admission analysis evidenced that almost 25% of the positive patients were dead at 1-year follow-up (22.4 vs. 2.4% negative D-dimer, P U 0.011). Multivariate logistic regression analysis showed that D-dimer has an independent association with 1-year mortality [odds ratio 1.06 (95% confidence interval 1.02-1.10), P U 0.006]. Positive significative correlations between D-dimer and hsCRP levels (R U 0.56, P < 0.001) were found. High levels of admission D-dimer were strongly associated with inhospital and 1-year mortality. Significant correlations with hsCRP could explain the inflammatory nature that led to poorer outcomes. D-dimer could be useful in risk stratification in acute coronary syndromes; however, a specific threshold should be defined for this type of patient.

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Section: Discussionmentioning

confidence: 89%

Association of hemostasis and inflammation biomarkers with outcomes in acute coronary syndromes

Matsudo

Aladio

Costa

et al. 2023

Blood Coagulation &Amp; Fibrinolysis

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“…Its internal autonomic component, ie the stress syndrome, which is realized through the mobilization of circulatory, respiratory functions, etc., is preserved and may even be more intense and prolonged than in the implementation of the behavioral response itself. This situation is characterized by the fact that the increased stress syndrome is manifested by prolonged and significant increases in the concentration of catecholamines and glucocorticoids in the blood [11][12][13].…”

Section: Damaging Stressful Situation and Adaptation To Itmentioning

confidence: 99%

Vision of the role of long-term social stress in the formation of "diseases of civilization". mechanisms of adaptation to stressor situations and factors of its failure

Hancheva

Romanova

2021

J Educ Health Sport

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Today, the issue of studying the mechanisms of the impact of social stress on public health and its role in the formation of key human diseases is relevant and necessary. A large number of works, both clinical observations and experimental studies, are devoted to this problem. However, despite the high interest in this problem, there are still "white spots". Therefore, the purpose of our study was to analyze modern sources of information that highlight current issues of long-term social stress and its role in the formation of "diseases of civilization." Matherials and methods: analysis of scientific publications from the following databases: Google Scholar, Web of Science, Pub Med, by keywords: rats, social stress, diseases of civilization, neuroendocrine regulation, hypothalamus, supraoptic nucleus, paravetricular nucleus. Conclusions: Thus, the analysis of resources shows the undoubted role of stress in the formation of human diseases. Many articles are devoted to the description and analysis of the negative effects of environmental factors and peculiarities of living conditions on human health. Most researchers agree on the key role of the hypothalamus in regulating the body's stress response and the presence of morphofunctional changes associated with stress. It is important to note that scientists have paid much attention to the study of individual models of stress, namely pain, immobilization and hypoxic over the past 20 years. Unfortunately, there are few facts concerning the analysis of the influence of long-term negative social factors that do not cause stereotyped reactions, but form latent changes that are inherent in classical stress reactions.

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“…Excessive or permanent release of cortisol promotes other pathological conditions (e.g., hypertension, glucose intolerance, hyperlipidaemia) linked to cardiovascular disease ( 19 ). Additionally, in the acute phase of coronary disease, studies show a correlation between higher cortisol levels and larger myocardial infarction size ( 20 , 21 ), arrhythmias and higher in-hospital mortality in acute coronary syndrome ( 22 , 23 ). Cortisol levels could be measured in hair, urine, blood or saliva.…”

Section: Introductionmentioning

confidence: 99%

High platelet adrenergic activity and concomitant activation of the pituitary/medullar axis as alarming laboratory parameters in ACS survivors—the STRESS-AMI study

Gulyás,

Horváth,

Hajtman

et al. 2024

Front. Cardiovasc. Med.

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IntroductionKinetics of stress-related biological parameters were determined in acute coronary syndrome (ACS) patients undergoing complex cardiovascular rehabilitation.MethodsWe determined platelet functionality in the absence/presence of a selective alpha-2 adrenergic receptor inhibitor, atipemazole parallel with salivary cortisol levels at enrolment, and at 3- and 12-months follow-up in 75 ACS patients with percutaneous coronary intervention.ResultsPharmacological/non-pharmacological secondary prevention methods have been efficiently applied. Baseline aggregometry indicated platelet hyperactivity, decreasing gradually and being significantly reduced late, at 12 months (p < 0.05). Cortisol levels followed similar kinetics (p < 0.05). Baseline epinephrine-induced aggregations (EIA) significantly correlated with most of the other platelet agonists, even at subsequent time-points. Patients with upper-quartile EIA at enrolment (EIA-UQ) had significantly higher ADP- and collagen-induced aggregations at enrolment, at 3- and 12-months follow-up as well, indicating that high adrenergic response in the acute phase is accompanied by general platelet hyperactivity and predicts sustained platelet activation. In the EIA-UQ group higher cardiac biomarker release, elevated C-reactive protein and cortisol levels, and lower baseline left ventricular ejection fraction were detected.Atipemazole significantly reduced platelet aggregation induced by several platelet agonists, being most potent and comparable to full in vitro P2Y12 inhibition on collagen-induced aggregations (p < 0.05), indicating that catecholamines might serve as promt/long-term modulators of platelet function.DiscussionDespite effective CCR programme and dual antiplatelet therapy, prolonged activation of sympathetic neuroendocrine system and general platelet hyperactivity can be detected up to one year in ACS patients with high adrenergic platelet activity. Moreover, initial high adrenergic activity is accompanied by clinical parameters associated to increased cardiovascular risk, therefore early identification of these patients might support complex optimal long-term therapy.

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Cortisol-Mediated Stress Response and Mortality in Acute Coronary Syndrome

Cited by 14 publications

References 24 publications

Association of hemostasis and inflammation biomarkers with outcomes in acute coronary syndromes

Association of hemostasis and inflammation biomarkers with outcomes in acute coronary syndromes

Vision of the role of long-term social stress in the formation of "diseases of civilization". mechanisms of adaptation to stressor situations and factors of its failure

High platelet adrenergic activity and concomitant activation of the pituitary/medullar axis as alarming laboratory parameters in ACS survivors—the STRESS-AMI study

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