Study first to connect stress-associated brain activity with cardiovascular risk

January 11, 2017, Massachusetts General Hospital
Credit: Tawakol et al, 2017, The Lancet

A study led by Massachusetts General Hospital (MGH) and Icahn School of Medicine at Mount Sinai (ISSMS) investigators has linked, for the first time in humans, activity in a stress-sensitive structure within the brain to the risk of subsequent cardiovascular disease. The team's findings, being published in the journal The Lancet, also reveals a pathway leading from activation of that structure—the amygdala—through elevated immune system activity to an increased incidence of cardiovascular events.

"While the link between and heart disease has long been established, the mechanism mediating that risk has not been clearly understood," says Ahmed Tawakol, MD, co-director of the Cardiac MR PET CT Program in the MGH Division of Cardiology and lead author of the paper. "Animal studies have shown that stress activates bone marrow to produce white blood cells, leading to arterial inflammation, and this study suggests an analogous path exists in humans. Moreover, this study identifies, for the first time in animal models or humans, the region of the brain that links stress to the risk of heart attack and stroke."

The paper reports on two complementary studies. The first, conducted at MGH, analyzed imaging and medical records data from almost 300 individuals who had PET/CT brain imaging, primarily for cancer screening, using a radiopharmaceutical called FDG that both measures the activity of areas within the brain and also reflects inflammation within arteries. All participants in that study had no active cancer or at the time of imaging and each had information in their medical records on at least three additional clinical visits in the two to five years after imaging. The second study, conducted at the Translational and Molecular Imaging Institute (TMII) at ISMMS in New York, enrolled 13 individuals with a history of , who were evaluated for their current levels of perceived stress and received FDG-PET scanning to measure both amygdala activity and arterial inflammation.

Among participants in the larger, longitudinal study, 22 experienced a cardiovascular event—such as a heart attack, stroke or episodes of angina—in the follow-up period; and the prior level of activity in the amygdala strongly predicted the risk of a subsequent cardiovascular event. That association remained significant after controlling for traditional , and after controlling for presence of symptom-free atherosclerosis at the time of imaging. The association became even stronger when the team used a more stringent definition of cardiovascular events—major .

Amygdalar activity was also associated with the timing of events, as those with the highest levels of activity had events sooner than those with less extreme elevation, and greater amygdalar activity was also linked to elevated activity of the blood-cell-forming tissue in the bone marrow and spleen and to increased arterial inflammation. In the smaller study, participants' current stress levels were strongly associated with both amygdalar activity and arterial inflammation.

Co-senior author Zahi A. Fayad, PhD, vice-chair for Research in the Department of Radiology and the director of TMII at ISMMS in New York, says, "This pioneering study provides more evidence of a heart-brain connection, by elucidating a link between resting metabolic activity in the amygdala, a marker of stress, and subsequent independently of established cardiovascular risk factors. We also show that amygdalar activity is related to increased associated perceived stress and to an increased vascular inflammation and hematopoeitic activity."

Tawakol adds, "These findings suggest several potential opportunities to reduce cardiovascular risk attributable to stress. It would be reasonable to advise individuals with increased risk of cardiovascular disease to consider employing stress-reduction approaches if they feel subjected to a high degree of psychosocial stress. However, large trials are still needed to confirm that stress reduction improves . Further, pharmacological manipulation of the amygdalar-bone marrow-arterial axis may provide new opportunities to reduce cardiovascular disease. In addition, increased stress associates with other diseases, such as cancer and inflammatory conditions, including rheumatoid arthritis and psoriasis. So it will be important to evaluate whether calming this stress mechanism produces benefits in those diseases as well."

Explore further: Signs of stress in the brain may signal future heart trouble

More information: The Lancet, DOI: 10.1016/S0140-6736(16)31714-7, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31714-7/fulltext

Related Stories

Signs of stress in the brain may signal future heart trouble

March 24, 2016
New research shows that individuals with a greater degree of activity in the stress center of the brain also have more evidence of inflammation in their arteries and were at higher risk for cardiovascular events, including ...

Review links anxiety disorders to risk of cardiovascular events

August 15, 2016
(HealthDay)—Anxiety disorders are associated with a range of cardiovascular events, according to a meta-analysis published in the Aug. 15 issue of The American Journal of Cardiology.

Cardiovascular event risk of RA patients comparable to type-2 diabetes over 15-year period

November 13, 2016
Rheumatoid arthritis is associated with serious risk of cardiovascular (CV) disease events such as heart attack or stroke. Over a 15-year period, people with RA may have double the risk of CV events as those in the general ...

Antiretroviral therapy may not be enough to reduce HIV-associated arterial inflammation

May 25, 2016
Initiating antiretroviral therapy (ART) soon after diagnosis of an HIV infection did not prevent the progression of significant arterial inflammation in a small group of previously untreated patients. The findings from a ...

Being fit protects against health risks caused by stress at work

November 1, 2016
It is a well-known fact that fitness and well-being go hand in hand. But being in good shape also protects against the health problems that arise when we feel particularly stressed at work. As reported by sports scientists ...

Study links depression to arterial stiffness during stress

March 14, 2014
(Medical Xpress)—According to a study by researchers at Emory's Rollins School of Public Health, symptoms of depression are associated with an increase in arterial stiffness induced by mental stress. Arterial stiffness ...

Recommended for you

Study reveals a promising alternative to corticosteroids in acute renal failure treatment

September 21, 2018
A protein produced by the human body appears to be a promising new drug candidate to treat conditions that lead to acute renal failure. This is shown by a study conducted at São Paulo State University (UNESP) in São José ...

Can a common heart condition cause sudden death?

September 20, 2018
About one person out of 500 has a heart condition known as hypertrophic cardiomyopathy (HCM). This condition causes thickening of the heart muscle and results in defects in the heart's electrical system. Under conditions ...

New drugs could reduce risk of heart disease when added to statins

September 20, 2018
New drugs that lower levels of triglycerides (a type of fat) in blood could further reduce the risk of heart attack when added to statins. These new drugs, which are in various stages of development, could also reduce blood ...

Mediterranean-style diet may lower women's stroke risk

September 20, 2018
Following a Mediterranean-style diet may reduce stroke risk in women over 40 but not in men—according to new research led by the University of East Anglia.

Inflammation critical for preventing heart attacks and strokes, study reveals

September 19, 2018
Inflammation, long considered a dangerous contributor to atherosclerosis, actually plays an important role in preventing heart attacks and strokes, new research from the University of Virginia School of Medicine reveals.

People who walk just 35 minutes a day may have less severe strokes

September 19, 2018
People who participate in light to moderate physical activity, such as walking at least four hours a week or swimming two to three hours a week, may have less severe strokes than people who are physically inactive, according ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.