Research & Publications
The Role of Stress and Emotional Factors in Incident Cardiovascular Disease Risk, and the Use of Behavioral Interventions to Reduce Risk
Our interest in the role of stress and emotion (e.g., anger, depression), including post-traumatic stress, has taken two approaches. We have been exploring mental stress provoked myocardial ischemia and cardiac arrhythmia, documenting the phenomenon in naturalistic and laboratory settings. This work has allowed us to identify the anger and stress related behavioral and emotional characteristics of individuals at risk for these phenomena, as well as the three fold greater risk of acute coronary events for people who experience these phenomena. Additional work has served to distinguish this form of ischemia from exercise provoked ischemia, both with regard to hemodynamic, vascular, inflammatory, and behavioral characteristics. Ongoing research is focused on the role of central nervous system mediation of inflammatory pathways, both chronically and dynamically. In addition, the relative importance of vascular function and processes by which vascular function is dynamically altered (e.g., inflammatory processes, autonomic modulation) are being explored. We have also been documenting the effects of acute stress and emotions such as anger on pro-arrhythmic processes in patients with implantable cardioverter defibrillators (ICD) and with atrial fibrillation. Past and current behavioral clinical trials test the effects of behavioral and psychotherapy interventions on event free survival in these populations,and on populations with depression after acute coronary syndrome events.
A second focus of our work is on hypertension - in particular the risk of hypertension as a function of combat exposure and post-traumatic stress in young military veterans - and the importance of sleep in modulating dynamic arterial stiffness in the natural setting. We are leveraging emerging technologies for ecological assessment of daily experiences in concert with continuous assessment of physiological indices important to vascular regulation.
Specialized Terms: role of emotion and stress on coronary heart disease; ischemia
Anesthesiology; Anger; Coronary Disease; Emotions; Heart Diseases; Ischemia; Stress, Psychological