Anesthesiology; Anger; Coronary Disease; Emotions; Heart Diseases; Ischemia; Stress, Psychological
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
Mental stress-induced myocardial ischemia: moving forward
Burg MM, Soufer R. Mental stress-induced myocardial ischemia: moving forward. J Nucl Cardiol 2007 14:308-13.
Risk for incident hypertension associated with PTSD in military veterans, and the effect of PTSD treatment
Burg MM, Brandt C, Buta E, Schwartz J, Bathulapalli H, Dziura J, Edmondson DE, Haskell S. Risk for incident hypertension associated with PTSD in military veterans, and the effect of PTSD treatment. Psychosom Med 2016 Aug 3
Ambulatory medical follow-up in the year after surgery and subsequent survival in a national cohort of veterans health administration surgical patients
Schonberger RB, Dai F, Brandt C, Burg MM. Ambulatory medical follow-up in the year after surgery and subsequent survival in a national cohort of veterans health administration surgical patients. J Cardiothorac Vasc Anesth 2016;30:671-9.
The confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion
Burg MM, Meadows J, Shimbo D, Davidson KD, Schwartz JS, Soufer R. The confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion. J Am Heart Assoc 2014 Oct 30;3(6):e000898.
Endothelial cell activation, reduced endothelial cell reparative capacity, and impaired endothelial-dependent vasodilation after anger provocation
Shimbo D, Rosenberg LB, Chaplin W, Zhao S, Goldensohn ER, Cholankeril M, Fu J, Hong SB, Jelic S, Burg MM. Endothelial cell activation, reduced endothelial cell reparative capacity, and impaired endothelial-dependent vasodilation after anger provocation. Int J Cardiol 2013;167:1064-5.
Post-traumatic stress disorder and cardiovascular disease
Burg MM, Soufer R. Post-traumatic stress disorder and cardiovascular disease. Curr Cardiol Rep 2016;18:1-7.
Autonomic contribution to endothelin-1 increase during laboratory anger-recall stress in patients with coronary artery disease
Burg MM, Soufer A, Lampert R, Collins D, Soufer R. Autonomic contribution to endothelin-1 increase during laboratory anger-recall stress in patients with coronary artery disease. Mol Med 2011;17:495-501.
Tendency to angry rumination predicts stress-provoked endothelin-1 increase in patients with coronary artery disease
Fernandez AB, Soufer R, Collins D, Soufer R, Ranjbaran H, Burg MM. Tendency to angry rumination predicts stress-provoked endothelin-1 increase in patients with coronary artery disease. Psychosom Med 2010;72:348-53.
Full List of PubMed Publications
- Burg MM, Schwartz JE, Kronish IM, Diaz KM, Alcantara C, Duer-Hefele J, Davidson KW: Does Stress Result in You Exercising Less? Or Does Exercising Result in You Being Less Stressed? Or Is It Both? Testing the Bi-directional Stress-Exercise Association at the Group and Person (N of 1) Level. Ann Behav Med. 2017 Mar 13; 2017 Mar 13. PMID: 28290065
- Soufer R, Burg MM: The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm? J Nucl Cardiol. 2017 Feb 2; 2017 Feb 2. PMID: 28155190
- Vadivelu N, Chang D, Lumermann L, Suchy T, Burg MM, Fontes ML: Management of Patients on Abuse-Deterrent Opioids in the Ambulatory Surgery Setting. Curr Pain Headache Rep. 2017 Feb. PMID: 28251526
- Burg MM, Brandt C, Buta E, Schwartz J, Bathulapalli H, Dziura J, Edmondson DE, Haskell S: Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment. Psychosom Med. 2017 Feb/Mar. PMID: 27490852
- Schwartz JE, Burg MM, Shimbo D, Broderick JE, Stone AA, Ishikawa J, Sloan R, Yurgel T, Grossman S, Pickering TG: Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population: Results From the Masked Hypertension Study. Circulation. 2016 Dec 6. PMID: 27920072
- Burg MM, Soufer R: Post-traumatic Stress Disorder and Cardiovascular Disease. Curr Cardiol Rep. 2016 Oct. PMID: 27566327
- Akhtar S, Liu J, Heng J, Dai F, Schonberger RB, Burg MM: Does intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations: a study of contemporary practice. J Clin Anesth. 2016 Sep; 2016 May 3. PMID: 27555166
- Schonberger RB, Dai F, Brandt C, Burg MM: Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients. J Cardiothorac Vasc Anesth. 2016 Jun; 2015 Dec 15. PMID: 27021176
- Soufer R, Fernandez AB, Meadows J, Collins D, Burg MM: Body mass index and risk for mental stress induced ischemia in coronary artery disease. Mol Med. 2016 May 19; 2016 May 19. PMID: 27261777
- Crowley OV, Kimhy D, McKinley PS, Burg MM, Schwartz JE, Lachman ME, Tun PA, Ryff CD, Seeman TE, Sloan RP: Vagal Recovery From Cognitive Challenge Moderates Age-Related Deficits in Executive Functioning. Res Aging. 2016 May; 2015 Aug 23. PMID: 26303063
- Schonberger RB, Dai F, Brandt CA, Burg MM: Balancing Model Performance and Simplicity to Predict Postoperative Primary Care Blood Pressure Elevation. Anesth Analg. 2015 Sep. PMID: 26214552
- Schonberger RB, Feinleib J, Holt N, Dai F, Brandt C, Burg MM: Preoperative depression symptom severity and its impact on adherence to preoperative beta-blocker therapy. J Cardiothorac Vasc Anesth. 2014 Dec; 2014 Sep 26. PMID: 25263776
- Yammine L, Frazier L, Padhye NS, Burg MM, Meininger JC: Severe depressive symptoms are associated with elevated endothelin-1 in younger patients with acute coronary syndrome. J Psychosom Res. 2014 Nov; 2014 Aug 2. PMID: 25129849
- Burg MM, Meadows J, Shimbo D, Davidson KW, Schwartz JE, Soufer R: Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion. J Am Heart Assoc. 2014 Oct 30; 2014 Oct 30. PMID: 25359402
- Ye S, Shaffer JA, Rieckmann N, Schwartz JE, Kronish IM, Ladapo JA, Whang W, Burg MM, Davidson KW: Long-term outcomes of enhanced depression treatment in patients with acute coronary syndromes. Am J Med. 2014 Oct; 2014 May 14. PMID: 24835038
- Schonberger RB, Brandt C, Feinleib J, Dai F, Burg MM: Atenolol is associated with lower day-of-surgery heart rate compared to long- and short-acting metoprolol. J Cardiothorac Vasc Anesth. 2013 Apr; 2012 Aug 11. PMID: 22889605
- Schonberger RB, Lukens CL, Turkoglu OD, Feinleib JL, Haspel KL, Burg MM: β-blocker withdrawal among patients presenting for surgery from home. J Cardiothorac Vasc Anesth. 2012 Dec; 2012 Mar 13. PMID: 22418043
- Schonberger RB, Burg MM, Holt N, Lukens CL, Dai F, Brandt C: The relationship between preoperative and primary care blood pressure among veterans presenting from home for surgery: is there evidence for anesthesiologist-initiated blood pressure referral? Anesth Analg. 2012 Jan; 2011 Nov 10. PMID: 22075017
- Burg MM, Soufer A, Lampert R, Collins D, Soufer R: Autonomic contribution to endothelin-1 increase during laboratory anger-recall stress in patients with coronary artery disease. Mol Med. 2011 May-Jun; 2011 Jan 19. PMID: 21267513
- Burg MM, Martens EJ, Collins D, Soufer R: Depression predicts elevated endothelin-1 in patients with coronary artery disease. Psychosom Med. 2011 Jan; 2010 Oct 14. PMID: 20947777
- Fernandez AB, Soufer R, Collins D, Soufer A, Ranjbaran H, Burg MM: Tendency to angry rumination predicts stress-provoked endothelin-1 increase in patients with coronary artery disease. Psychosom Med. 2010 May; 2010 Apr 5. PMID: 20368479
- Donahue RG, Lampert R, Dornelas E, Clemow L, Burg MM, RISTA Investigators.: Rationale and design of a randomized clinical trial comparing stress reduction treatment to usual cardiac care: the Reducing Vulnerability to Implantable Cardioverter Defibrillator Shock-Treated Ventricular Arrhythmias (RISTA) trial. Psychosom Med. 2010 Feb; 2009 Dec 22. PMID: 20028832
- Burg MM, Graeber B, Vashist A, Collins D, Earley C, Liu J, Lampert R, Soufer R: Noninvasive detection of risk for emotion-provoked myocardial ischemia. Psychosom Med. 2009 Jan; 2008 Oct 21. PMID: 18941131
- Stopper M, Joska T, Burg MM, Batsford WP, McPherson CA, Jain D, Lampert R: Electrophysiologic characteristics of anger-triggered arrhythmias. Heart Rhythm. 2007 Mar; 2006 Nov 10. PMID: 17341385
- Soufer R, Burg MM: The heart-brain interaction during emotionally provoked myocardial ischemia: implications of cortical hyperactivation in CAD and gender interactions. Cleve Clin J Med. 2007 Feb. PMID: 17455547
- Shah R, Burg MM, Vashist A, Collins D, Liu J, Jadbabaie F, Graeber B, Earley C, Lampert R, Soufer R: C-reactive protein and vulnerability to mental stress-induced myocardial ischemia. Mol Med. 2006 Nov-Dec. PMID: 17380191
- Lampert R, Shusterman V, Burg MM, Lee FA, Earley C, Goldberg A, McPherson CA, Batsford WP, Soufer R: Effects of psychologic stress on repolarization and relationship to autonomic and hemodynamic factors. J Cardiovasc Electrophysiol. 2005 Apr. PMID: 15828878
- Soufer R, Arrighi JA, Burg MM: Brain, behavior, mental stress, and the neurocardiac interaction. J Nucl Cardiol. 2002 Nov-Dec. PMID: 12466790
- Lampert R, Joska T, Burg MM, Batsford WP, McPherson CA, Jain D: Emotional and physical precipitants of ventricular arrhythmia. Circulation. 2002 Oct 1. PMID: 12356633