Table 1.

Effects of acute mental stress and chronic care-giving strain on platelet reactivity

Author	Study design	Comorbidities	Medication allowed and health behavior	Stress task and assessment inventory	Sampling and Analysis	Platelet reactivity	Result
Patterson et al[86] 1995	Acute mental stress and cold pressor test on platelet activity in healthy stress (22) vs no-stress group (5)	None		Rest 1 10 min mental arithmetics	Rest 1 mental task	PF-4	Mental arithmetics : ↑PF-4 (P < 0.001) and β-TG (P < 0.001) vs baseline
					Rest 2 cold pressor task	β-TG
				Rest 2 2.5 min cold pressor test			Cold pressor test: ↑PF-4 (P < 0.001) and β-TG (P < 0.001) vs baseline
Hamer et al[87] 2006	Acute mental stress in full-time employees	None		3 min role speech task	Baseline	% PLA	↑PLA and ↑PMA by trial (P < 0.001) and session (P = 0.020) vs baseline
				5 min mirror tracing task	10 min post-stress	% PMA
	Longitudinal design				FACS
	91 non-smoking men (33.2 yr average)
Steptoe et al[88] 2003	Acute mental stress in men regarding socioeconomic status, cross sectional design	None	No aspirin allowed	Stroop Colour Word Interference Test	Baseline	% PLA	↑PLA (P < 0.009), ↑PMA (P < 0.037), ↑Plt-ne-agg (P < 0.045) over trial vs baseline, greater number of overall PLA (P = 0.031) in lower social status vs higher, ↑PLA (P < 0.001) and Plt-ne-agg (P = 0.003) in both groups in stress vs baseline
			No coffein		imm post-stress	% Plt-mo agg
			No caffeinated beverages	Mirror tracing task	30 min post-stress	% Plt-ly agg
	15 men with higher socioeconomic status vs 20 lower socioeconomic status		No alcohol		75 min post-stress	% Plt-ne agg
			No exercise before testing		FACS
Aschbacher et al[92] 2009	Acute mental stress in CG +/- persistent depressive symptoms, longitudinal design	Myocardial infarction	Aspirin	3 min impromptu speech	Baseline	% P-sel exp	Persistent DEP predicted P-sel reactivity and recovery (P < 0.01) vs transient DEP
		Others not specified	Antidepressants after enrollment: β-blocker		imm post-stress (reactivity)
				Brief Symptom Inventory	14 min post-stress (recovery)
	99 CG (73 yr average, 68% female, 93% Caucasian)				FACS
Aschbacher et al[91] 2009	Acute mental stress in elderly persons, longitudinal design	Myocardial infraction	Aspirin, antidepressants, statins, NSAIDs, anti-hypertensives, β-blockers, HRT, anti-aggregation drugs, anti-platelet drugs	3 min impromptu speech	Baseline	% plt agg	↑All platelet (P < 0.001) outcome measures in stress vs rest
		Diabetes			imm post-stress	% FbR exp
	149 elderly participants (mean age 71 yr, 30% male, 93% Caucasian)	Hypertension			FACS	% P-sel exp
		Hypercholesterolemia
		Cerebrovascular incident
Aschbacher et al[89] 2008	Acute mental stress in CG +/- negative effect	Cerebrovascular disease	Aspirin, antidepressants, α blockers, after enrollment: β-blocker	3 min impromptu speech	Baseline	% plt agg	↑P-selectin reactivity (P < 0.001), delayed P-selectin recovery (P = 0.039) in CG with DEP vs non-CG
		Coronary artery disease			imm post-stress	% FbR exp
	Cross-sectional design	Diabetes		Role overload scale	14 min post-stress	% P-sel exp
	39 care-givers vs 31 non care-givers	Hypercholesterolemia			FACS
		Hypertension
		CVD condition
Aschbacher et al[90] 2007	Acute mental stress on CG women +/- HRT	Coronary artery disease	Aspirin, NSAIDs, antidepressants, anti-platelet drugs, antihypertensives, statins	3 min impromptu speech	Baseline	% plt agg	HRT x CG effect on recovery of AGG (P = 0.025), P-sel (P = 0.013), FbR (P = 0.012); CG +HRT delayed post stress recovery of AGG (P = 0.038) and P-sel (P = 0.004) vs NCG + HRT, no CG effect among non-HRT
		Cerebrovascular disease			imm post-stress (reactivity)	% FbR exp
	Cross-sectional design	Diabetes			14 min post-stress (recovery)	% P-sel exp
	51 CG women (24 HRT) vs 27 non-CG (15 HRT)	Hypercholesterolemia			FACS
		Hypertension

%: The percentage of; PF-4: Platelet factor 4; β-TG: β-thromboglobulin; PLA: Platelet-leukocyte aggregates; PMA: Platelet-monocyte aggregates; Plt-mo: Platelet-monocyte aggregates; Plt-ly: Platelet-lymphocyte aggregates; Plt-ne: Platelet-neutrophil aggregates; P-sel: P-selectin; CG: Care-giver; non-CG: Non care-giver; HRT: Hormone replacement therapy; CG X HRT: Interaction between care-giving stress and hormone replacement therapy; AGG: Aggregates; FbR: Fibrinogen binding receptor; DEP: Depressive symptoms; Plt: Platelet; Mo: Monocyte, Ly: Lymphocyte; Ne: Neutrophils; Exp: Expression; NSAIDs: Non steroidal anti-inflammatory drug; FACS: Fluorescence-activated cell sorting; imm: Immediately.