Table 2.

Effects of mental and physical stress on platelet reactivity of patients with cardiovascular disease

Author	Study design	Comorbidities	Medication allowed and health behavior	Stress task and assessment inventory	Sampling	Platelet outcome parameters	Results
Markovitz et al[95] 1996	Hostility and stress task in post MI-patients	Not specified	Sublingual nitro, no calcium-channel blockers or platelet inhibitors for 10 d, NSAIDs for 10 d, no β-blockers for 48 h	Structured Interview Type A behavior and “Potential for Hostility”	Baseline	β-TG	↑β-TG (P = 0.006) in healthy controls vs post-MI, correlation of ↑levels of Type A and ↑β-TG reactivity (P = 0.02)
					Post-stress task
	Cross-sectional design
	14 stable post-MI vs 15 age matched healthy men			Speech Task
				“Cook-Medley Hostility” Scale
				BDI
				Paffenberger Questionnaire
				Spielberger State Anxiety Inventory
Markovitz et al[96] 1998	Hostility in patients with CHD	Not specified	Sublingual nitro statins, no aspirin/anti-platelet medication for 14 d, no oral or topic nitrates for 48 h, no calcium channel blockers for 48 h, no SSRIs	Type A Structured Interview	Wound incision	Wound induced fibrinogen receptor activation indicators	Relationship between hostility and FbR activation at 2 min and FbR binding at 1 min (P = 0.02) in CHD patients vs healthy controls
	Cross sectional design			BDI	1 min after incision
	32 non-smoking patients vs 23 non-smoking healthy controls aged 45 to 73 yr				2 min after incision
						FbR activation
						FbR binding
						FACS
Reid et al[99] 2009	Acute mental stress in CAD patients requiring coronary angioplasty	Diabetes	Diabetes hypertension, aspirin, ACE inhibitors, β-blockers, topical or oral nitrate statins, clopidogrel	Mental arithmetics	Baseline	GPIIa/IIIb expression	↑GPIIb/IIIa (P = 0.002), ↑% of MNC bound plt (P = 0.01) and ↑P-sel (P = 0.005) in stress vs baseline, ↑% of plt P-sel (P < 0.01) in stress vs baseline
		Hypertension		Anger recall	imm post stress	% of MNC bound plt
		Previous MI		BDI		P-sel expression
	Cross sectional design	Previous PCI		Maastricht Questionnaire		% of P-sel expression
	249 patients (15, 3% women)			STAEI		β-TG
				Cook-Medley Hostility short-form		FACS
				PSS		ELISA
Bacon et al[97] 2006	Acute mental and acute physical stress in CAD patients with elective cardiological intervention	Hypertension	Aspirin/copidrogrel, ACE-inhibitors, β-blockers, calcium-channel blockers, diuretics, nitrates, statins, antidiabetic medication	Rest 1 8 min Paced Auditory Serial Addition	Rest 1 post task	PF-4	Mental stress: PF-4 ns changes vs baseline, physical stress: PF-4 ns changes vs baseline
		Hyperlipidemia			Rest 2 post task	ELISA
		Diabetes		Rest 2 8 min submaximal exercise test
	Cross-sectional design	Smokers
	72 patients (57 men, 15 women)
Strike et al[101] 2006	Acute stress in male patients with survived ACS		18 patients withdrawn medication vs 16 patients taking β-blockers, aspirin, statins, ACE inhibitors, no antidepressants	Stroop Colour Word Interference Test	Baseline	PLA	Emotion-trigger group: sig ↑all platelet outcome parameters (P < 0.001) in stress vs baseline vs non-emotion trigger group (P < 0.05), ↑Plt-mo agg at 30 min post stress (P < 0.05) in the emotion trigger group vs baseline vs non emotion trigger group
					imm post-stress task	% Plt-mo agg
	Cross sectional design			Speech task	30 min post stress	% Plt-ne agg
	14 Emotion trigger group vs 20 non-trigger group			HADS	75 min post stress	FACS
				Scale for MI-patients	120 min post-stress
Strike et al[98] 2004	Acute stress in male CAD patients, stable disease and PCTA or coronary intervention		Aspirin	Stroop Colour Word interference task	Baseline	% of PLA	↑PLA (P < 0.05) in CAD at 75 min post stress vs healthy controls, group by trial interaction on PLA (P < 0.01)
			No statins 72 h		Stress	FACS
			No β-blockers 72 h	Mirror tracing task	30 min post-stress
	Cross-sectional design			HADS	75 min post-stress
	17 patients vs 22 healthy			Sleep quality assessed by Scale of Jenkins et al
Wallén et al[100] 1997	Acute mental and acute physical stress in patients with stable angina pectoris vs healthy controls		Aspirin, ACE inhibitors, digoxin, diuretics, β-blockers, calcium–channel blockers switched to study medication metoprolol and verapamil	Stroop Colour Word Conflict Test	Baseline	PF-4	Physical exercise: patients ↑PF-4 (P < 0.05) and ↑β-TG (P < 0.01) vs baseline, healthy controls ↑β-TG (P < 0.01) and ↑PF-4 (P < 0.01) vs baseline; mental stress: ↑PF-4 (P = 0.06)NS and ↑β-TG (P < 0.05) in patients vs healthy controls
	Cross sectional design			Ergometer examination	Stress-task	β-TG
	113 patients (21 on aspirin) vs 50 matched controls					ELISA
Tomoda et al[103] 1999	Acute mental stress in patients with essential hypertension	WHO stage II patients with proteinuria, elevated serum creatinin, left ventricular hypertrophy, hypertensive retinopathy	Not specified	10 min arithmetic test	Baseline	β-TG	Stress induced increase β-TG (P < 0.05) in WHO stage I and II patients vs rest, baseline β-TG levels (P < 0.05) in WHO stage II vs WHO stage I vs controls
					Immediately post stress task	RIA
	Cross-sectional design
	24 hypertensive (11 WHO stage I, 13 WHO stage II) patients vs 14 normotensive controls

Plt: Platelet; %: Percentage of; P-sel: P-selectin; PF-4: Platelet factor 4; β-TG: β-thromboglobulin; FbR: Firbrinogen receptor binding; MNC: Mononuclear cell; CAD: Coronary artery disease; CHD: Coronary heart disease; MI: Myocardial infarction; PCI: Percutanuos coronary intervention; PCTA: Percutaneous coronary angiography; BDI: Beck Depression Inventory; STAEI: State-Trait Anger Expression Inventory; PSS: Perceived Stress Scale; HADS: Hospital Anxiety and Depression Scale; ACE: Antgiotensin converting enzyme; MI: Myocardial infarction; PLA: Platelet-leukocyte aggregates; Plt-mo agg: Platelet-monocyte aggregates; Plt-ne agg: Platelet-neutrophil aggregates; imm: Immediately; SSRI: Selective serotonin reuptake inhibitor; ELISA: Enzyme linkes immunosorbent assay; FACS: Fluorescence-activated cell sorting; NS: Not significant.