Perceived stress status and sympathetic nervous system activation in young male patients with coronary artery disease in China

• The incidence of coronary artery disease in younger subjects is increasing in China.
• Young adults, especially males, have faced increasing psychological stress in China.
• Perceived stress is associated with activation of the sympathetic nervous system.
• Perceived stress is a risk factor for coronary artery disease in young Chinese males.

Background and purposeYoung Chinese male adults have faced increasing psychological stress. Whether this is associated with the increased risk of coronary artery disease (CAD) in young Chinese males remains unclear. This study aimed to evaluate the correlation and underlying mechanisms of perceived stress and CAD in young male patients.MethodsA total of 178 male patients diagnosed as young CAD (aged ≤ 55 years) by coronary angiography (CAG) were enrolled, and 181 age-matched non-CAD individuals were set as control group. Traditional cardiovascular risk factors and levels of epinephrine and norepinephrine were measured, and perceived stress status was accessed by Perceived Stress Scale (PSS).ResultsThe PSS score was correlated with levels of epinephrine (r = 0.45), norepinephrine (r = 0.41), high-sensitivity C-reactive protein (hs-CRP) (r = 0.38, p < 0.01), and current smoking (r = 0.32) (all p < 0.05). Multivariate logistic regression analysis showed that smoking (OR, 3.12; 95%CI, 1.23–7.91), triglycerides (OR, 1.42; 95%CI, 1.04–1.94), hs-CRP (OR, 3.57; 95%CI, 1.65–7.72), and PSS score (OR, 1.81; 95%CI, 1.23–2.66) were independently correlated with CAD in young patients. The association between PSS score and risk of CAD become insignificant (OR, 1.43; 95%CI, 0.96–2.13) when further adjusted for the levels of epinephrine and norepinephrine.ConclusionsAfter adjustment for multiple cardiovascular risk factors, high perceived stress was an independent risk factor for CAD in young Chinese male patients. Abnormal activation of the sympathetic nervous system may play an important role linking perceived stress with the risk of CAD.