Mental stress: A novel cardiovascular risk factor

Table 4 Some recent studies on laboratory induction of stress

Ref.	Setting	Main results
Meyer et al[235], 2016	Hospitalized female PTSD patients and controls completed standardized laboratory-based stress testing including a MA test and an audiotape recording of a crying infant	Controls and PTSD patients both showed a significantly increased HR and reduced pre-ejection period from baseline rest to the arithmetic stressor. Parasympathetic activation caused by the crying infant stressor was blunted in PTSD patients as compared to healthy individuals. Under the crying infant condition, a vagal dominance was observed only in controls
Brindle et al[297], 2016	Multivariate cluster analysis examined the relationship between HR and BP reactivity patterns and hypertension in a large prospective cohort (age range 55-60 years). Four clusters emerged with statistically different SBP, DBP and HR reactivity patterns	Cluster 1 was characterised by a relatively exaggerated BP and HR rate response while the responses of cluster 2 were in line with the sample mean. Cluster 3 was characterised by blunted CV stress reactivity and cluster 4 by an exaggerated BP and modest HR response. Membership to cluster 4 conferred an increased risk of hypertension at 5-year follow-up (HR = 2.98, 95%CI: 1.50-5.90, P < 0.01)
Wang et al[272], 2016	A total of 34 young healthy male subjects were recruited and performed a MA task	MA task increased HR, SBP, DBP, and CO. The HFr power component of HRV decreased during MA, but the normalized LF power component and LF/HFr ratio of HRV increased only at the late stage
Sherwood et al[301], 2017	Overall, 199 outpatients diagnosed with HF, with ejection fraction ≤ 40%, underwent an evaluation of BP and HR reactivity to a laboratory-based simulated public-speaking stressor. Cox proportional hazards regression models were used to examine the prospective association between BP and HR reactivity on a combined endpoint of death or CV hospitalization over a 5-year median follow-up period	Both SBP and DBP reactivity were inversely related to risk of death or CV hospitalization (P < 0.01) after controlling for established risk factors. HR reactivity was unrelated to outcome (P = 0.12). High SBP reactivity, compared to intermediate SBP reactivity, was associated with lower risk (HR = 0.498, 95%CI: 0.335-0.742, P = 0.0019); while low SBP reactivity did not differ from intermediate reactivity. For DBP, high reactivity was marginally associated with lower risk compared to intermediate DBP reactivity (HR = 0.767, 95%CI: 0.515-1.14, P = 0.193), while low DBP reactivity was associated with greater risk (HR = 1.49, 95%CI: 1.027-2.155, P = 0.0359)
Ginty et al[99], 2017	Data from 64 participants were collected. HR, SBP, and DBP were measured at baseline and during a standard MA stress task	Individuals who experienced abuse showed diminished CVR to acute psychological stress, specifically by the history of sexual abuse
Xie et al[273], 2017	In total, 25 male subjects were recruited. RR intervals, SBP, DBP, SV, CO, and SVR values were collected during rest and MA. BRS was derived using the transfer function method	MA was characterized by increased HR, SBP, DBP, and CO with decreased BRS attributable to prolonged parasympathetic withdrawal. Moreover, cardiovascular coupling was disrupted in MA
Xin et al[193], 2017	The stress response to a standardized laboratory stress induction procedure (TSST) was measured with a combination of cardiovascular reactivity, hypothalamic-pituitary-adrenal axis reactivity, and subjective affect in healthy individuals	Higher neuroticism predicted lower HR stress reactivity, lower cortisol stress response, more decline of positive affect and lower subjective controllability. Individuals higher in extraversion showed smaller cortisol activation to stress and less increase of negative affect. In addition, higher openness score was associated with lower cortisol stress response
Antoun et al[35], 2018	Twenty healthy adults performed three tasks: Control, driving and exercise plus driving. HR, HRV, BP and cortisol were measured to quantify the acute stress response to each condition	HR was elevated and HRV was reduced during the driving task compared with control. HR was elevated and HRV was reduced comparing the exercise plus driving with the driving condition
Chou et al[284], 2018	Individuals with PTSD recalled a traumatic memory	Significant increase in parasympathetic activity during trauma recall, with greater parasympathetic dominance being indicative of greater state depersonalisation/derealisation. Overall, decreases in HR during trauma recall were associated with increased fear and perceived threat; flashbacks were accompanied by short-term increases in HR
Emery et al[279], 2018	Cardiac activity was recorded via ECG during a standardized speech stress task with three phases: 5-minute rest, 5-minute speech, and 5-minute recovery	Women exhibited higher HR than did men and greater HR reactivity in response to the speech stress. However, women also exhibited greater HRV in both the time and frequency domains
O'Súilleabháin et al[298], 2018	In a sample of 62 healthy young female adults, CV responsivity during a stress exposure was examined	Significant linear interaction for openness across the entire exposure for SBP, and CO. A significant between-subjects effect for HR also emerged. Those highest in openness exhibited an increasingly adaptive myocardial hemodynamic response profile throughout the exposure
Grinberg et al[223], 2018	Authors examined the association between adults’ subjective separation-related distress and changes in HR and BP across the acute-stress laboratory paradigm	Adults who reported greater separation-related distress exhibited higher initial BP, a slower linear increase in BP, and significantly slower declines in DBP following the acute stress task
Kibler[280], 2018	The sample consisted of 50 trauma-exposed civilian women ranging from 19 years to 49 years of age. Cardiovascular recovery was assessed after oral speaking stressor as percentage return to baseline; the recovery measures consisted of impedance cardiography-derived CO and TPR, HR and BP	Total PTSD severity was associated with less CO recovery, r = -0.39, P = 0.006; this effect was similar across PTSD symptom categories. However, only PTSD severity in the avoidance cluster was associated with less TPR recovery, r = -0.29, P = 0.047. Total PTSD severity was associated with greater threat appraisal, r = 0.30, P = 0.035, and greater threat appraisal was associated with less CO recovery, r = -0.33, P = 0.019
Zaffalon et al[304], 2018	In a total of 96 young women divided into SW and AW, the R-R interval was recorded to quantify the cardiac autonomic modulation at rest and in response to the Stroop Color Test	The physical health domain of quality of life was compromised in the SW group. The SW group presented higher HR, lower variance of RR interval and higher cardiac sympathovagal balance (LF/HF) both at rest and in response to the mental stress test
Delliaux et al[305], 2019	A 1-hour computerized switching task (letter recognition) was performed by 24 subjects while monitoring their performance (accuracy, response time) and ECG. The HRV was evaluated from the beat-to-beat RR intervals in time-, frequency-, and informational- domains, before and during the task	The HR, BP, and baroreflex function were unchanged, whereas most of the HRV parameters markedly decreased. The maximum decrease occurred during the first 15 minutes of the task, before starting to return to the baseline values reached at the end of the task. The RR interval dimension correlation decrease was the most significant (P < 0.001)
Kim et al[281], 2019	Overall, 549 patients with stable CAD underwent mental stress testing with a standardized public speaking stressor and followed prospectively for cardiovascular endpoints. Digital pulse wave amplitude was continuously measured using PAT. sPAT was calculated and dichotomized by into “low” and “high” sPAT ratio groups	The median sPAT ratio was 0.68 (IQR: 0.48-0.88), indicating 32% vasoconstriction with mental stress. Men were more likely to have low sPAT ratio than women (OR = 1.79, P = 0.007) while those on beta blockers were less likely to have low sPAT ratio (OR = 0.52, P = 0.003). After adjusting for demographic and cardiovascular risk factors, medications, and rate-pressure product change during mental stress, those with low sPAT ratio were at significantly higher risk of adverse outcomes (HR = 1.77, 95%CI: 1.12-2.80)
Lima et al[282], 2019	Cohort study of 569 individuals with stable CAD conducted at a university-affiliated hospital network. Participants were subjected to a laboratory mental stress task (public speaking)	FMD decreased from a mean (SD) of 4.8% (3.7%) before mental stress to 3.9% (3.6%) after (23% reduction; P < 0.001). The presence of transient endothelial dysfunction with mental stress was associated with a 78% increase (HR = 1.78, 95%CI: 1.15-2.76) in the incidence of MACE
Riordan et al[174], 2019	A sample of 76 healthy undergraduate students completed the DS14 type D measure, before undergoing a traditional cardiovascular reactivity protocol. SBP, DBP, and HR were monitored throughout	No associations were evident for BP. However, a significant personality × sex × social context interaction on HR reactivity was found; here type D was associated with a higher HR response to the social task amongst males, while type D females typically exhibited blunted reactions
Sullivan et al[283], 2019	The study used data from 632 patients with CAD. Patients’ residential addresses were geocoded with poverty data. SBP, DBP, HR, rate-pressure product, epinephrine, interleukin-6, and hs-CRP were measured before and after a public speaking stress task	After adjusting for potential confounders, participants living in high (vs low) poverty neighbourhoods had similar hemodynamic values at rest and lower values during mental stress for SBP (P = 0.07), HR (P = 0.02) and rate-pressure product (P = 0.01). There were no significant differences in inflammatory and epinephrine responses to mental stress
Wittbrodt et al[313], 2019	Participants with CAD underwent brain imaging with HIGH RESOLUTION POSITRON EMISSION TOMOGRAPHY and radiolabelled water during control (verbal counting, neutral speaking) and mental stress (MA, public speaking). Traumatic events in childhood were assessed with the ETI-SR-SF and participants were separated by presence (ETI+) or absence (ETI-)	Compared to ETI-, ETI+ experienced greater (P < 0.005) activations during mental stress within the left anterior cingulate, left occipital lobe, bilateral frontal lobe and deactivations (P < 0.005) within the left insula, left parahippocampal gyrus, right dorsal anterior cingulate, bilateral cerebellum, bilateral fusiform gyrus, left inferior temporal gyrus, right occipital lobe, and right parietal lobe. Significant (P < 0.005) positive correlations between brain activation and ETI-SR-SF scores were observed within the left hippocampus, bilateral frontal lobe, left occipital cuneus, right parietal precuneus, and bilateral temporal lobe
Lee et al[274], 2020	In a sample of 125 undergraduates, during a modified TSST, appraisals of the stressor were assessed and BP and HR were measured	PTSD symptoms are associated with current physical health (resting BP and HR) and more negative appraisals of the stressor; in turn, more negative appraisals were associated with increases in cardiovascular response
Liu et al[324], 2020	A total of 77 patients with known CAD underwent echocardiography before and during MA stress task. MSIMI was diagnosed by new or worsening wall motion abnormalities greater than or equal to a 5% reduction of left ventricle ejection fraction	MA induced a significant increase in stromal cell-derived factor-1α and monocyte chemoattractant protein-1 in all subjects; 20.78% of the patients with known CAD developed MSIMI during the arithmetic task. MSIMI positive patients had significantly lower baseline levels of interleukin-1β and tumour necrosis factor-α, but a higher response in levels of stromal cell-derived factor-1α than MSIMI negative patients
Lucas et al[290], 2020	Authors examined changes in HR tracked via an Apple Watch during three typical work shifts in a retail store setting	Increase in HR during a work shift to a level observed during a moderate stressor (P < 0.0001). Female subjects demonstrated a significantly elevated maximum HR, a larger change in HR, and a larger percent change in HR compared with males (all P < 0.05)
Widmer et al[322], 2020	In a prospective study 417 patients with ACS were enrolled in two sites at the United States and Qatar. Response to three different mental stress examinations (Stroop colour word, MA, and Spiral Omnibus) as assessed by ratio of reactive hyperaemia tonometry (EndoPAT)	Women were more likely to experience MACE in the year following ACS (RR = 2.42, 95%CI: 1.53-3.84, P = 0.044) and had a significantly lower mental stress ratio compared to women who did not (P = 0.04). In multivariate analyses, baseline peripheral endothelial dysfunction (EndoPAT < 1.7) (P = 0.005) and mental stress ratio (P = 0.0069, were independently predictive of MACE in women, but not men
Schneider et al[299], 2021	Participants completed the life experience survey and positive and negative affect schedule and undertook a standardized social-evaluative stress task. Cardiac activity was measured via HR and non-linear HRV indices sample entropy, SD1, SD2 and SD1/SD2 ratio	Higher HR reactivity in individuals reporting higher number and impact of negative and total life events. Life-events are associated with elevated HR and diminished HR complexity in response to acute stress
Kim et al[224], 2021	Using smartphones, ten young participants completed ecological assessments 6 times a day for two weeks regarding their current affective state. They also wore a chest-mounted HR monitor and a wrist accelerometer to monitor cardiovascular response and physical activity, respectively	Higher HR and lower HRV were related to subsequent greater feelings of stress at the 5-minute and 30-minute time intervals
Formolo et al[277], 2022	Sixty-six young men underwent anthropometric and body fat assessment (dual-energy X-ray absorptiometry) and carotid artery ultrasonography. Accelerometers assessed physical activity levels and sleep efficiency. MS was induced through the Stroop colour-word test while BP, HR, and cardiac interval were measured	An interaction between fat mass index and time for HR reactivity was observed. Cardiac interval variability analysis showed that only participants with normal fat displayed parasympathetic withdrawal during MS (P < 0.05). Multiple linear regression analysis supported the role of adiposity and autonomic modulation in the HR reactivity to MS and showed involvement of carotid distensibility and sleep efficiency (P < 0.05). Carotid distensibility was the only predictor for BP reactivity (P < 0.05)
Zhang et al[309], 2022	The scale of CTQ was administered to 192 healthy undergraduates who underwent continuous cardiovascular monitoring while facing two consecutive psychosocial stress (public speaking tasks	Childhood maltreatment was negatively associated with HR and cardiac output reactivity to the first stress exposure and HR reactivity to the second stress exposure
Lee et al[303], 2022	Using a cross-sectional observational design, 84 trauma-exposed community adults who endorsed at least one core PTSD symptom were enrolled. Participants completed a physical exam, self-reports of trauma history and PTSD symptoms, and BP and HRV frequency-domain measurements during rest, stressor (MA task), and recovery	Arousal/reactivity was not associated with BP or HRV reactivity but with a higher LF/HF ratio during recovery reflecting sympathetic predominance. During the stressor, more avoidance and intrusion were associated with increased DBP from baseline; more avoidance was associated with parasympathetic predominance (lower LF/HF); and more negative cognitions/mood was associated with decreased SBP, DBP, and LF from baseline. During recovery, more intrusion and negative cognitions/mood were associated with increased SBP from baseline; less negative cognitions/mood was associated with sympathetic predominance (higher LF/HF)
Legaz et al[274], 2022	Hypertensive patients and healthy controls groups performed TSST. During both stages, a sensitive HRV parameter (the LF/HF ratio) and an online neurophysiological measure. the HEP were assessed. Neuroanatomical data via voxel-based morphometry were obtained for correlation with online markers	Relative to controls, hypertensive patients exhibited increased LF/HF ratio and greater HEP modulations during baseline, reduced changes between baseline and stress periods, and lack of significant stress-related HRV modulations associated with the grey matter volume of putative frontrostriatal regions. They presented signs of stress-related autonomic imbalance, reflected in a potential basal stress overload and a lack of responsiveness to acute psychosocial stress, accompanied by neuro-physio-anatomical alterations
Griffin and Howard[192], 2022	Forty-eight participants completed a standardized laboratory stress paradigm incorporating a 20-minute acclimatization period, a 10-minute baseline, and two 5-minute speech tasks separated by a 10-minute rest period. CV parameters were measured using the Finometer Pro	Greater habitual use of suppression was associated with exaggerated BP responding to both tasks. However, only in response to the negative-emotion task was greater use of reappraisal associated with a challenge-oriented cardiovascular response
McLoughlin et al[276], 2022	Eighty-six participants reported their exposure to lifetime non-sport and sport-specific stressors before completing two consecutive TSST, while cardiovascular (i.e., HR) and endocrine (i.e., salivary cortisol) data were recorded	Exposure to a moderate number of lifetime non-sport and sport-specific stressors was associated with adaptive cardiovascular reactivity, whereas very low or very high stressor exposure was related to maladaptive reactivity. Moreover, experiencing a very low number of lifetime non-sport (but not sport-specific) stressors was associated with poorer habituation. In contrast, lifetime stressor severity was unrelated to cardiovascular reactivity. Finally, greater lifetime non-sport and sport-specific stressor counts were associated with blunted cortisol reactivity and poorer habituation
Winzeler et al[310], 2017	One hundred eighteen healthy young women provided data on ACEs and underwent psychosocial stress testing. SBP and RSA, quantified by HF-HRV variability, were assessed as measures of sympathetic and parasympathetic CV activity, respectively	The effect of ACEs on HR reactivity was mediated by SBP reactivity but not by RSA reactivity. ACEs were associated with reduced SBP at rest. ACEs were associated with down-regulation in a measure of sympathetic but no alteration in a measure of parasympathetic cardiovascular stress reactivity in adulthood
Almuwaqqat et al[315], 2023	Authors studied 300 patients with a recent AMI. Patients underwent myocardial perfusion imaging with mental stress and were followed for 5 years	A diffuse MSIMI increment of 1 standard deviation was associated with a 40% higher risk for adverse events (HR = 1.4, 95%CI: 1.2-1.5). In sex-specific analysis, higher levels of MSIMI (per SD increment) were associated with 53% higher risk of adverse events in women (HR = 1.5, 95%CI: 1.2-2.0) but not in men (HR = 0.9, 95%CI: 0.5-1.4), P = 0.001
Bremner et al[221], 2023	CHD patients underwent cardiac imaging with Tc-99m sestamibi single photon emission tomography at rest and during a public speaking mental stress task. Patients returned for a second day and underwent positron emission tomography imaging of the brain, heart, bone marrow, aorta (indicating inflammation) and subcutaneous adipose tissue, after injection of 18F2-fluoro-2-deoxyglucose for assessment of glucose uptake followed mental stress	Patients with MSIMI showed a pattern of increased uptake in the heart, medial prefrontal cortex, and adipose tissue with stress. In the heart disease group, activity increases with stress in the medial prefrontal brain and amygdala correlated with stress-induced increases in spleen (P = 0.038 and P = 0.04 respectfully). Stress-induced frontal lobe increased uptake correlated with stress-induced aorta uptake (P = 0.016). Activity in insula and medial prefrontal cortex was correlated with post-stress activity in bone marrow and adipose tissue. Increases in medial prefrontal activity with stress correlated with increased cardiac glucose uptake with stress, suggestive of myocardial ischemia (P = 0.004)
Gentilin et al[312], 2023	The carotid hf-PWV index, MAP, PP, TPR, and HR were measured in 26 young at rest and throughout a 10-minute bout of MA stress	Mental stress increased hf-PWV, MAP, PP, and HR from baseline throughout the entire stimulation period (P < 0.005). TPR diminished in the first minute of stimulation (P < 0.001) in both sexes and increased in the last minutes in women only (P < 0.005). Hf-PWV was lower in women than men (P < 0.001) at rest and during mental stress, but the changes from baseline were similar
Lee et al[300], 2023	A sample of 92 adolescent girls self-reported early life stressors. SBP, DBP, and HR were continuously measured before, during, and after a laboratory peer rejection paradigm	Adolescent girls with higher early life stress had lower, not higher, HR during the recovery period. Early life stress was not associated with SBP or DBP recovery. Additionally, early life stress was not associated with SBP, DBP, or HR reactivity
Liu et al[196], 2023	In 883 treatment-naive individuals from a longitudinal cohort study of Midlife in the United States, symptoms of stress were assessed by PSS. Cardiovascular reactivity was measured using standardized, laboratory-based stressful tasks	Treatment-naive individuals with higher stress levels (PSS ≥ 27) had blunted cardiovascular reactivity multivariate linear regression showed that stress was associated with reduced SBP and DBP reactivity but with a nonsignificant association with HR reactivity (P = 0.056)
Lü et al[266], 2023	The CTQ was administered to 359 junior school students who underwent a two-successive stress exposures protocol with continuous cardiovascular monitoring. HR and SBP, DBP, and their saliva samples for deoxyribonucleic acid genotyping were collected	ELA was associated with blunted HR reactivity to the first and second stress exposures, blunted SBP reactivity to the first stress exposure, and attenuated SBP habituation to repeated stress exposures. Moreover, COMT rs4680 moderated these associations, such that the associations between ELA and blunted HR, SBP, and DBP reactivity to the first stress and disrupted DBP habituation to repeated stress exposures only existed in GA/AA genotype carriers
Mrug et al[287], 2023	The sample included 1027 adolescents and young adults who reported on ELS exposure and coping styles. Participants completed a standardized TSST, with HR and BP measured before, during, and after. Self-reports of negative emotions during the TSST indexed emotional stress reactivity	ELS was associated with lower HR stress reactivity; avoidant coping was related to lower SBP and DBP during stress and lower SBP during recovery; and higher emotion-oriented coping and lower task-oriented coping predicted greater emotional stress reactivity. A consistent pattern emerged where emotion-oriented coping amplified the associations between ELS and maladaptive stress responses (blunted cardiovascular stress reactivity and recovery; enhanced emotional stress reactivity), whereas lower levels of emotion-oriented coping were associated with resilient profiles among those who experienced ELS (lower resting HR; lower emotional stress reactivity; average HR and BP stress reactivity and recovery)
Okoh et al[316], 2023	In 812 patients with stable CHD at a university-affiliated hospital network, FMD was assessed before and 30 minutes after mental stress. TED was defined as a lower post-stress FMD than prestress	FMD significantly declined with mental stress in both groups. TED occurred more often in Black than non-Black patients (aOR = 1.6, 95%CI: 1.5-1.7). Black participants had a 419% higher risk of either cardiovascular death or nonfatal AMI than non-Black participants (95%CI: 1.01-1.95). TED with mental stress explained 69% of this excess risk
O’Riordan et al[176], 2023	Undergraduate students competed a standardised cardiovascular reactivity experimental protocol consisting of resting baseline and stressor phase (MA), with SBP, DBP and HR monitored throughout	The continuous Type D interaction term (negative affect × social inhibition) significantly predicted lower SBP reactivity to the MA stressor amongst women, independent of confounding variables. This remained significant after adjustment for anxiety and depressive symptoms
Perez Alday et al[269], 2023	Overall, 238 male Veteran twins listened to audio recordings of a one-minute neutral script followed by a one-minute trauma script. Authors examined two HRV metrics: DC and log-LF power from beat-to-beat intervals extracted from ambulatory ECG and assessed longitudinal PTSD status with a structured clinical interview and the severity with the PTSD symptoms scale	PTSD status and acute PTSD symptom severity were not associated with DC or log-LF measured during the neutral session but were significantly associated with lower DC and log-LF during the traumatic script listening session. Long-standing PTSD was associated with a 038 (95%CI: -0.83 to -0.08) and 0.79 (-1.30 to -0.29) standardized unit lower DC and log-LF, respectively, compared to no history of PTSD
Sullivan et al[317], 2023	In the MIMS2 study, 263 patients hospitalized for an AMI were prospectively followed for 5 years. Reactive hyperaemia index and flow-mediated dilation were used to measure microvascular and endothelial function, respectively, before and 30 minutes after a public-speaking mental stress task	Worse microvascular response to stress (for each SD decrease in the reactive hyperaemia index) was associated with 50% greater risk of MACE (HR = 1.5, 95%CI: 1.05-2.13; P = 0.03) among women only (sex interaction: P = 0.03). Worse TED in response to stress (for each SD decrease in flow-mediated dilation) was associated with a 35% greater risk of MACE (HR = 1.35, 95%CI: 1.07-1.71; P = 0.01); the association was similar in women and men
Tyra et al[270], 2023	A sample of 453 participants completed a repeated stress paradigm, which consisted of two 10-minute baselines and two identical 4-minute stress tasks, separated by a 10-minute recovery period. HR was measured continuously; SBP/DBP every 2 minutes. Participants completed the ERQ and DERS	Impulse control difficulties when distressed (a DERS subscale) were significantly associated with blunted SBP, DBP, and HR reactivity to both stressors, as well as impaired HR habituation across the stressors. None of the ERQ subscales (cognitive reappraisal, expressive suppression) were found to be associated with cardiovascular stress reactivity or habituation
Ji et al[288], 2024	Chinese adolescents first reported their childhood trauma and social anxiety using the Childhood Trauma Questionnaire and the Social Interaction Anxiety Scale, then participated in a social stress task, during which their cardiovascular data (HR, SBP, DBP) were monitored	The results showed that high levels of childhood trauma were associated with blunted HR, SBP, and DBP reactivity, which in turn were associated with high levels of social anxiety. Mediation analysis indicated that childhood trauma was indirectly associated with social anxiety via blunted cardiovascular reactivity
Gallagher et al[286], 2024	Two hundred and six participants from the Pittsburgh Cold Study underwent a modified version of the TSTT	Social network size was positively associated with DBP reactivity (β = 0.19, 95%CI: 0.05-0.29, P = 0.005), while loneliness was not. In addition, social network size moderated the loneliness-DBP reactivity relationship
Sinnot et al[289], 2024	The study aimed to examine the influence of both PTSS and self-blame (negative appraisal after trauma, commonly sexual) on BP and HR reactivity measured before, during, and after a laboratory-based sexual trauma reminder among 72 young adult women who have experienced sexual trauma	Higher PTSS predicted lower DBP reactivity during the trauma reminder. Higher levels of self-blame predicted higher HR and SBP reactivity during and after the trauma reminder. Overall, these findings suggest that survivors of sexual trauma with higher levels of PTSS experience a blunting reaction of DBP when exposed to trauma reminders
Almuwaqqat et al[314], 2024	In 427 patients with stable CAD undergoing a laboratory-based MS test, CPCs were enumerated using flow cytometry as CD34-expressing mononuclear cells before and 45 minutes after stress. Changes in brain regional blood flow with MS were measured using high resolution-positron emission tomography	MS increased CPC counts by a mean of 150 cells/mL (15%), P < 0.001. Greater limbic lobe activity, indicative of activation of emotion-regulating centres, was associated with greater CPC mobilization (P < 0.005). After adjustment, greater CPC mobilization was associated with a higher adjusted risk of adverse events during a 5-year follow-up; a rise of 1000 cells/mL was associated with a 50% higher risk of cardiovascular death/MI (HR = 1.5, 95%CI: 1.1-2.2)
Osei et al[325], 2024	Authors examined the relationship between stress-induced autonomic dysfunction, measured by low HRV using Holter monitoring, and MSIMI in patients with stable CAD before and during a standardized laboratory-based speech stressor. HRV at rest and stress were categorized into low HRV vs high HRV; the low category was used as an indicator of autonomic dysfunction	Compared with high HRV during stress, low HRV during stress (both HF and LF) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (OR for HF HRV: 2.1, 95%CI: 1.3-3.3; OR for LF HRV: 2.1, 95%CI: 1.3-3.3). LF HRV at rest was also associated with MSIMI but with slightly reduced effect estimates
Rasero et al[318], 2025	Midlife adults from two different cohorts underwent two information-conflict tasks, in which patterns of hemodynamic brain responses exhibited a generalizable association with carotid artery intima-media thickness, which was mediated by an area-under-the-curve measure of aggregate SBP reactivity	Task-averaged patterns of hemodynamic brain responses exhibited a generalizable association with CA-IMT, which was mediated by an area-under-the-curve measure of aggregate SBP reactivity. Importantly, this effect held in sensitivity analyses. Implicated brain areas in this mediation included the ventromedial prefrontal cortex, anterior cingulate cortex, insula and amygdala
Nawar et al[291], 2024	This pilot study investigated data from a validated, multimodal, wearable patch to examine physiological correlations of laboratory-based hypertensive stress responses. The device collected ECG and photoplethysmogram signals during a protocol involving a public speaking stressor	MAP changes correlated significantly with changes in HR (P < 0.001, r = 0.69), left ventricular ejection time (P < 0.001, r = -0.63), pulse arrival time (P < 0.001, r = -0.58), and pulse transit time (P < 0.001, r = -0.56) captured by the patch
Martin et al[76], 2024	In 179 older male twins from the Vietnam Era Twin Registry, lifetime history of PTSD and last month PTSD symptoms were assessed. Participants listened to neutral and personalized trauma scripts while peripheral vascular tone (peripheral arterial tonometry ratio) and systemic vascular tone (TVC) were measured	Compared to their brothers without PTSD, during trauma recall, participants with a history of PTSD had greater increases in peripheral (β = -1.01, 95%CI: -1.72 to -0.30) and systemic (TVC: β = -1.12, 95%CI: -1.97 to -0.27) vasoconstriction after adjusting. Analysis of current PTSD symptom severity showed consistent results
Maffei et al[201], 2025	A version of TSST was employed to experimentally induce stress in a sample of 40 dyads, each comprising a target participant who was paired with a second participant, acting as a supporter. In half of the dyads the target and the supporter were in a romantic relationship (partner group), while in the other half not (stranger group)	Participants in the partner group exhibited a lower HR during the acute stress compared to the participants in the stranger group, highlighting that the buffering of the physiological stress activity is stronger within close relationships. Nonetheless, participants in the partner group reported more anxiety and stress during the task
Strotsava and Brindle[271], 2025	Participants completed the CTQ and a socially evaluative MA stressor in the laboratory. HR, BP, and baroreflex function were measured during both baseline and stress conditions. Stress reactivity was defined as the change in HR, BP, or baroreflex function from baseline to stress	HR and BP significantly increased and baroreflex function significantly decreased in response to mental stress (all P < 0.001). However, after controlling for sex, cohort, baseline values, and perceived stress, no significant associations emerged between CTQ scores, total or subscales, and either cardiovascular or baroreflex reactivity (all P ≥ 0.55)
Bigalke et al[319], 2025	In adult volunteers beat-by-beat blood pressure (finger plethysmography), heart rate, and MSNA reactivity (microneurography) were recorded during a 10-minute quiet rest followed by the TSST	Endorsement of a threat appraisal was positively associated with changes in MSNA burst frequency (P = 0.018), burst incidence (P = 0.009), and total MSNA (P = 0.037) during the speech stress period. Moreover, increase in threat appraisal across tasks was associated with elevated MSNA burst frequency (P = 0.023), incidence (P = 0.030), and total MSNA (P = 0.027) responsiveness
Tyra et al[293], 2025	Participants completed a 10-minute baseline, 5-minute speech preparation, and 5-minute speech delivery, which was repeated after a 10-minute recovery. They were randomly assigned to either suppression or control instructions before the second speech prep. HR, SBP/DBP, and pre-ejection period were measured throughout. Habitual use of suppression was assessed using the Emotion Regulation Questionnaire	All participants exhibited significant CV habituation, irrespective of condition, suggesting instructed suppression did not hinder habituation. Instructed suppression was not associated with changes in perceived psychological stress or positive affect across tasks; however, instructed suppression was associated with greater habituation of negative affect
Costello et al[294], 2025	This study used previously collected data from the Pittsburgh Cold Study 3. One-hundred and eighty-nine participants completed two separate, identical, standardized stress-testing protocols and had their BP and HR monitored throughout a baseline, stress task and recovery phase	Delta change score from task, percent change task and area under the curve with respect to ground demonstrated the strongest temporal stability for blood pressure and HR recovery between visits
Zhou et al[320], 2025	Using data collected from involving acute mental stress and TMNS (with stress-mitigating effect), authors examined the ability of six plausibly explainable physio-markers to capture cardiovascular responses to acute mental stress and TMNS	The synthetic multi-modal variable showed explainable responses to acute mental stress and TMNS in more experiments. It also exhibited superior consistency, balanced sensitivity, and robustness compared to individual physio-markers
Martin et al[321], 2025	Using a cross-sectional design, authors assessed childhood trauma and HR and BP responses to public speaking in AMI survivors	Black participants showed significantly lower HR and SBP and DBP reactivity to mental stress compared with White participants. High childhood trauma was independently associated with lower HR and SBP reactivity. Black participants with high trauma had the lowest HR (β = -8.2; 95%CI: -11.2 to -5.2) SBP (β = -7.7; 95%CI: -11.9 to -3.5), and DBP reactivity (β = -2.9; 95%CI: -5.4 to -0.4) relative to White participants with low trauma
Linsley et al[278], 2025	Participants completed passive (IAPS and active PASAT) stress task cardiovascular measures (including SBP, DBP, HR) and blood samples determining inflammatory responses (circulating and stimulated IL-6, SIRI, NLR, TNF-α, and P- and E-selectin) were collected	Cardiovascular measures were higher during the PASAT than IAPS (P < 0.001). Circulating IL-6 levels increased from baseline to 45-minute after both tasks (P ≤ 0.001), with no difference between 45-minute post-PASAT and 45-minute post-IAPS. SIRI increased from baseline to post-IAPS (P = 0.013), 45-minute post-IAPS (P = 0.004), and 45-minute post-PASAT (P < 0.001). No difference in SIRI between 45-minute post-PASAT and 45-minute post-IAPS existed. NLR increased from baseline to 45-minute post-PASAT (P = 0.008). There were no significant time effects for TNF-α, P-selectin, or E-selectin
Lee et al[295], 2025	Authors conducted a laboratory-based study with 84 adult trauma survivors to test threat and challenge appraisals as mediators of the relationships of positive states of mind with HRV responses to stress	Stronger appraisal of challenges mediated the effects of more positive states of mind on lower LF during recovery. Threat appraisal was not a significant mediator of any association between positive states of mind and HRV reactivity or recovery. Challenge appraisal may explain the association between greater positive states of mind and lower sympathetic arousal during recovery
Goldberg et al[285], 2025	Overall, 67 participants underwent BP measurements during baseline, after a 5-10-minute GR task, and during a 10-minute recovery period. Repeated measures compared SBP and DBP at baseline and 0-, 5-, and 10-minute post-GR. Participants meeting PGD criteria were descriptively compared to individuals reporting grief severity below the median of the Prolonged Grief-13 questionnaire and to those above the median without PGD	SBP and DBP increased post-GR and remained elevated during the 10-minute recovery (SBP: P = 0.009; DBP: P = 0.03). Pairwise comparisons revealed significant differences between SBP and DBP at baseline compared to post-GR measurements. Descriptively, the PGD subgroup showed higher baseline values, similarly pronounced reactivity compared to the rest of the sample, and a delayed decline in SBP and DBP, particularly compared to participants with low grief severity
Naliboff et al[296], 2025	Fifty healthy women designated as HS based on above threshold scores on a measure of perceived stress were compared to 50 women with LS. Psychological, autonomic nervous system and plasma metabolite assessments were obtained before, during and after exposure to multiple tasks including viewing affective pictures, performing stressful MA and figure ground discrimination	The HS group showed a greater increase in negative affect when challenged with a laboratory stressor (P < 0.001) and in response to neutral affective pictures (P = 0.040); this same group showed overall less sympathetic arousal than the LS group during a MA challenge (P = 0.034). The HS group had a higher plasma metabolite tryptophan/kynurenine ratio than the LS group at baseline, but this did not change with stress

PTSD: Post-traumatic stress disorder; MA: Mental arithmetic; HR: Heart rate; BP: Blood pressure; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; CV: Cardiovascular; HR: Hazard ratio; CI: Confidence interval; CO: Cardiac output; HFr: High frequency; HRV: Heart rate variability; LF: Low frequence; CVR: Cardiovascular reactivity; SV: Stroke volume; SVR: Systemic vascular resistances; BRS: Baroreflex sensitivity; TSST: Trier Social Stress Test; ECG: Electrocardiogram; TPR: Total peripheral resistance; SW: Sedentary women; AW: Active women; CAD: Coronary artery disease; PAT: Peripheral artery tonometry; sPAT: Stress/rest peripheral artery tonometry ratio; IQR: Interquartile range; OR: Odds ratio; SD: Standard deviation; MACE: Major adverse cardiovascular events; hs-CRP: High sensitivity C reactive protein; ETI: Early trauma inventory; MSIMI: Mental stress induced myocardial ischemia; ACS: Acute coronary syndrome; RR: Risk ratio; MS: Mental stress; CTQ: Childhood trauma questionnaire; HEP: Heartbeat-evoked potential; RSA: Respiratory sinus arrhythmia; ACEs: Adverse childhood experiences; hf-PWV: Heart-femoral pulse wave velocity; MAP: Mean arterial pressure; PP: Pulse pressure; PSS: Perceived Social Stress; ELA: Early life adversity; FMD: Flow-mediated dilation; TED: Transient endothelial dysfunction; aOR: Adjusted odds ratio; DC: Deceleration capacity; MIMS2: Myocardial Infarction and Mental Stress 2; ERQ: Emotion Regulation Questionnaire; DERS: Difficulties in Emotion Regulation Scale; PTSS: Posttraumatic stress symptoms; CPC: Circulation progenitor cell; TVC: Total vascular conductance; MSNA: Muscle sympathetic nerve activity; TMNS: Transcutaneous median nerve stimulation; AMI: Acute myocardial infarction; IAPS: International Affective Picture System; PASAT: Paced Auditory Serial Addition Test; IL: Interleukin; SIRI: Systemic inflammation response index; NLR: Neutrophil/Lymphocyte ratio; TNF: Tumor necrosis factor; GR: Grief recall; PGD: Prolonged grief disorder; HS: High stress; LS: Low stress.