{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:52:33Z","timestamp":1793332353547,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20210608"],"award-info":[{"award-number":["20210608"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>To investigate associations between psychosocial (PS) burden and biomarkers reflecting pathophysiological pathways in patients with chronic coronary syndrome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Psychosocial factors were collected from self-assessed questionnaires and biomarkers representing inflammation [high-sensitivity (hs)-C-reactive protein (CRP), interleukin-6 (IL-6), lipoprotein-associated phospholipase A2 (Lp-PLA2)] and cardiac injury\/stress [hs-troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP)] were measured in 12 492 patients with chronic coronary syndrome in the STABILITY trial. Associations between level of each PS factor [never\u2013rarely (reference), sometimes, often\u2013always] and biomarkers were evaluated using linear models with adjusted geometric mean ratios (GMR). A score comprising four factors (\u2018feeling down\u2019, \u2018loss of interest\u2019, financial stress\u2019, and \u2018living alone\u2019) that previously demonstrated association with cardiovascular (CV) outcome was created, and categorized into three levels: low, moderate, and high PS burden. Associations between PS score and biomarkers were evaluated similarly. Greater PS burden was significantly associated with a gradual increase in inflammatory biomarkers [GMR (95% confidence interval) for moderate vs. low PS burden; and high vs. low PS burden]: hs-CRP [1.09 (1.04\u20131.14); 1.12 (1.06\u20131.17)], IL-6 [1.05 (1.02\u20131.07); 1.08 (1.05\u20131.11)], LpPLA2 [1.01 (1.00\u20131.02); 1.02 (1.01\u20131.04)], and cardiac biomarkers hs-TnT [1.03 (1.01\u20131.06); 1.06 (1.03\u20131.09)] and NT-proBNP [1.09 (1.04\u20131.13); 1.21 (1.15\u20131.27)].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with chronic coronary syndrome, greater PS burden was associated with increased levels of inflammatory and cardiac biomarkers. While this observational study does not establish causal nature of these associations, the findings suggest inflammation and cardiac injury\/stress as plausible pathways linking PS burden to an elevated CV risk that needs to be further explored.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwae252","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T03:51:28Z","timestamp":1723002688000},"page":"456-465","source":"Crossref","is-referenced-by-count":4,"title":["Associations between psychosocial burden and prognostic biomarkers in patients with chronic coronary syndrome: a STABILITY substudy"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9258-2137","authenticated-orcid":false,"given":"Charlotte","family":"Wassberg","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Cardiology, Uppsala University , Box 256, 751 05 Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2480-9547","authenticated-orcid":false,"given":"Gorav","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology, Uppsala University , Box 256, 751 05 Uppsala ,","place":["Sweden"]},{"name":"Uppsala Clinical Research Center (UCR) , Uppsala University, Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nermin","family":"Hadziosmanovic","sequence":"additional","affiliation":[{"name":"Uppsala Clinical Research Center (UCR) , Uppsala University, Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3221-0144","authenticated-orcid":false,"given":"Emil","family":"Hagstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology, Uppsala University , Box 256, 751 05 Uppsala ,","place":["Sweden"]},{"name":"Uppsala Clinical Research Center (UCR) , Uppsala University, Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey D","family":"White","sequence":"additional","affiliation":[{"name":"Green Lane Cardiovascular Service, Te Whatu Ora Health New Zealand, Te Toka Tumai Auckland and University of Auckland , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph A H","family":"Stewart","sequence":"additional","affiliation":[{"name":"Green Lane Cardiovascular Service, Te Whatu Ora Health New Zealand, Te Toka Tumai Auckland and University of Auckland , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3955-5671","authenticated-orcid":false,"given":"Agneta","family":"Siegbahn","sequence":"additional","affiliation":[{"name":"Uppsala Clinical Research Center (UCR) , Uppsala University, Uppsala ,","place":["Sweden"]},{"name":"Department of Medical Sciences, Clinical Chemistry, Uppsala University , Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0378-6531","authenticated-orcid":false,"given":"Lars","family":"Wallentin","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology, Uppsala University , Box 256, 751 05 Uppsala ,","place":["Sweden"]},{"name":"Uppsala Clinical Research Center (UCR) , Uppsala University, Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9402-7404","authenticated-orcid":false,"given":"Claes","family":"Held","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology, Uppsala University , Box 256, 751 05 Uppsala ,","place":["Sweden"]},{"name":"Uppsala Clinical Research Center (UCR) , Uppsala University, Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,6]]},"reference":[{"key":"2025042122320196900_zwae252-B1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1001\/jamanetworkopen.2021.38920","article-title":"Psychosocial risk factors and cardiovascular disease and death in a population-based cohort from 21 low-, middle-, and high-income countries","volume":"4","author":"Santosa","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025042122320196900_zwae252-B2","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.pcad.2013.03.009","article-title":"A global perspective on psychosocial risk factors for cardiovascular disease","volume":"55","author":"Neylon","year":"2013","journal-title":"Prog Cardiovasc Dis"},{"key":"2025042122320196900_zwae252-B3","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur Heart J"},{"key":"2025042122320196900_zwae252-B4","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/S0140-6736(04)17019-0","article-title":"Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study","volume":"364","author":"Rosengren","year":"2004","journal-title":"Lancet"},{"key":"2025042122320196900_zwae252-B5","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"2025042122320196900_zwae252-B6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/joim.12692","article-title":"Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease","volume":"283","author":"Hagstr\u00f6m","year":"2018","journal-title":"J Intern Med"},{"key":"2025042122320196900_zwae252-B7","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0022-3999(02)00311-2","article-title":"Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms","volume":"53","author":"Carney","year":"2002","journal-title":"J Psychosom Res"},{"key":"2025042122320196900_zwae252-B8","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1093\/eurheartj\/ehm584","article-title":"Work stress and coronary heart disease: what are the mechanisms?","volume":"29","author":"Chandola","year":"2008","journal-title":"Eur Heart J"},{"key":"2025042122320196900_zwae252-B9","doi-asserted-by":"crossref","first-page":"e010931","DOI":"10.1161\/CIRCIMAGING.120.010931","article-title":"Disentangling the links between psychosocial stress and cardiovascular disease","volume":"13","author":"Osborne","year":"2020","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025042122320196900_zwae252-B10","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.3389\/fimmu.2018.02031","article-title":"Stress and inflammation in coronary artery disease: a review psychoneuroendocrineimmunology-based","volume":"9","author":"Fioranelli","year":"2018","journal-title":"Front Immunol"},{"key":"2025042122320196900_zwae252-B11","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.amjcard.2005.05.064","article-title":"Role of depression and inflammation in incident coronary heart disease events","volume":"96","author":"Shimbo","year":"2005","journal-title":"Am J Cardiol"},{"key":"2025042122320196900_zwae252-B12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11936-019-0724-5","article-title":"Psychosocial stress and cardiovascular disease","volume":"21","author":"Dar","year":"2019","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"2025042122320196900_zwae252-B13","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.005077","article-title":"Inflammatory biomarkers interleukin-6 and c-reactive protein and outcomes in stable coronary heart disease: experiences from the STABILITY (stabilization of atherosclerotic plaque by initiation of darapladib therapy) trial","volume":"6","author":"Held","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025042122320196900_zwae252-B14","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1093\/eurheartj\/ehi036","article-title":"Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study","volume":"26","author":"Schnabel","year":"2005","journal-title":"Eur Heart J"},{"key":"2025042122320196900_zwae252-B15","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1056\/NEJMoa1415921","article-title":"Troponin and cardiac events in stable ischemic heart disease and diabetes","volume":"373","author":"Everett","year":"2015","journal-title":"N Engl J Med"},{"key":"2025042122320196900_zwae252-B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/JAHA.116.003407","article-title":"Lipoprotein-associated phospholipase A2 activity is a marker of risk but not a useful target for treatment in patients with stable coronary heart disease","volume":"5","author":"Wallentin","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"2025042122320196900_zwae252-B17","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1056\/NEJMoa1315878","article-title":"Darapladib for preventing ischemic events in stable coronary heart disease","volume":"370","author":"White","year":"2014","journal-title":"N Engl J Med"},{"key":"2025042122320196900_zwae252-B18","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.ahj.2010.07.006","article-title":"Study design and rationale for the clinical outcomes of the STABILITY trial (STabilization of atherosclerotic plaque by initiation of darapLadIb TherapY) comparing darapladib versus placebo in patients with coronary heart disease","volume":"160","author":"White","year":"2010","journal-title":"Am Heart J"},{"key":"2025042122320196900_zwae252-B19","doi-asserted-by":"crossref","first-page":"695925","DOI":"10.1155\/2013\/695925","article-title":"Depression and cardiac disease: epidemiology, mechanisms, and diagnosis","volume":"2013","author":"Huffman","year":"2013","journal-title":"Cardiovasc Psychiatry Neurol"},{"key":"2025042122320196900_zwae252-B20","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.amjmed.2008.09.010","article-title":"Depression in patients with coronary heart disease","volume":"121","author":"Carney","year":"2008","journal-title":"Am J Med"},{"key":"2025042122320196900_zwae252-B21","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1177\/2047487318770510","article-title":"Factors associated with emotional distress in patients with myocardial infarction: results from the SWEDEHEART registry","volume":"25","author":"Norlund","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2025042122320196900_zwae252-B22","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1093\/eurjpc\/zwad102","article-title":"Increased cardiovascular events in young patients with mental disorders: a nationwide cohort study","volume":"30","author":"Park","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"2025042122320196900_zwae252-B23","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1056\/NEJMoa032804","article-title":"C-Reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease","volume":"350","author":"Danesh","year":"2004","journal-title":"N Engl J Med"},{"key":"2025042122320196900_zwae252-B24","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1056\/NEJMra043430","article-title":"Inflammation, atherosclerosis, and coronary artery disease","volume":"352","author":"Hansson","year":"2005","journal-title":"N Engl J Med"},{"key":"2025042122320196900_zwae252-B25","first-page":"E30285","article-title":"Predictive value of baseline C-reactive protein level in patients with stable coronary artery disease: a meta-analysis","volume":"101","author":"Luo","year":"2022","journal-title":"Med (United States)"},{"key":"2025042122320196900_zwae252-B26","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1017\/S0033291708003723","article-title":"Associations of C-reactive protein and interleukin-6 with cognitive symptoms of depression: 12-year follow-up of the Whitehall II study","volume":"39","author":"Gimeno","year":"2009","journal-title":"Psychol Med"},{"key":"2025042122320196900_zwae252-B27","doi-asserted-by":"crossref","first-page":"110657","DOI":"10.1016\/j.jpsychores.2021.110657","article-title":"Prospective increases in depression symptoms and markers of inflammation increase coronary heart disease risk\u2014the Whitehall II cohort study","volume":"151","author":"Piantella","year":"2021","journal-title":"J Psychosom Res"},{"key":"2025042122320196900_zwae252-B28","doi-asserted-by":"crossref","first-page":"2138920","DOI":"10.1001\/jamanetworkopen.2021.38920","article-title":"Psychosocial risk factors and cardiovascular disease and death in a population-based cohort from 21 low-, middle-, and high-income countries + supplemental content","volume":"4","author":"Santosa","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025042122320196900_zwae252-B29","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ijcard.2008.03.093","article-title":"Financial strain predicts recurrent events among women with coronary artery disease","volume":"135","author":"Georgiades","year":"2009","journal-title":"Int J Cardiol"},{"key":"2025042122320196900_zwae252-B30","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.bbi.2017.01.011","article-title":"The effects of acute psychological stress on circulating and stimulated inflammatory markers: a systematic review and meta-analysis","volume":"64","author":"Marsland","year":"2017","journal-title":"Brain Behav Immun"},{"key":"2025042122320196900_zwae252-B31","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.amjcard.2007.11.006","article-title":"Effects of acute mental stress and exercise on inflammatory markers in patients with coronary artery disease and healthy controls","volume":"101","author":"Kop","year":"2008","journal-title":"Am J Cardiol"},{"key":"2025042122320196900_zwae252-B32","doi-asserted-by":"crossref","first-page":"e010329","DOI":"10.1161\/JAHA.118.010329","article-title":"Young women with coronary artery disease exhibit higher concentrations of interleukin-6 at baseline and in response to mental stress","volume":"7","author":"Sullivan","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025042122320196900_zwae252-B33","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1093\/eurheartj\/eht216","article-title":"Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study","volume":"34","author":"Nabi","year":"2013","journal-title":"Eur Heart J"},{"key":"2025042122320196900_zwae252-B34","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1016\/j.jacc.2013.05.070","article-title":"The association between cortisol response to mental stress and high-sensitivity cardiac troponin T plasma concentration in healthy adults","volume":"62","author":"Lazzarino","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2025042122320196900_zwae252-B35","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.psyneuen.2018.06.001","article-title":"Associations of NT-proBNP and parameters of mental health in depressed coronary artery disease patients","volume":"96","author":"Fangauf","year":"2018","journal-title":"Psychoneuroendocrinology"},{"key":"2025042122320196900_zwae252-B36","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(17)32814-3","article-title":"Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial","volume":"391","author":"Ridker","year":"2018","journal-title":"Lancet"},{"key":"2025042122320196900_zwae252-B37","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1056\/NEJMoa1912388","article-title":"Efficacy and safety of low-dose colchicine after myocardial infarction","volume":"381","author":"Tardif","year":"2019","journal-title":"N Engl J Med"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwae252\/58906245\/zwae252.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/32\/6\/456\/58906245\/zwae252.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/32\/6\/456\/58906245\/zwae252.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T02:32:14Z","timestamp":1745289134000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/article\/32\/6\/456\/7728237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,6]]},"references-count":37,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,8,6]]},"published-print":{"date-parts":[[2025,4,22]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwae252","relation":{},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2024,8,6]]}}}