Association Of Perceived Stress With Risk For Coronary Heart Disease And The Intervention Effect Of "Yueju Pills"

Objective1. We conducted a systematic review and meta-analysis of the association between perceived stress and CHD to verify their relationship2. We developed an stress model to observe the changes of markers of inflammation under stress, and to examine the intervention effect of the " Yueju pills " during this process, to clarify the full effect of " Yueju pills ", to exert the advantage of traditional Chinese medicine, and looking for new methods of stress management.Methods1. meta-analysis:We included studies if they met all the criteria:1. prospective observational cohort study;2. published in foreign language during January 1990 to February 2016;3. follow-up duration≥3 years;4. the study reported relative risks (RRs) or hazard ratios (HRs) and 95% confidence intervals (CIs) for events associated with high-stress versus low stress. Pubmed, EMBASE, and The Cochrane Library have been searched as data sources.after removing of the duplicated and unqualified studies by Endnote, We identified 8 studies to extract the characteristics and estimates of the risk of incident CHD associated with high perceived stress vs. low perceived stress. Then, we used Revman 5.3 to complete all statistical tests.2. The animal experiment:In 40 rats as the object of experimental research, 8 in each group, divided into A high dose of Chinese medicine+stress model group; B low dose of Chinese medicine+stress model group; C Deanxit+stress model group; D physiological saline+stress model group; E Blank group. Medicine have been given to animals once a day for 3 weeks. At termination time-points, blood was harvested for serum and whole aortas. Corticosterone、 IL-6、 hs-CRP、 sICAM-1 were measured in the serum using ELISA kit while E-selecting was measured in the aorta using E-selecting ELISA kit.Results:1. meta-analysis:We identified 25 potentially relevant articles, of which 8 met our criteria. Among them,2 studies were conducted in England,2 studies was from Japan,1 study was from Sweden,1 study was from Scotland, and 1 study was from Australia,1 study was from Denmark. As far as gender is con-cerned, 1 study was conducted exclusively among men, and 1 study was restricted to women, whereas the other 6 studies included both men and women. Questionnaires based on the Cohen Perceived Stress Scale (PSS) were used to measure perceived stress in 1 paper, and the Reeder Stress Inventory (RSI) was conducted in 1 paper, others simply asked 1 or 2 questions about intensity of daily stress. The nature of these questions was similar to questions included in the validated measures of perceived stress. The follow-up time varied from 3.0 to 21 years.3 studies used death as the primary CHD outcome while 3 studies used diagnosis of CHD as outcome,2 study used both fatal and non-fatal CHD events as outcome.2. The animal experiment:stress have increased the expression of Corticosterone、hs-CRP、ICAM-1 and E-selectine in rats, while Chinese medicine and Deanxit act similarity to reduce the expression of it. Among them, only the hs-CRP has expressed as a dose-response manner.Besides,there were no significant difference in the expression of IL-6, may due to the insufficient modeling time.ConclusionThis meta-analysis suggests that high perceived stress is associated with a moderately increased risk of CHD.The animal experiment suggests that stress could increase the expression of Corticosterone、hs-CRP、ICAM-1 and E-selectine, markers of inflammation, thus, increase the risk for coronary heart disease. And "Yueju pills" could reverse these elevations.