Association of arterial stiffness with reactivity to psychoemotional stress in patients with stable coronary artery disease

Aim – to investigate the impact of increased arterial stiffness, assessed by the cardio-ankle vascular index (CAVI), on the results of psychoemotional stress tests in patients with stable coronary artery disease (CAD). Material and methods: a single-center prospective study included 109 patients with stable CAD (mean age 66.1 ± 9.1 years) prior to elective percutaneous coronary intervention (PCI). Arterial stiffness was assessed using volume sphygmography (Vasera VS-1000 device); a CAVI ≥ 9.0 was considered indicative of pathological stiffness. Psychophysiological testing was performed using the «BO- SLAB Professional Plus» system: a five-stage cycle alternating rest periods (1 min) and cognitive load (3 min – serial mental arithmetic test and Stroop test). The following parameters were recorded: electrocardiogram (ECG), photoplethysmography, electromyography (EMG), and galvanic skin response (GSR). We analyzed the Baevsky stress index (SI) of regulatory systems, R-R intervals, EMG, and GSR. Results. Patients with CAVI ≥ 9.0 (n = 60) were older (median age 71.0 years vs. 63.0 years in the CAVI < 9.0 group; p < 0,001) and more likely to have diabetes mellitus (46.7 % vs. 20.4 %; p = 0,004), multifocal atherosclerosis (51.7 % vs. 28.6 %; p = 0,014), and brachiocephalic artery disease (stenosis ≥ 30 %: 51.7 % vs. 28.6 %; p = 0,015). During stress testing, the dynamics of R-R intervals and Baevsky SI were comparable between groups (p > 0,05). Patients with CAVI ≥ 9.0 showed rigidity of muscle tension (as assessed by EMG, p = 0,072), while the CAVI < 9.0 group demonstrated high EMG lability (p < 0,001). The GSR level in the high-stiffness group was consistently lower (p < 0,05), indicating a reduced functional reserve of autonomic regulation. Conclusions. In patients with stable CAD, increased arterial stiffness (CAVI ≥ 9.0) is associated with altered reactivity to psychoemotional stress, manifested as rigidity of neuromuscular response (per EMG) and reduced functional reserve of autonomic regulation (per GSR). Sympathetic activation (assessed by R-R intervals and Baevsky SI) remains at a comparable level regardless of vascular stiffness.

1. Zhang J, Jia X, Li H, Yang Q. Temporal and joint associations of hypertension and estimated pulse wave velocity with incident cardiovascular diseases: a population-based cohort study. Eur. J. Med. Res. 2025 Jul 4; 30 (1): 572. doi: 10.1186/s40001-025-02843-6

2. Podzolkov V.I., Safronova T.A., Vasyuk Yu.A., Kotovskaya Yu.V., Kislyak O.A., Starodubova A.V., Kopylov F.Yu., Evsevieva M.E., Sumin A.N., Tarzimanova A.I., Ostroumova O.D., Larina V.N., Pavlova O.S., Ivanova S.V., Chulkov V.S., Bes ta vashvili A.A., Kochetkov A.I., Liskova Yu.V., Luzina A.V., Pokrovskaya A.E., Sergeeva O.V., Shupe nina E.Yu., Bragina A.E. Diagnosis of arterial stiffness using the cardio-ankle vascular index. Expert consensus. Cardiovascular. Therapy and Prevention. 2025; 24 (8): 4481. (In Russ.)

3. Agbaje A.O., Barker A.R., Tuomainen T.P. Effects of Arterial Stiffness and Carotid Intima-Media Thickness Progression on the Risk of Overweight/Obesity and Elevated Blood Pressure/Hypertension: a Cross-Lagged Cohort Study. Hypertension. 2022 Jan; 79 (1): 159–169. doi: 10.1161/HYPERTEN-SIONAHA.121.18449

4. Gentilin A., Cevese A., Schena F., Tarperi C. Mental stress augments central artery stiffness in young individuals of both sexes. Biol. Psychol. 2023 Mar; 178: 108513. doi: 10.1016/j.biopsycho.2023.108513

5. Tajima T., Ikeda A., Steptoe A., Takahashi K., Maruyama K., Tomooka K., Saito I., Tanigawa T. The independent association between salivary alpha-amylase activity and arterial stiffness in Japanese men and women: the Toon Health Study. Hypertens. Res. 2022 Aug; 45 (8): 1249–1262. doi: 10.1038/s41440-022-00963-8

6. Szaló G., Eriksson M.C.M., Hellgren M., Ottarsdottir K., Li Y., Chen Y., Rådholm K., Brumback L.C., Allison M., Lindblad U., Daka B. Perceived stress is associated with impaired artery elasticity: An observational study from the Vara-Skövde cohort. PLoS ONE. 2025 Nov 13; 20 (11): e0336298. doi: 10.1371/journal.pone.0336298

7. Massamba V.K., Milot A., Talbot D., Gilbert-Ouimet M., Brisson C., Trudel X. Repeated exposure to psychosocial work-related factors and arterial stiffness among aging workers. Int. Arch. Occup. Environ. Health. 2025 Dec; 98 (9-10): 973–985. doi: 10.1007/s00420-025-02177-0

8. Sumin A.N., Shcheglova A.V.Assessment of Arterial Stiffness Using the Cardio-Ankle Vascular Index – What We Know and What We Strive for. Rational Pharmacotherapy in Cardiology. 2021; 17 (4): 619–627. (In Russ.).

9. Shcheglova A.V., Sumin A.N., Barbarash O.L. Dynamics of the vascular stiffness index START in patients with coronary artery disease after coronary artery bypass grafting. Russian Medical Journal. Medical Review. 2024; 8 (7): 366–374. (In Russ.).

10. Kume D, Nishiwaki M, Hotta N, Endoh H. Impact of acute mental stress on segmental arterial stiffness. Eur. J. Appl. Physiol. 2020 Oct; 120 (10): 2247–2257. doi: 10.1007/s00421-020-04448-9

11. Balint E.M., Jarczok M.N., Langgartner D., Reber S.O., Endes S., Schmidt-Trucksäss A., Funk A., Klinghammer J., Campbell S., Gündel H., Waller C. Heightened Stress Reactivity in Response to an Attachment Related Stressor in Patients With Medically Treated Primary Hypertension. Front. Psychiatry. 2021 Sep 9; 12: 718919. doi: 10.3389/fpsyt.2021.718919

12. Antropova O.N., Osipova I.V. Stress reactivity to psycho-emotional stimuli: clinical implications in patients with arterial hypertension. Arterial Hypertension. 2018; 24 (2): 145–150. (In Russ.).

13. Zieff G., Sharma N., Stone K., Pagan Lassalle P., Chauntry A.J., Hanson E.D., Meyer M.L., Battaglini C., Moore J.B., Paterson C., Stoner L. Acute Psychological Stress and Pulse Wave Velocity: Meta-Analysis and Recommendations for Future Research. Psychophysiology. 2025 May; 62 (5): e70068. doi: 10.1111/psyp.70068

14. Shimizu K., Takahashi M., Sato S., Saiki A., Nagayama D., Harada M., Miyazaki C., Takahara A., Shirai K. Rapid Rise of Cardio-Ankle Vascular Index May Be a Trigger of Cerebro-Cardiovascular Events: Proposal of Smooth Muscle Cell Contraction Theory for Plaque Rupture. Vasc. Health. Risk Manag. 2021 Feb 12; 17: 37–47. doi: 10.2147/VHRM.S290841

15. Nagayama D. Psychological stress-induced increase in the cardio-ankle vascular index (CAVI) may be a predictor of cardiovascular events. Hypertens. Res. 2022 Oct; 45 (10): 1672–1674. doi: 10.1038/s41440-022-00996-z

16. Zagorskaya N.N., Shcheglova A.V., Sumin A.N., Prokashko I.Yu. Psychophysiological stress reactivity of the body in response to a cognitive load test in young healthy individuals: gender differences. Complex Issues of Cardiovascular Diseases. 2024; 13 (4S): 116–125. (In Russ.).

17. Queirolo L., Boscolo A., Cracco T., Moscardi O., Facco E., Zanette G., Stellini E., Navalesi P. Hypnosis reshapes multilevel stress response and enhances executive performance in stressed medical students. Sci. Rep. 2026 Feb 26; 16 (1): 8844. doi: 10.1038/s41598-026-40770-6

18. Oda H., Fujibayashi M., Matsumoto N., Nishiwaki M. Acute Effects of Low-Intensity Electrical Stimulation on Segmental Arterial Stiffness. Front. Physiol. 2022 Jun 6; 13: 828670. doi: 10.3389/fphys.2022.828670

19. Kume D., Nishiwaki M., Takahara R., Hotta N. Three-minute bench step exercise as a countermeasure for acute mental stress-induced arterial stiffening. PLoS ONE. 2022 Dec 30; 17 (12): e0279761. doi: 10.1371/journal.pone.0279761

20. Mackersie C.L., Calderon-Moultrie N. Autonomic Nervous System Reactivity During Speech Repetition Tasks: Heart Rate Variability and Skin Conductance. Ear Hear. 2016 Jul–Aug; 37 Suppl 1: 118S–125S. doi: 10.1097/AUD.0000000000000305

21. Kuznetsov A.A., Tsvetkova E.E., Kuznetsova A.A., Maksimov V.N., Denisova D.V., Voevoda M.I. Association of arterial stiffness indicators and arrhythmogenesis in the male population of Novosibirsk. Atherosclerosis. 2020; 16 (1): 9–13. (In Russ.).

22. Shirai K., Hitsumoto T., Sato S., Takahashi M., Saiki A., Nagayama D., Ohira M., Takahara A., Shimizu K. The Process of Plaque Rupture: The Role of Vasa Vasorum and Medial Smooth Muscle Contraction Monitored by the Cardio-Ankle Vascular Index. J. Clin. Med. 2023 Nov 30; 12 (23): 7436. doi: 10.3390/jcm12237436