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Endothelin-1 and Psychosocial Risk Factors for Cardiovascular Disease: A Systematic Review

Yammine, Luba PhD; Kang, Duck-Hee PhD; Baun, Mara M. PhD; Meininger, Janet C. PhD

doi: 10.1097/PSY.0000000000000026
Systematic Review/Meta-Analysis

Objectives Psychosocial factors (i.e., social environment and emotional factors) contribute to an increased risk of cardiovascular disease (CVD). Perturbation in a potent vasoconstrictive peptide endothelin (ET)-1 could be one of the mechanisms linking psychosocial factors to CVD. Our aim was to evaluate the literature on the relationship between plasma ET-1 and psychosocial risk factors for CVD.

Methods MEDLINE and PsycINFO databases were searched for articles on human studies published in peer-reviewed English-language journals through September 2012.

Results Of the 20 studies that met the inclusion criteria, 14 were experimental studies of acute psychological/mental challenges and 6 were observational studies of psychological and social factors. The inferences drawn from this review were as follows: a) laboratory-induced acute psychological/mental stress may result in exaggerated plasma ET-1 release in those with CVD and those at risk for CVD (positive studies: 5/10); b) chronic/episodic psychosocial factors may have a positive relationship to plasma ET-1 (positive studies: 3/5); and c) race (African American), sex (male), and individual differences in autonomic and hemodynamic responses to stress (parasympathetic withdrawal and elevated blood pressure responsiveness) may moderate the relationship between psychosocial factors and plasma ET-1.

Conclusions This review indicates that psychosocial risk factors for CVD are associated with elevated plasma ET-1; however, the relatively small number of studies, methodological differences, and variable assessment tools preclude definitive conclusions about the strength of the association. Specific suggestions regarding the selection of psychosocial factors, optimization of acute challenge protocols, and standardization of methods and timing of the ET-1 measures are provided.

From the Departments of Family Health (L.Y.) and Nursing Systems (D.-H.K., M.M.B., J.C.M.), School of Nursing, University of Texas Health Science Centerat Houston, Texas.

Address correspondence and reprint requests to Luba Yammine, PhD, Department of Family Health, School of Nursing, University of Texas Health Science Center at Houston, 6901 Bertner Ave, Room 767, Houston, TX 77030. E-mail:

Received for publication December 9, 2012; revision received November 13, 2013.

Copyright © 2014 by American Psychosomatic Society
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