24 The endothelium through the process of nitric oxide production inhibits smooth muscle cell growth, platelet aggregation, and leukocyte adhesion and maintains vascular tone.24 selleck chemical AZD9291 depression has been linked in several studies to endothelial dysfunction.110,111 Sherwood and colleagues showed that brachial flow-mediated dilation in 143 patients with CHD was impaired in patients reporting at least mild symptoms of depression.110 Depression has also been linked to higher levels of endothelin-1 in patients with CHD.111 Endothelin-1 has been found to be associated #http://www.selleckchem.com/products/Oligomycin-A.html keyword# with plaque rupture and post-acute coronary syndrome survival.111 Depression

has been shown to be associated with elevated 24-hour, urine-free cortisol levels, adrenal gland enlargement and, in patients with severe depression, failure to suppress Inhibitors,research,lifescience,medical cortisol response to the dexamethasone suppression test.112 Researchers have recently posited that in subjects with depression there is reduced

responsiveness of the HPA axis to experimental and physiologic challenges due to chronic hyperactivity of this endocrine system.102 Thus, blunted cortisol response to acute mental stressors has been Inhibitors,research,lifescience,medical shown in depressed compared with nondepressed patients with multiple cardiovascular risk factors.113 Some,114,115 but not all,116 studies Inhibitors,research,lifescience,medical have shown flatter diurnal cortisol profiles in individuals with depression. Several studies have also shown an association of depression with impaired awakening cortisol levels.117,118 A potential consequence

of long-term activation of cortisol is the development of central adiposity. Higher cortisol levels may lead to redistribution of fat from subcutaneous to visceral fat depots.119 Inhibitors,research,lifescience,medical Several studies have shown that community respondents with depression had an increased risk of higher amounts of visceral adipose tissue (VAT).120,121 VAT promotes insulin resistance more than subcutaneous fat, and is associated with a higher risk of cardiovascular disease. Depression is also associated with abnormalities in sympathetic nervous system functioning, including decreased heart rate variability (HRV), higher resting heart rates, and higher heart rate Carfilzomib responses to physical stressors.24,101,102 Increases in catecholamines and cytokines associated with sympathetic hyperactivity may also lead to insulin resistance and increases in blood pressure.121,122 Low HRV has been linked to mortality in patients with CHD and is a marker for excessive sympathetic and/or decreased parasympathetic nervous system activity122,123 Most,124,125 but not all,126 studies have found depression to be linked with decreased HRV in patients with coronary disease.