Thomas Münzel et al. JACC 2018;71:

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Thomas Münzel et al. JACC 2018;71:688-697 Proposed Pathophysiological Mechanisms of Noise-Induced Cardiometabolic Disease Noise causes annoyance and stress responses characterized by activation of the hypothalamic-pituitary-adrenal axis, inflammation, thrombosis, and altered gene expression. See text, section “Potential (molecular) mechanisms underlying noise-induced cardiovascular disease,” for details. Modified/combined from Münzel et al. (73) with permission of the publisher. Copyright © 2017, Oxford University Press. Ang II = angiotensin II; AT1 = angiotensin receptor type 1; ATM = ataxia telangiectasia mutated; eNOS = endothelial nitric oxide synthase; Fas = cell death signaling molecule (CD95); FOXO = Forkhead box O; HPA = hypothalamic-pituitary-adrenal; iNOS = inducible nitric oxide synthase; NADPH = nicotinamide adenine dinucleotide phosphate; Nox = NADPH oxidase; NO = nitric oxide; O2 = oxygen; TGF = transforming growth factor. Thomas Münzel et al. JACC 2018;71:688-697 2018 The Authors