Article

Blood Pressure Reactivity to Psychological Stress and Coronary Calcification in the Coronary Artery Risk Development in Young Adults Study

April 2006
Hypertension 47(3):391-5

April 2006
47(3):391-5

DOI:10.1161/01.HYP.0000200713.44895.38

Source
PubMed

Authors:

Diane Tucker

University of Alabama at Birmingham

Mary A Whooley

UCSF University of California, San Francisco

A longstanding hypothesis is that individuals who exhibit large increases in blood pressure during psychological stress are at risk for atherosclerosis. We tested whether blood pressure changes during psychological stress predict subsequent coronary calcification (CaC) in young healthy adults. We evaluated 2816 healthy black and white women, 20 to 35 years of age, from the Coronary Artery Risk Development in Young Adults Study, who were not using medication for hypertension or diabetes in 1987-1988. Participants completed video game and star tracing tasks while their blood pressure was recorded. Thirteen years later (2000-2001), they completed computed tomography measures of CaC. Overall 9.3% (261 of 2816) had CaC present at follow-up. Each 10 mm Hg change in systolic blood pressure during the video game was associated with a 24% increased odds of having CaC at follow-up (unadjusted odds ratio, 1.24; 95% CI, 1.06 to 1.46; P=0.008). This association persisted after adjustment for age, race, sex, education, smoking, alcohol, family history of myocardial infarction, smoking, daily alcohol consumption, body mass index, and resting or baseline blood pressure (odds ratio, 1.31; 95% CI, 1.08 to 1.58; P=0.006). Blood pressure changes during the star tracing task were not associated with subsequent CaC. Blood pressure changes during a video game predicted the presence of CaC 13 years later. To our knowledge, this is the first study that reports blood pressure reactivity to a stressor being related to calcification in the coronary arteries. Blood pressure reactivity may provide useful prognostic information about future risk beyond standard risk factors.

Blunted cardiovascular reactivity to psychological stress and prospective health: A systematic review

Article

Apr 2022
Health Psychol Rev

Novel research demonstrates that lower or "blunted" cardiovascular reactions to stress are associated with a range of adverse outcomes. The aim of the current review was (1) to examine the prospective outcomes predicted by blunted cardiovascular reactivity and (2) to identify a range of blunted cardiovascular reaction levels that predict these outcomes. Electronic databases were systematically searched (Medline, PsycArticles, PsycInfo, CINAHL, PubMed, Web of Science). Studies were included if they examined the prospective influence of blunted cardiovascular reactivity to psychological stress (SBP, DBP or HR) on a negative health, behavioural or psychological outcome. A total of 23 studies were included in the review. Blunted reactivity predicted (1) adverse cardiovascular health, primarily in cardiac samples (e.g., myocardial infarction, carotid atherosclerosis) and (2) outcomes associated with motivational and behavioural dysregulation in healthy samples (e.g., obesity, smoking addiction, depression). The cardiovascular reactivity threshold levels that were predictive of adverse health outcomes ranged between -3.00-12.59bpm (14.41% - 136.59% lower than the sample mean) and -2.4 - 5.00mmhg (65.99% -133.80% lower than sample mean), for HR and DBP respectively. We posit that blunted reactions lower than, or equal to, the ranges reported here may be utilised by clinicians and researchers to identify individuals who are at increased risk of adverse cardiovascular health outcomes, as well as outcomes associated with motivational and behavioural dysregulation.

Early Life Stress, Coping, and Cardiovascular Reactivity to Acute Social Stress

Article

Dec 2022
PSYCHOSOM MED

Objective: Early life stress (ELS) occurring during childhood and adolescence is an established risk factor for later cardiovascular disease and dysregulated reactivity to acute social stress. This study examined whether ELS associations with baseline cardiovascular functioning, cardiovascular stress reactivity and recovery, and emotional stress reactivity vary across levels of emotion-oriented, task-oriented, and avoidant coping styles. Methods: The sample included 1,027 adolescents and young adults (Mean age 19.29 years; 50% females; 64% Black, 34% Non-Hispanic White) who reported on their ELS exposure and coping styles. Participants completed a standardized acute social stress test (the Trier Social Stress Test; TSST), with heart rate (HR) and blood pressure (BP) measured before, during, and after the TSST. Self-reports of negative emotions during the TSST indexed emotional stress reactivity. Results: Multiple regression models adjusting for demographic factors and body mass index (BMI) showed that ELS was associated with lower HR stress reactivity; avoidant coping was related to lower SBP and DBP during stress and lower SBP during recovery; and higher emotion-oriented coping and lower task-oriented coping predicted greater emotional stress reactivity. A consistent pattern emerged where emotion-oriented coping amplified the associations between ELS and maladaptive stress responses (blunted cardiovascular stress reactivity and recovery; enhanced emotional stress reactivity), whereas lower levels of emotion-oriented coping were associated with resilient profiles among those who experienced ELS (lower resting HR; lower emotional stress reactivity; average HR and BP stress reactivity and recovery). However, low levels of emotion-oriented coping also conferred a risk of higher BP during recovery for those with high levels of ELS. Conclusions: These results suggest that low to moderate levels of emotion-oriented coping promote optimal cardiovascular and emotional reactivity to acute stress among individuals exposed to ELS.

Evaluation of a remote, internet-delivered version of the Trier Social Stress Test

Article

Apr 2021
INT J PSYCHOPHYSIOL

The Trier Social Stress Test (TSST) is a widely used, reliable, and ecologically valid method for inducing acute stress under controlled conditions. Traditionally, the TSST is administered with staff physically present with participants, which limits the participant populations that can be exposed to the TSST. We describe an adaptation of the TSST to remote, online delivery over video-conferencing, which we call the internet-delivered Trier Social Stress Test (iTSST). This adaption has participants use wearable, self-administered ECG monitors received and returned via mail. Fifty participants were recruited to take part in a pilot study evaluating stress-reduction interventions and completed the iTSST at two occasions separated by approximately 12 weeks. Perceived stress and heart rate variability (HRV) were measured during both administrations of the iTSST. Forty-one participants completed both assessments and were included in the set of analyses. Both administrations were characterized by an increase in self-reported stress and reduction in self-reported relaxation from the resting phase to the speech task, which returned to baseline during recovery. In terms of HRV, we observed a significant parasympathetic response to the iTSST in 90% of participants, evidenced by a decrease in RMSSD and increase in heart rate from resting to the speech task, which recovered during the recovery phase. In terms of repeatability, there was little evidence of habituation and the iTSST elicited a stress response during both the initial administration and the 12-week follow-up. While the utility is limited by the lack of a measure of sympathetic and HPA-axis activity, the iTSST represents a promising research tool when physically interacting with participants is not feasible.

Is stressor‐evoked cardiovascular reactivity a pathway linking positive and negative emotionality to preclinical cardiovascular disease risk?

Article

Dec 2020

Stressor‐evoked cardiovascular reactivity, trait positive emotionality, and negative emotionality are all associated with cardiovascular disease. It is unknown, however, whether cardiovascular reactivity may constitute a pathway by which trait positive or negative emotionality relates to disease risk. Accordingly, this study modeled the cross‐sectional relationships between trait positive and negative emotionality, stressor‐evoked cardiovascular reactivity, and severity of a subclinical vascular marker of cardiovascular risk, carotid artery intima‐media thickness (CA‐IMT). The sample consisted of healthy, midlife adults free from clinical cardiovascular disease (N = 286; ages 30–54; 50% female). Trait positive and negative emotionality were measured by three questionnaires. Heart rate and blood pressure reactivity were assessed across three stressor tasks. CA‐IMT was assessed by ultrasonography. Latent factors of positive and negative emotionality, blood pressure reactivity, heart rate reactivity, and CA‐IMT were created using structural equation modeling. Greater negative emotionality was marginally associated with more CA‐IMT (β = .21; p = .049), but lower blood pressure reactivity (β = −.19; p = .03). However, heightened blood pressure (β = .21; p = .03), but not heart rate reactivity (β = −.05; p = .75), associated with greater CA‐IMT. Positive emotionality was uncorrelated with cardiovascular reactivity (blood pressure: β = −.04; p = .61; heart rate: β = .16; p = .11) and CA‐IMT (β = .16; p = .07). Although trait negative emotionality associates with a known marker of cardiovascular disease risk, independent of positive emotionality, it is unlikely to occur via a stressor‐evoked cardiovascular reactivity pathway.

Stress-Induced Blood Pressure Elevation Self-Measured by a Wearable Watch-Type Device

Article

Full-text available

Aug 2020
Am J Hypertens

Background: Psychological stress contributes to blood pressure (BP) variability, which is a significant and independent risk factor for cardiovascular events. We compared the effectiveness of a recently developed wearable watch-type BP monitoring (WBPM) device and an ambulatory BP monitoring (ABPM) device for detecting ambulatory stress-induced BP elevation in 50 outpatients with one or more cardiovascular risk factors. Methods: The WBPM and ABPM were both worn on the subject's non-dominant arm. ABPM was measured automatically at 30-min intervals, and each ABPM measurement was followed by a self-measured WBPM measurement. We also collected self-reported information about situational conditions, including the emotional state of subjects at the time of each BP measurement. We analyzed 642 paired BP readings for which the self-reported emotional state in the corresponding diary entry was happy, calm, anxious, or tense. Results: In a mixed-effect analysis, there were significant differences between the BP values measured during negative (anxious, tense) and positive (happy, calm) emotions in both the WBPM (systolic BP [SBP]: 9.3±2.1 mmHg, p<0.001; diastolic BP [DBP]: 8.4±1.4 mmHg, p<0.001) and ABPM (SBP: 10.7±2.1 mmHg, p<0.001; DBP: 5.6±1.4 mmHg; p<0.001). The absolute BP levels induced by emotional stress self-measured by the WBPM were similar to those auto-measured by the ABPM (SBP, WBPM: 141.1±2.7 mmHg; ABPM: 140.3±2.7 mmHg; p=0.724). The subject's location at the BP measurement was also significantly associated with BP elevation. Conclusions: The self-measurement by the WBPM could detect BP variability induced by multiple factors, including emotional stress, under ambulatory conditions as accurately as ABPM.

Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System

Article

Full-text available

Mar 2024
PLOS ONE

Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension). PURPOSE: Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other. METHODS: We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans ( n = 21,076); non-combat veterans with no PD/TBI ( n = 3,150); combat veterans with no PD/TBI ( n = 1,979); and veterans (combat and non-combat) with PD and/or TBI ( n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables. RESULTS: One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p <0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI ( p <0.05). DISCUSSION: Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure).

Effects of examination-induced stress on memory and blood pressure

Article

Full-text available

Nov 2023

Stress has been defined in many ways as a state of psychological arousal that results when the external demand is beyond what one can cope with. Stress is caused by various factors called stressors. Medical students are subjected to different kinds of stressors, such as pressure of academics with obligation to succeed, an uncertain future and difficulties of integrating into the system and different teaching protocols, which may affect their learning ability and performance. Stress has a great impact on brain mainly in the form of impaired memory and on cardiovascular function in the form of increased heart rate and blood pressure. The study was planned to assess the effects of examination induced stress on memory and blood pressure. The study was longitudinal in nature conducted at Department of Physiology, Santosh Medical College, Ghaziabad, India. Initially 100 subjects were selected from 17-24 years of age group then all the subjects were divided into two groups of ‘slow-learners’ and ‘fast-learners’ based upon their past academic performances. Readings were taken at two stages of academic year, 05 months before pre-prof examination and 03 days before pre-prof examination. Blood Pressure were measured and the memory assessments were done by using 10 subtests of PGI memory scale. We found a significant increase in stress level 3 days before the examination, compared to 5 months before the examination which in turn affected both blood pressure and memory functions. But, slow-learners were affected more compared to fast-learners.

Patterns of Respiration Rate Reactivity in Response to a Cognitive Stressor Associate With Self-Reported Mental Health Outcomes

Article

Apr 2023
PSYCHOL REP

Many studies have examined physiological responses to acute stress in healthy and clinical populations. Some have documented exaggerated physiological stress reactivity in response to acute stress, while others have reported blunted physiological stress reactivity. Although the literature is conflicted, the relationship between abnormal physiological stress reactivity and negative outcomes is well-established. However, past research has neglected a critical aspect of physiological stress response - respiration - and it is unclear whether differences in respiration rate responses to acute stress are related to health outcomes. This secondary cross-sectional analysis explored differences in outcomes between three subgroups: blunted, moderate, and exaggerated respiration rate reactivity to an acute stress task. In a sample of at least mildly-stressed older adults (n = 55), we found that perceived stress (b = -7.63; p = .004) and depression (b = -9.13; p = .007) were significantly lower in the moderate reactivity group compared to the high reactivity group, and that self-reported mindfulness (b = 10.96; p = .008) was significantly lower in the moderate reactivity group as compared to the low reactivity group. Across outcomes, participants in the moderate range of physiological reactivity showed less negative and more positive psychological attributes and better health outcomes, while the blunted subgroup demonstrated more negative and less positive psychological attributes and worse health outcomes overall, when compared to the exaggerated and moderate groups. This study extends the literature by adding respiration to markers of acute physiological stress reactivity and demonstrating the effects of blunted respiration reactivity on negative psychological attributes and health outcomes.

Evaluating the use of coronary artery calcium scoring as a tool for coronary artery disease (CAD) risk stratification and its association with coronary stenosis and CAD risk factors: a single-centre, retrospective, cross-sectional study at a tertiary centre in Pakistan

Article

Full-text available

Jul 2022

Objective Coronary artery disease (CAD) risk stratification plays a fundamental role in the early detection and optimal management of CAD. The aim of our study is to investigate the use of coronary artery calcium scoring (CACS) as a tool for CAD risk stratification through evaluation of its correlation with the degree of coronary stenosis and its association with conventional cardiovascular risk factors in asymptomatic patients. Design Single-centre, retrospective, cross-sectional study. Setting The study was conducted at a tertiary centre (Shifa International Hospital) in Islamabad, Pakistan, through review of medical records of patients who underwent coronary CT between the years 2016 and 2020. Participants A total of 1014 patients were included in the study. The study population was analysed for presence of conventional risk factors (gender, age, diabetes, hypertension, body mass index, dyslipidaemia) and association with CACS (zero: n=534; minimal: 0 to ≤10, n=70; mild: >10 to ≤100, n=130; moderate: >100 to ≤400, n=118; and severe: >400, n=49). The association of CACS with the degree of coronary artery stenosis seen on CT scan (significant: ≥50% stenosis, n=216; non-significant: <50% stenosis, n=685) was also analysed. Outcome measures The main outcome was the association of coronary artery stenosis with CACS. The secondary outcome was the association of CACS with conventional CAD risk factors. Results A significant positive association was shown between CACS and coronary artery stenosis (zero vs minimal: OR 0.39, 95% CI 0.20 to 0.79, p=0.01; zero vs mild: OR 0.16, 95% CI 0.10 to 0.27, p<0.0001; zero vs moderate: OR 0.05, 95% CI 0.03 to 0.08, p<0.0001; zero vs severe: OR 0.02, 95% CI 0.01 to 0.050, p<0.0001). Age >45 (OR 1.03, 95% CI 1.01 to 1.05, p<0.0001), hypertension (OR 1.16, 95% CI 0.79 to 1.71, p=0.001) and diabetes (OR 1.33, 95% CI 0.88 to 1.99, p<0.0001) were associated with an increased risk of coronary artery stenosis. Moreover, plaques with higher calcium burden were found in the left anterior descending artery (mean CACS: 386.15±203.89), followed by right coronary (239.77±219.83) and left circumflex (175.56±153.54) arteries. Conclusion The results indicate a strong positive association of CACS with coronary artery stenosis. CACS was also significantly associated with conventional CAD risk factors in this population.

Estrés y trastornos cardiovasculares: Los factores psicosociales en el corazón y la circulación

Chapter

Jan 2019

The Cardiovascular Cost of Silence: Relationships Between Self-silencing and Carotid Atherosclerosis in Midlife Women

Article

Jun 2021

Background Individuals engage in a range of behaviors to maintain close relationships. One behavior is self-silencing or inhibiting self-expression to avoid relationship conflict or loss. Self-silencing is related to poor mental health and self-reported physical health in women but has not been examined in relation to cardiovascular health, particularly using direct measures of the vasculature. Purpose To test associations between self-silencing and carotid atherosclerosis in midlife women; secondary analyses examined moderation by race/ethnicity. Methods Women (N = 290, ages 40–60) reported on self-silencing in intimate relationships and underwent physical measurements, blood draw, and ultrasound assessment of carotid intima–media thickness (IMT) and plaque. Associations between self-silencing and mean IMT and plaque index (0, 1, ≥2) were tested in linear regression and multinomial logistic regression models, respectively, followed by interaction terms between self-silencing and race, adjusted for demographic factors, CVD risk factors, partner status, depression, physical activity, and diet. Results Forty-seven percent of women demonstrated carotid plaque. Greater self-silencing was related to increased odds of plaque index ≥2 (e.g., for each additional point, odds ratio [95% confidence interval] = 1.16 [1.03–1.31], p = .012), relative to no plaque). Moderation analyses indicated that self-silencing was related to odds of plaque index ≥2 in non-white women (1.15 [1.05–1.26], p = .004), but there was no significant relationship in white women (1.01 [0.97–1.06], p = .550). No associations emerged for IMT. Conclusions Among midlife women, self-silencing was associated with carotid plaque, independent of CVD risk factors, depression, and health behaviors. Emotional expression in relationships may be important for women’s cardiovascular health.

Occupational Health and Safety, Organisational Commitment, and Turnover Intention in the Spanish IT Consultancy Sector

Article

Full-text available

May 2021
Int J Environ Res Publ Health

Background: The purpose of this study is to analyse the impact that occupational health and safety policies have on employees' work and organisational commitment and, in turn, on their intention to leave the company. Methods: For this study, we designed a questionnaire with a five-level Likert scale and distributed it among professionals from different companies in the IT consultancy sector in Spain. The data collected from 458 completed questionnaires were analysed using the partial least squares structural equation modelling (PLS-SEM) technique using the SmartPLS software. Results: From the analysis of the data, it was concluded that there is indeed a positive relationship between occupational health and safety policies and employees' work and organisational commitment, as well as a negative relationship between these policies and the intention to leave the company. Similarly, there is a negative relationship between employees' work and organisational commitment and their turnover intention. Conclusions: Although, due to the activity of professionals in the sector, occupational health and safety has not been an area of priority, it was concluded from this study that an improvement in these areas would have a beneficial effect on the commitment of workers to the company, thus helping to reduce the high levels of turnover in the sector. Future lines of research, as well as their practical application and the limitations of the study, are indicated at the end of the paper.

Trait neuroticism does not relate to cardiovascular reactivity or habituation to repeated acute psychosocial stress

Article

Apr 2021

Neuroticism has been associated with adverse cardiovascular health. Adverse cardiovascular health outcomes have also been linked to cardiovascular reactivity and cardiovascular reactivity habituation to acute psychosocial stress. As such, cardiovascular stress reactivity and habituation may be a factor in the association between neuroticism and disease risk. However, studies of the relationship between neuroticism and cardiovascular reactivity have produced mixed results. Moreover, the relationships between neuroticism, cardiovascular reactivity habituation, and general affect across a repeated stress paradigm have not been examined. The present study aimed to assess the relationships between neuroticism, positive and negative affect, and cardiovascular reactivity and habituation to acute psychosocial stress in a large, demographically diverse sample. Participants (N = 426) completed two 4-min mental arithmetic stressors, each with a separate baseline, in a single laboratory session while having discrete blood pressure and heart rate measurements taken. State positive and negative affect were measured immediately following informed consent, after receiving task instructions, and after each stress task. Trait neuroticism was measured using the Big Five Inventory. Each stress task elicited significant cardiovascular changes. Trait neuroticism was not significantly associated with cardiovascular reactivity or cardiovascular reactivity habituation, within or across stress tasks (all p's > 0.12). Across the entire study protocol, neuroticism was significantly related to lower positive affect and higher negative affect (both p's < 0.001). Trait neuroticism did not relate to stress-related cardiovascular adjustments but might confer a predisposition toward high negative affect.

Eudaimonic and Hedonic Well-Being: An Integrative Perspective with Linkages to Sociodemographic Factors and HealthAn Integrative Perspective with Linkages to Sociodemographic Factors and Health

Chapter

May 2021

This chapter provides an overview of hedonic and eudaimonic approaches to well-being, both with roots traceable to the ancient Greeks. The authors examine the history of each approach and describe scientific endeavors seeking to translate the ideas to empirical assessment tools. They review how these two varieties of well-being are distributed in the general population by attending to their associations with major demographic factors (age, socioeconomic status, gender, race) as well as the interplay (intersectionality) of such factors. Such information contextualizes what is known about who reports they are or are not experiencing various aspects of well-being. The authors then examine how hedonic and eudaimonic well-being are linked with multiple indicators of health (self-reported, morbidity, mortality, biological systems). There is a paucity of studies that have jointly examined both types of well-being. The authors then draw attention to changing historical conditions and what this means for the future study of well-being and health.

The impact of physical proximity and attachment working models on cardiovascular reactivity: Comparing mental activation and romantic partner presence

Article

Jan 2019

Close relationships, especially high‐quality romantic relationships, are consistently associated with positive physical health outcomes. Attenuated cardiovascular reactivity is one physiological mechanism implicated in explaining these effects. Drawing on attachment and social baseline theories, this experimental study evaluated two potential affiliative cues as mechanisms through which romantic relationships may attenuate cardiovascular reactivity to a laboratory‐based stressor. Prior to a cold pressor task, 102 participants were randomly assigned to either have their partner physically present, call upon a mental representation of their partner, or think about their day during the stressor. Consistent with our preregistered hypotheses, participants in both the partner present and mental activation conditions had significantly lower blood pressure (BP) reactivity during the cold pressor task compared to control participants for both systolic (d = −0.54) and diastolic BP (d = −0.53), but no significant differences emerged for heart rate or heart rate variability. Although participants in the partner present and mental activation conditions had similar BP reactivity to the cold pressor task, those in the partner present condition reported significantly less pain as a result of the task. The difference in BP reactivity by condition was moderated—BP reactivity was greater for people with lower self‐reported relationship satisfaction. The results suggest that accessing the mental representation of a romantic partner and a partner's presence each buffer against exaggerated acute stress responses to a similar degree.

Occupational Stress and Demographic Characteristics among Information Technology Professionals

Article

Full-text available

Nov 2018

Occupational stress among information system professionals is gaining more recognition because it may lead to high turnover and less productivity. The present research focuses on software development professionals to examine their occupational stress and demographic characteristics in India. A questionnaire was developed to identify the occupational stress among software development professionals (SDP) using dimensions such as age, average daily working hours, gender, training and nature of work. Data from 156 respondents working in information technology companies in Chennai and Bangalore was collected. It was found that those who were more than 30 years of age have stress due to work family interface. Employees working less than 10 hours daily experience more stress due to fear of obsolescence, individual team interaction, work culture, lack of family support and technical risk propensity. In terms of gender, men and women professionals do not differ in their occupational stress. However, employees who had computer training especially in software programming in addition to their engineering degree face more stress due to fear of obsolescence and technical risk propensity. Software development professionals whose nature of work is purely technical experience more stress because of fear of obsolescence than others. The results are discussed and based on these the relevant implications are suggested.

The Effect of Breathing Exercise on Fatigue and Stress in Patients with Coronary Artery Diseases: A Randomized Controlled Trial

Article

Full-text available

Jan 2016

(Too) Anxious to help? Social support provider anxiety and cardiovascular function

Article

Full-text available

Sep 2017
INT J PSYCHOPHYSIOL

Provider factors, such as anxiety, may be important in understanding effects of received social support (SS), which are less consistently positive than those of perceived SS. Due to the dyadic nature of support, anxiety on the part of the provider was predicted to influence the effectiveness of received SS. This laboratory study examined effects of SS provider anxiety within unacquainted dyads on cardiovascular reactivity during acute stress. 148 participants were assigned to support roles, and each dyad was randomized to low or high provider anxiety. Results include that SS provider anxiety resulted in greater blood pressure reactivity and less recovery toward baseline diastolic blood pressure within the dyad. Overall, it appears provider anxiety contributes to less effective SS for recipients and that health costs may accompany providing and receiving support under nonoptimal conditions.

Familial Risk for Insomnia Is Associated With Abnormal Cortisol Response to Stress

Article

Full-text available

Aug 2017

Objectives Abnormalities in the stress system have been implicated in insomnia. However, studies examining physiological stress regulation in insomnia have not consistently detected differences in the hypothalamic–pituitary–adrenal (HPA)-axis response to stress. One explanation may be that deficits in the stress system are associated specifically with a biological vulnerability to insomnia rather than the phenotypic expression of insomnia. To examine stress response as a function of vulnerability to insomnia, this study tested response to the Trier Social Stress Test in a sample of healthy sleepers with varying familial risk for insomnia. Methods Thirty-five healthy individuals with and without familial risk for insomnia were recruited to complete a laboratory stressor. Participants with one or both biological parents with insomnia were categorized as positive for familial risk, whereas those without biological parents with insomnia were categorized as negative for familial risk. Participants completed the Trier Social Stress Test in the laboratory, and psychological and physiological (autonomic and HPA-axis) responses were compared. Results Despite self-reported increases in anxiety, those positive for familial risk exhibited a blunted cortisol response relative to those without familial risk for insomnia. Individuals with blunted cortisol also reported heightened reactivity to personal life stressors, including increased sleep disturbances, elevated cognitive intrusions, and more behavioral avoidance. Conclusions Findings from this study provide initial evidence that abnormal stress regulation may be a biological predisposing factor conferred via familial risk for insomnia. This deficit may also predict negative consequences over time, including insomnia and the associated psychiatric comorbidities.

Adrenoceptors and Hypertension

Chapter

Jun 2024
Handbook Exp Pharmacol

Hypertension is a very prevalent condition associated with high mortality and morbidity, secondary to changes resulting in blood vessels and resultant end-organ damage. Haemodynamic changes, including an initial rise in cardiac output followed by an increase in total peripheral resistance, denote the early changes associated with borderline or stage 1 hypertension, especially in young men. Increased sodium reabsorption leading to kidney damage is another mechanism proposed as one of the initial triggers for essential hypertension. The underlying pathophysiological mechanisms include catecholamine-induced α1- and ß1-adrenoceptor stimulation, and renin–angiotensin–aldosterone system activation leading to endothelial dysfunction which is believed to lead to persistent blood pressure elevation. α1 blockers, α2 agonists, and ß blockers were among the first oral anti-hypertensives. They are no longer first-line therapy after outcome trials did not demonstrate any benefits over and above other agents, despite similar blood pressure reductions. Angiotensin-converting enzyme inhibitors (or angiotensin receptor blockers), calcium channel blockers, and thiazide-like diuretics are now considered the first line of therapy, although adrenoceptor agents still have a role as second- or third-line therapy. The chapter also highlights hypertension in specific medical conditions such as pregnancy, phaeochromocytoma, hyperthyroidism, portal hypertension, pulmonary arterial hypertension, and ocular hypertension, to provide an overview for clinicians and researchers interested in the role of adrenoceptors in the pathophysiology and management of hypertension.

Social isolation: relationship with cardiovascular diseases

Article

Mar 2024

G. I. Lobov

Social and demographic changes in the recent decades have led to an increase in the prevalence of social isolation and loneliness in modern society. Social isolation and loneliness are common but underrated factors that determine health, especially cardiovascular health. In addition, the results of various studies have shown that the negative impact of loneliness and social isolation leads to dysfunction of other systems. Social isolation and loneliness are accompanied by the development of oxidative stress in brain structures. This stress activates neurons in the prefrontal cortex and limbic areas, which is accompanied by prolonged increased production of glucocorticoid hormones, eventually leading to resistance to glucocorticoids. At the same time, the sympathetic nervous system is also activated, which, against the backdrop of resistance to glucocorticoids, causes a persistent increase in blood pressure and the development of a pro-inflammatory state. As a result, lonely people experience increased peripheral vascular resistance and increased blood pressure. In addition, the atherosclerotic changes in the arteries develop faster. Although the molecular mechanisms responsible for increased cardiovascular risk in lonely and socially isolated people are not well studied, these changes have been proven to contribute to an increased risk of developing cardiovascular disease. Current measures to fight against loneliness and social isolation have the potential to reduce their negative impact on health. However, given their limited use, their effectiveness for society as a whole is insufficient. In order to better understand the mechanisms of the negative impact of loneliness and social isolation on cardiovascular health, more in-depth research and the development of more effective interventions are needed.

Neurophysiological substrates of cardiovascular reactivity to stress

Chapter

Jan 2024

Stress and the Development of Atherosclerotic Cardiovascular Disease

Chapter

Oct 2022

Emotion suppression and acute physiological responses to stress in healthy populations: a quantitative review of experimental and correlational investigations

Article

Aug 2023

Emotion suppression may be linked to poor health outcomes through elevated stress-related physiology. The current meta-analyses investigate the magnitude of the association between suppression and physiological responses to active psychological stress tasks administered in the laboratory. Relevant articles were identified through Medline, PsychINFO, PubMed, and ProQuest. Studies were eligible if they (a) used a sample of healthy, human subjects; (b) assessed physiology during a resting baseline and active psychological stress task; and (c) measured self-report or experimentally manipulated suppression. Twenty-four studies were identified and grouped within two separate random effects meta-analyses based on study methodology, namely, manipulated suppression (k = 12) and/or self-report (k = 14). Experimentally manipulated suppression was associated with greater physiological stress reactivity compared to controls (Hg = 0.20, 95% CI [0.08, 0.33]), primarily driven by cardiac, hemodynamic, and neuroendocrine parameters. Self-report trait suppression was not associated with overall physiological stress reactivity but was associated with greater neuroendocrine reactivity (r = 0.08, 95% CI [0.01, 0.14]). Significant moderator variables were identified (i.e., type/duration of stress task, nature of control instructions, type of physiology, and gender). This review suggests that suppression may exacerbate stress-induced physiological arousal; however, this may differ based upon the chosen methodological assessment of suppression.

Role Of Homoeopathic Medicines In Management Of Stress In Essential Hypertension Patients HOMOEOPATHIC MANAGEMENT OF STRESS IN ESSENTIAL HTN PATIENTS

Article

Full-text available

Jan 2022

Several surveys have suggested that stress is associated with the pathogenesis of Essential Hypertension. Studies have also investigated scope of homoeopathic medicines in managing stress. However the role of homoeopathic medicines in management of stress in essential hypertension patients and it's effect on levels of blood pressure remains to be accomplished. It was a monocentric, single-blind, non-randomised, interventional, time-bound study. 30 patients meeting the inclusion and exclusion criteria were enrolled willingly with regular follow ups. The post treatment outcome assessment measures were reduction in PSS, demotion in stage of essential hypertension along-with mean reduction in blood pressure values, and improvement in the QoL scores in SF36 domains. The mean reduction in PSS AFTER intervention was 18.07 ± 2.89 (p<0.0001). The mean reduction in SBP and DBP was 13.32 ± 6.24(p<0.0001) and 7.31 ± 2.73(p<0.0001) respectively. The mean score of QoL AFTER the intervention showed significant overall improvement. A reduction in PSS, mean reduction of both SBP, DBP and demotion in hypertension stages in majority of the patients was witnessed Post treatment. Post intervention significantly high improvement in QoL was seen in the patients. It was seen that 3.33% patients showed mild improvement, 73.33% showed moderate improvement, 23.33% showed marked improvement while no patient worsened or showed no improvement according to change in BP level and demotion in Stage of Hypertension AFTER intervention. Thus we conclude that Homoeopathic medicines have significant effect in managing stress and in reducing blood pressure levels in patients with essential hypertension.

Homoeopathic management of stress of essential hypertension patients : a literature review. Manejo homeopático del estrés de los pacientes con hipertensión esencial: una revisión de la literatura

Article

Full-text available

Jul 2023

Hypertension kills insidiously as it is commonly asymptomatic. Stress is conceived to be a significant contributing element towards development of essential hypertension. Homeopathy being the second largest system of medicine has immense scope, allowing in depth study of stress and offering individualized approach to these cases of stress led essential hypertension. There are several homoeopathic medicines which could prove useful in managing stress of essential hypertension. This article attempts to review some of the existing literature in this context discussing role of homoeopathy in management of stress of essential hypertension patients. RESUMEN La hipertensión mata insidiosamente ya que es comúnmente asintomática. El estrés se concibe como un elemento importante que contribuye al desarrollo de la hipertensión esencial. Siendo la homeopatía el segundo sistema más grande de medicina, tiene un alcance inmenso, lo que permite un estudio en profundidad del estrés y ofrece un enfoque individualizado para estos casos de hipertensión esencial provocada por el estrés. Hay varios medicamentos homeopáticos que podrían resultar útiles para controlar el estrés de la hipertensión esencial. Este artículo intenta revisar parte de la literatura existente en este contexto que discute el papel de la homeopatía en el manejo del estrés de los pacientes con hipertensión esencial.

Unraveling the connection: Tracing the link between neurobiological and peripheral physiological responses to acute stress, and long-term cardiovascular risk

Article

Jul 2023
J PSYCHOSOM RES

Roland von Känel

Homoeopathic management of stress of essential hypertension patients : A literature review

Article

Full-text available

Apr 2023

Insomnia: clinical presentation, diagnostic characterization, and etiological considerations

Chapter

Jan 2023

Child Maltreatment and Inflammatory Response to Mental Stress Among Adults Who Have Survived a Myocardial Infarction

Article

Aug 2022

Objectives: Experiences of child maltreatment are associated with cardiovascular risk and disease in adulthood, however the mechanisms underlying these associations are poorly understood. Methods: We examined associations between retrospectively self-reported exposure to child maltreatment (Early Trauma Inventory Self-Report Short Form), and inflammatory responses to mental stress among adults (mean age = 50 years) who recently had a myocardial infarction (N = 227). Inflammation was assessed as blood interleukin-6 (IL-6), matrix metalloprotease-9 (MMP-9) and monocyte chemoattractant protein-1 (MCP-1) concentrations, measured prior to and following a standardized public speaking stress task. We used mixed linear regression models adjusting for cardiovascular disease severity, medication usage and psychosocial, demographic and lifestyle factors. Results: In women, increases in IL-6 levels and MMP-9 levels with stress were smaller in those exposed to sexual abuse, relative to those unexposed (IL-6 geometric mean increases = 1.6, 95% confidence interval [CI]: 1.4, 1.9 pg/mL versus 2.1, 95% CI: 1.8, 2.4 pg/mL; MMP-9 geometric mean increases = 1.0, 95% CI: 0.9, 1.2 ng/mL versus 1.2, 95% CI: 1.1, 1.4 ng/mL). No differences were noted for emotional or physical abuse. By contrast in men, individuals exposed to sexual abuse had larger IL-6 responses than those not exposed to abuse. Conclusions: These findings suggest sex differences in stress response among survivors of a myocardial infarction exposed to abuse early in life. They also underscore the importance of examining sex as an effect modifier of relationships between exposure to early life adversity and inflammatory responses to mental stressors in mid-life.

Adverse childhood experiences (ACEs) relate to blunted cardiovascular and cortisol reactivity to acute laboratory stress: A systematic review and meta-analysis

Article

Jan 2022
NEUROSCI BIOBEHAV R

Adverse childhood experiences (ACEs) are associated with poor future mental and physical health. Altered biological reactivity to mental stress may be a possible mechanism linking ACEs to poor health. However, it is not clear if ACEs relate to blunted or exaggerated stress reactivity. This meta-analysis aimed to determine whether exposure to ACEs is associated with cardiovascular and cortisol stress reactivity. A systematic review yielded 37 sources. Random-effects modelling tested the aggregate effects of 83 studies of the association between ACEs and stress reactivity. Exposure to ACEs was associated with relatively blunted cardiovascular and cortisol stress reactivity. Effect sizes did not vary as a function of sample sex or reactivity measure (e.g., heart rate, blood pressure, or cortisol). Meta-regression revealed preliminary evidence of greater blunting in samples of a younger age and samples reporting greater ACE exposure. Subgroup analyses for stress task, ACE measurement instrument, and sample race were not conducted because of a lack of between-study variability. Exposure to ACEs is associated with dysregulation of multiple components of the human stress response system.

Stress system dysfunction revealed by integrating reactivity of stress pathways to psychological stress in lean and overweight/obese men

Article

Dec 2021

While the patterns of response within the sympatho-adrenal medullary (SAM) system and hypothalamo-pituitary adrenal (HPA) axis are interesting and important in their own accord, the overall response to acute psychological stress involves reactivity of both pathways We tested the hypothesis that consideration of the integrated response of these pathways may reveal dysregulation of the stress systems that is not evident when considering either system alone. Age matched lean and overweight/obese men were subjected to a Trier Social Stress Test and reactivity of the SAM system (salivary alpha amylase, systolic blood pressure, diastolic blood pressure and heart rate) and the HPA axis (salivary cortisol) were measured. Relative reactivity of SAM system and HPA axis was calculated as the ratio between the measures from each pathway. While analysis of reactivity of individual stress pathways showed no evidence of dysfunction in overweight/obese compared with lean men, analysis of HPA/SAM reactivity revealed significantly lower cortisol over systolic blood pressure (CoSBP) and cortisol over diastolic blood pressure (CoDBP) reactivity in overweight/obese compared with lean men. Other measures of HPA/SAM reactivity and all measures of SAM/HPA reactivity were unaltered in overweight/obese compared with lean men. These findings suggest that the cortisol response per unit of blood pressure response is blunted in men with elevated adiposity. Further, these findings support a notion of a coordinated overall approach to activation of the stress pathways with the degree of activation in one pathway being related to the degree of activation of the other.

Unpredictable Chronic Mild Stress-Induced Depressive-Like Behaviors in Spontaneously Hypertensive Rats

Article

Full-text available

Oct 2021

Objective The objective is to explore whether hypertension influences unpredictable chronic mild stress (UCMS)-induced depressive-like behaviors and the potential therapeutic effect of Guan-Xin-Shu-Tong capsules (GXST) in controlling hypertension and depressive-like behaviors. Materials and Methods Fifteen spontaneously hypertensive rats (SHR) and 15 wistar rats were divided into three groups respectively ( n = 5, in each group), including control, UCMS, and UCMS + GXST groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at the end of the experiment. Rats were subjected to seven kinds of UCMS over 4 weeks. GXST treatments were administrated (2.8 g/kg) by intragastric gavage once a day over 4 consecutive weeks during UCMS treatment. Sucrose-preference and open-field tests were used to detect depressive-like behaviors. Results SHR exposed to 4-week UCMS treatment had lower HR when compared with control and UCMS + GXST groups ( P < 0.05); Wister rats receiving UCMS or UCMS + GXST had lower SBP ( P < 0.05), lower DBP ( P < 0.05) and lower MAP ( P < 0.05) than controls. Compared with the controls, UCMS reduced the sucrose preference of Wistar rats, UCMS and UCMS + GXST decreased both grid-crossings and the number of upright postures measured in Wistar rats ( P < 0.05). SHR showed lower sucrose consumption, less sucrose preference, and fewer grid-crossings after UCMS than control SHR. However, the lower incidence of upright postures in SHR was prevented by GXST treatment ( P < 0.05). Linear correlation showed that grid-crossings or upright postures were negatively related to the values of SBP, DBP, or MAP, presenting the positive relationship between depressive-like behaviors and SBP, DBP, or MAP reduction in Wistar rats; there was a negative correlation between grid-crossings and DBP responses, and MAP responses in SHR, and a positive correlation between depressive-like behaviors and DBP and MAP response elevation in SHR. Conclusions UCMS-induced depressive-like behaviors in Wistar and SHR, accompanied by a blood pressure decrease in Wistar rats but not in SHR. While GXST exhibited effective relief of depressive-like behaviors in SHR without influencing their blood pressure.

Sexual Violence and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis

Article

Aug 2021
MATURITAS

Background: Cardiovascular disease (CVD) is a leading cause of death among adults. Over 35% of women worldwide report lifetime exposure to sexual violence. While psychosocial factors broadly have been linked to CVD risk, it is unclear if a history of sexual violence is associated with increased risk for CVD. This study employed quantitative meta-analysis to investigate the association between sexual violence and CVD risk. Methods: PubMed and PsycINFO databases were searched through March 1, 2021. Included articles had a measure of sexual violence and at least one cardiovascular outcome (i.e., clinical CVD, subclinical CVD, select CVD risk factors) in women and men aged 18 years or more. Data were expressed as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI) extracted from fully-adjusted models. OR and HR effects were pooled separately, given the inability to statistically harmonize these effects and differences in interpretation, using random effects meta-analysis. Heterogeneity of effects was tested using Cochran's Q test. Results: Overall, 44 articles based on 818,159 adults (77.5% women) were included (112 individual effects expressed as OR and 9 individual effects expressed as HR). Results indicated that sexual violence was related to adult CVD risk (OR [95%CI] = 1.26 [1.12-1.42]; HR [95%CI] = 1.17, [1.05-1.31]). Results varied by outcome type and measurement, and timing of violence. Conclusions: Adults with a history of sexual violence demonstrate greater CVD risk relative to those without this history. The results highlight the importance of addressing sexual violence in CVD risk reduction efforts.

Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness

Article

Aug 2021
CURR PROB CARDIOLOGY

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.

Internalized Shame and Social Stress-Induced Blood Pressure Patterns among Young Black Women

Article

Apr 2021
ETHNIC DIS

Background: The increasing prevalence of hypertension among young Black women warrants further exploration of hypertension risk factors in this population. Social cognitive pathways that increase hypertension risk have been understudied among Black women. Shame, an emotional response to social evaluative threats, may be important to understanding the contribution of social emotions to hypertension risk. The current study examined the association of internalized shame on systolic (SBP) and diastolic blood pressure (DPB) patterns of reactivity and recovery in a sample of Black women. Methods: Black women (N=32) aged 18-22 were recruited from a public university in August 2019 and January 2020. Participants completed the Internalized Shame Scale, Self-Esteem subscale, and the Perceived Stress Scale. All participants completed the Trier Social Stress Test (TSST) and subsequent blood pressure readings were recorded at baseline and 1 min, 15 min, 30 min, 45 min, and 60 min post-TSST. Two separate repeated measures ANOVAs examined time and group effects of low shame (ISS score ≤ 39.9) vs high shame (ISS score ≥ 40) on blood pressure reactivity patterns. Results: A significant effect of shame on DBP responses to the TSST was observed (P=.020). DBP for women in the low shame group peaked immediately following the TSST relative to baseline (M =81.2 mm Hg vs M =72.2 mm Hg) and remained stable during 60-minute recovery. DBP for women in the high shame group did not peak until 45 min post-TSST relative to baseline (M =84.2 mm Hg vs M =68.0 mm Hg) only slightly decreasing at 60 min post-TSST. Implications: These results highlight the need to further examine the role of shame on hypertension risk among young Black women.

The Impact of Aerobic Training on Cardiovascular Reactivity to and Recovery From Psychological and Orthostatic Challenge

Article

Dec 2020

Objective: Elevated CV reactivity to, and reduced recovery from, challenging events may increase the risk of CVD and exercise training may reduce this reactivity. However, in a randomized controlled trial of aerobic vs. strength training in sedentary, healthy young adults, we found no training group differences in reactivity or recovery. Because strength training also may have a reactivity-reducing effect, we conducted a secondary analysis of data from another trial, this time with a wait-list control condition. Methods: 119 healthy, young, sedentary adults were randomized to a 12-week aerobic training program or wait-list control. Before (T1) and after (T2) training and after 4 weeks of sedentary deconditioning (T3), we measured heart rate (HR), heart rate variability (HRV), and blood pressure (BP) at rest and in response to and recovery from psychological and orthostatic challenge. Data were analyzed using a group (aerobic vs. waitlist) by session (T1, T2, and deconditioning), by period (baseline, psychological challenge, recovery, standing) 3-way ANOVA with prespecified contrasts. Results: Aerobic capacity significantly increased at T2 and decreased at T3 only in the aerobic training group. The groups did not differ on HR, HRV, or BP reactivity to or recovery from challenge. Without baseline adjustment, there were no significant treatment differences in response to challenges. With baseline adjustment, there were significant treatment by session effects for HR (Cohen's d=0.54, p=.002), SBP (d=0.44, p=.014), DBP (d=0.74, p=.002), and rMSSD (d=0.48, p=.006) reactivity from T1 to T2 only for orthostatic challenge: at T2, reactivity in the aerobic group was nonsignificantly reduced, compared to T1. In the waitlist group, reactivity significantly increased after T1. Conclusions: This study raises further doubt about attenuation of CV reactivity or enhancement of recovery as a cardioprotective mechanism of aerobic exercise training.Clinical Trial Registration--ClinicalTrials.gov Unique identifier: NCT01335737.

Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence

Article

Feb 2020
PSYCHONEUROENDOCRINO

Background: Acute psychological stress activates the sympatho-adrenal medullary (SAM) system and hypothalamo-pituitary adrenal (HPA) axis. The relevance of this stress reactivity to long-term health and disease outcomes is of great importance. We examined prospective studies in apparently healthy adults to test the hypothesis that the magnitude of the response to acute psychological stress in healthy adults is related to future health and disease outcomes. Methods: We searched Medline Complete, PsycINFO, CINAHL Complete and Embase up to 15 Aug 2019. Included studies were peer-reviewed, English-language, prospective studies in apparently healthy adults. The exposure was acute psychological stress reactivity (SAM system or HPA axis) at baseline. The outcome was any health or disease outcome at follow-up after ≥1 year. Results: We identified 1719 papers through database searching and 1 additional paper through other sources. Forty-seven papers met our criteria including 32,866 participants (range 30-4100) with 1-23 years of follow-up. Overall, one third (32 %; 83/263) of all reported findings were significant and two thirds (68 %; 180/263) were null. With regard to the significant findings, both exaggerated (i.e. high) and blunted (i.e. low) stress reactivity of both the SAM system and the HPA axis at baseline were related to health and disease outcomes at follow-up. Exaggerated stress reactivity at baseline predicted an increase in risk factors for cardiovascular disease and decreased telomere length at follow-up. In contrast, blunted stress reactivity predicted future increased adiposity and obesity, more depression, anxiety and PTSD symptoms, greater illness frequency, musculoskeletal pain and regulatory T-Cell percentage, poorer cognitive ability, poorer self-reported health and physical disability and lower bone mass. Conclusion: Exaggerated and blunted SAM system and HPA axis stress reactivity predicted distinct physical and mental health and disease outcomes over time. Results from prospective studies consistently indicate stress reactivity as a predictor for future health and disease outcomes. Dysregulation of stress reactivity may represent a mechanism by which psychological stress contributes to the development of future health and disease outcomes.

Impact Of Occupational Stress And Demographic Variables At Software Development Professional's Performance A Field Study At Jordanian Software Companies

Article

Full-text available

May 2019

The study aims to investigate the differences in the perception of stress based on demographic factors, and the impact of occupational stressat software development professional's performance. The study sample consisted of 116 respondents working in (20)Jordanian software Company which located in Amman, Irbid and Zarqa.The result showsa statistically significant effect at the level of (P ≤ 0.05) for occupational stress among software development professional's performance in the Jordanian software Companies.

The Relationship between the Korean Occupational Stress Scale and Pulse Wave Velocity among Male Firefighters

Article

Jan 2011

Potential predictors for mental stress-induced myocardial ischemia in patients with coronary artery disease

Article

Apr 2019

Background: Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in coronary artery disease (CAD) patients and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI. Methods: This study enrolled 82 patients with documented CAD between Jun. 01, 2017 and Nov. 09, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, logistic regression. Results: CAD patients with MSIMI had significantly greater resting NT-proBNP (141.02 [interquartile range (IQR): 45.85 to 202.76] vs. 57.95 [IQR: 27.06 to 117.64] pg/ml; Z=-2.23, P=0.03) and SBP (145.56 ± 16.87 vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-minute mental stress task, those who developed MSIMI present higher elevation of post stressor hs-cTnI (0.020 [IQR: 0.009 to 0.100] vs. 0.009 [IQR: 0.009 to 0.010]ng/ml; Z = -2.45, P = 0.01), post stressor NT-proBNP (138.96 [IQR: 39.93 to 201.56] vs. 61.55 [IQR: 25.66 to 86.50] pg/ml; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post stressor hs-cTnI≥0.015 ng/ml had 7-fold (odds ration (OR): 7.09; 95%CI: 1.65-30.48; P = 0.009) increase in the risk of developing MSIMI, a rest NT-proBNP≥80.51 pg/ml had nearly 8-fold increase (OR: 7.85; 95%CI: 1.51-40.82; P = 0.014), a post stressor NT-proBNP≥98.80 pg/ml had 35-fold increase (OR: 34.96; 95%CI: 3.72-328.50; P = 0.002), a rest SBP≥129.50 mmHg had 11-fold increase (OR: 11.42; 95%CI: 1.21-108.17; P = 0.034). Conclusions: The present study shows that CAD patients have higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.

Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings

Article

May 2018

Masanori Munakata

High blood pressure is the most significant risk factor of cardiovascular and cerebrovascular diseases worldwide. Blood pressure and its variability are recognized as risk factors. Thus, hypertension control should focus not only on maintaining optimal levels but also on achieving less variability in blood pressure. Psychosocial stress is known to contribute to the development and worsening of hypertension. Stress is perceived by the brain and induces neuroendocrine responses in either a rapid or long-term manner. Moreover, endothelial dysfunction and inflammation might be further involved in the modulation of blood pressure elevation associated with stress. White-coat hypertension, defined as high clinic blood pressure but normal out-of-office blood pressure, is the most popular stress-related blood pressure response. Careful follow-up is necessary for this type of hypertensive patients because some show organ damage or a worse prognosis. On the other hand, masked hypertension, defined as high out-of-office blood pressure but normal office blood pressure, has received considerable interest as a poor prognostic condition. The cause of masked hypertension is complex, but evidence suggests that chronic stress at the workplace or home could be involved. Chronic psychological stress could be associated with distorted lifestyle and mental distress as well as long-lasting allostatic load, contributing to the maintenance of blood pressure elevation. Stress issues are common in patients in modern society. Considering psychosocial stress as the pathogenesis of blood pressure elevation is useful for achieving an individual-focused approach and 24-h blood pressure control.

EFEITOS DA AURICULOTERAPIA NA REDUÇÃO DO ESTRESSE EM ACADÊMICOS DO CURSO DE FISIOTERAPIA DE UMA INSTITUIÇÃO PRIVADA

Article

Full-text available

May 2018

Stress is the state generated by stimuli that causes emotio- nal arousal and disturbs homeostasis, producing physiological and psychological disorders. Students are exposed to various stressful factors, so it is important to pay attention to their health. Using effective interventions to reduce the symptoms of stress, can enhance the performance of students in clinical practice. The present study objectified, evaluates the effects of auriculotherapy in reducing stress in students from a private institution’s physiotherapy course. This study is characterized as an, almost-experimental design before and after, longitudinal, interventionist and analytical character. The participants were 20 students from the 5th to the 8th semester of ASCES UNITA’s physiotherapy course. Participants answered one questionnaire for the identification of socio-economic profiles and lifestyles. The second questionnaire was the Inventory of Stress Symp- toms for Adults Lipp (ISSL), to identify stress symptoms. The participants were grouped into one of four levels of stress and within each level were placed into a group placebo (GP) and an experimental group (EG). During the ISSL questionnaire, we analyzed the distribution of the stress levels among students. We discovered that the vast majority of students were allocated to the resistance phase by 68%, and 24% in the exhaust pha- se. Although not conclusive, the findings of this research can contribute to understanding auriculotherapy as an alternative therapy for the fight against stress.

EFEITOS DA AURICULOTERAPIA NA REDUÇÃO DO ESTRESSE EM ACADÊMICOS DO CURSO DE FISIOTERAPIA DE UMA INSTITUIÇÃO PRIVADA

Article

Full-text available

May 2018

Estresse é o estado gerado por estímulos que provocam excitação emocional e ao perturbar a homeostasia, produzem distúrbios fisiológicos e psicológicos. Os acadêmicos são expostos a diversos estressores, por isso é relevante atentar para a saúde destes, utilizando intervenções efetivas na redução dos sintomas do estresse, pois isso influencia seu desempenho na prática clínica. O presente estudo objetivou avaliar os efeitos da auriculoterapia na redução do estresse em acadêmicos do curso de Fisioterapia de uma instituição privada. Trata-se de um estudo caracterizado como um desenho quase-experimental antes e depois, analítico, longitudinal e intervencionista. A amostra foi composta por 20 estudantes em estágio curricular, do 5º ao 8º período do curso de Fisioterapia da ASCES-UNITA. Os participantes responderam um questionário destinado à identificação do perfil socioeconô-mico e hábitos de vida e o segundo questionário, o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), para identificar a sintomatologia estressora. Após isso, foram agrupados em 4 níveis de estresse e dentro de cada nível foram alocados em grupo placebo (GP) e grupo experimental (GE). No questionário ISSL foi analisado a distribuição do nível de estresse entre os alunos e observou-se que a maioria se encontrava na fase de resistência (68%) e 24% na fase de exaustão. Apesar de não conclusivos, os achados desta pesquisa contribuíram para a compreensão da auriculoterapia como uma terapia alternativa para combate ao estresse. ABSTRACT Stress is the state generated by stimuli that causes emotional arousal and disturbs homeostasis, producing physiological and psychological disorders. Students are exposed to various stressful factors, so it is important to pay attention to their health. Using effective interventions to reduce the symptoms of stress, can enhance the performance of students in clinical practice. The present study objectified, evaluates the effects of auriculotherapy in reducing stress in students from a private institution's physiotherapy course. This study is characterized as an, almost-experimental design before and after, longitudinal, interventionist and analytical character. The participants were 20 students from the 5th to the 8th semester of ASCES UNITA's physiotherapy course. Participants answered one questionnaire for the identification of socioeconomic profiles and lifestyles. The second questionnaire was the Inventory of Stress Symptoms for Adults Lipp (ISSL), to identify stress symptoms. The participants were grouped into one of four levels of stress and within each level were placed into a group placebo (GP) and an experimental group (EG). During the ISSL questionnaire, we analyzed the distribution of the stress levels among students. We discovered that the vast majority of students were allocated to the resistance phase by 68%, and 24% in the exhaust phase. Although not conclusive, the findings of this research can contribute to understanding auriculotherapy as an alternative therapy for the fight against stress.

Evaluation du stress et de l'anxiété comme facteur de risque de la santé bucco-dentaire

Thesis

May 2013

Benard Meryl

Le stress est un phénomène universel qui peut entraîner des perturbations biologiques, physiologiques et psychologiques lorsqu'il devient trop important. La santé bucco-dentaire n'est pas épargnée et des études épidémiologiques récentes considèrent le stress comme facteur de risque des maladies parodontales.Afin de tester l'incidence du stress psychique sur la santé parodontale, nousprésentons les résultats d'une étude épidémiologique réalisée au Centre de Médecine préventive de Nancy pour laquelle nous disposions, pour chaque participant, d'un score d'échelle de stress, d'informations sur la situation sociale et professionnelle et d'une consultation bucco-dentaire. Si les femmes ont admis un score de stress deux fois plus élevé que celui des hommes, une corrélation positive entre les deux scores, du stress et de l'indicegingival, n'est observée que pour le sexe masculin.

Role of Self-Efficacy and Collective Efficacy as Moderators of Occupational Stress Among Software Development Professionals

Chapter

Jan 2017

Emergence of new professions and novel approaches to work contribute to newer causes of occupational stress. The current study focuses on one such emergent group namely, the software development professionals. An attempt has been made to examine the role of self-efficacy, collective efficacy and perception of control in the study of occupational stress. The data was collected from 156 software development professionals in India. Variables such as self-efficacy, collective efficacy and perception of control using multiple moderated regression revealed that these variables moderate the negative consequences of stress with respect to work exhaustion, organizational commitment and intent to turnover but not with respect to job satisfaction. The results indicate that self-efficacy and collective efficacy have to be strengthened in order to mitigate the negative consequences of stress. The knowledge pertaining to causes of stress can empower individuals and organizations to plan effective stress management interventions.

Relations entre méthylation de l’ADN et facteurs de risque des pathologies liées au stress, pathologies cardio-vasculaires, infectieuses et mentales : une étude épidémiologique

Thesis

Oct 2014

Sandt Estelle

L’expression des gènes est régulée en partie par de nombreux mécanismes endogènes, mais également par desfacteurs environnementaux. Les modifications épigénétiques représentent la principale interface entre le génomeet l’environnement[1][2][3]. Parmi les différents mécanismes épigénétiques, la méthylation de l’ADN est sansdoute la mieux connue. De plus le profil de méthylation de l’ADN est susceptible de subir des modificationsinduites par des facteurs environnementaux.Compte tenu de son implication dans la régulation de la transcription et l’inactivation des gènes[4], laméthylation de l’ADN pourrait également jouer un rôle clé dans l’apparition de différentes maladies, incluant lesmaladies liées au stress.Le Département d’Immunologie du Centre de Recherche Public de la Santé (CRP-Santé) de Luxembourg aacquis une expérience considérable dans le domaine de l’épigénétique, en particulier concernant les gènesimpliqués dans la réponse au stress ainsi que dans la conduite d’études cliniques. Mon stage de Master 2 au seinde ce Département, m’a permis de travailler sur deux études portant sur le niveau de méthylation de l’ADN.L’étude “Cold Pressor Test” a montré un lien entre la réponse à un stress induite par un test validé- le ColdPressor Test - et la méthylation du gène du récepteur aux glucocorticoïdes (GR). Durant mon stage, je me suischargée de l’analyse des données de cette étude.Ces résultats ainsi que ceux d’études précédentes menées par le groupe PsychoImmunologie du CRP-Santé ontconduit à l’élaboration du protocole de l’étude “Long term epigenetic and physiological effects of early lifeadversity” (EpiPath). EpiPath analysera l’impact des maltraitances subies durant la petite enfance, ou "Early LifeAdversity" (ELA) sur les facteurs de risque de problèmes de santé publiques majeurs: maladiescardiovasculaires, mentales, du système immunitaire et altération de la réponse au stress. Le lien entre desantécédents d’ELA et la survenue de ces pathologies ayant déjà été mis en évidence, l’objectif de cette étudeest de fournir une meilleure compréhension de l’impact de l’ELA sur la méthylation de l’ADN et lesconséquences cliniques.

Role of Stress in Diseases and Its Remedial Approach by Herbal and Natural Products in Stress-Related Disease Management

Chapter

Feb 2018

Psychological stress is the most prevalent issue in today's life, affecting millions of people worldwide in terms of productivity and quality of life. Chronic mental stress leading to sustained elevated levels of cortisol, a stress biomarker, is detrimental for the body and a causative factor for chronic diseases such as heart disease, hypertension, metabolic syndrome, impaired immunity, diabetes, psychosomatic disorders, and related neurotic disorders, etc. Until now there have been limited options available to manage stress, with variable effective outcomes. Potential antistress herbal candidates such as ginseng, ashwagandha, Ocimum, Rhodiola, Ginkgo, lavender, etc. and nutritional agents such as fish oil, poly unsaturated fatty acids, omega-3 fatty acid, natural proteins such as milk peptides, etc. are established clinically and preclinically to control elevated stress cortisol levels and to help individuals coping with psychological stressors with minimal adverse effects. They might be the promising therapeutic intervention to alleviate both physical and mental stress-related symptoms such as fatigue, anxiety, depression, etc. with a preventive approach in diminishing chances of sustained elevated levels of stress hormone-induced chronic diseases.

Socioeconomic Status and Cardiovascular Responses to Standardized Stressors: A Systematic Review and Meta-Analysis

Article

Jan 2018

Objective: Disparities in cardiovascular health by socioeconomic status (SES) are a pressing public health concern. Hypothesized mechanisms linking low SES to poor health are large cardiovascular responses to and delayed recovery from psychological stress. The current study presents a meta-analysis of the literature on the association of SES with blood pressure and heart rate reactivity to and recovery from acute stress tasks. Methods: The PubMed database was searched, and 26 unique studies with relevant data were identified (k = 25 reactivity (n = 14,617), k = 6 recovery (n = 1,324)). Results: Using random effects models, no significant association between SES and cardiovascular reactivity to stress emerged (r = .008, 95% CI: -.02, .04), although higher SES was associated with better recovery from stress (r = -.14, 95% CI: -.23, -.05). Stressor type moderated the reactivity effect, wherein higher SES was associated with greater reactivity to cognitive stressors (r = .036, p = .024), not with reactivity to interpersonal stressors (r = -.02, p = .62), but was associated with lower reactivity to tasks with combinations of cognitive, interpersonal, and physical challenges (r = -.12, p = .029). Accounting for publication bias revealed a significant association between SES and reactivity in the opposite direction of hypotheses. Conclusions: Cardiovascular recovery from acute stress, but not reactivity to stress, may be a key pathway between low SES and risk for cardiovascular diseases. Heterogeneity in effect size and direction, challenges related to working across temporal dynamics, and recommendations for future research are discussed.

Stress and Addiction: When a Robust Stress Response Indicates Resiliency

Article

Aug 2017

Mustafa al'Absi

Objective: Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health. Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic. Methods: This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical (HPA) axis, the endogenous opioid system (EOS), and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories. Results: Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort. Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators (i.e., sex, personality traits, and early life adversity) and HPA- and EOS-related mechanisms in the altered response to stress. We integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency. Conclusions: A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception and addictive disorders. The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation.

Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group

Article

Full-text available

Jan 1999

The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the carotid-artery intima and media and the incidence of new myocardial infarction or stroke in persons without clinical cardiovascular disease. Noninvasive measurements of the intima and media of the common and internal carotid artery were made with high-resolution ultrasonography in 5858 subjects 65 years of age or older. Cardiovascular events (new myocardial infarction or stroke) served as outcome variables in subjects without clinical cardiovascular disease (4476 subjects) over a median follow-up period of 6.2 years. The incidence of cardiovascular events correlated with measurements of carotid-artery intima-media thickness. The relative risk of myocardial infarction or stroke increased with intima-media thickness (P<0.001). The relative risk of myocardial infarction or stroke (adjusted for age and sex) for the quintile with the highest thickness as compared with the lowest quintile was 3.87 (95 percent confidence interval, 2.72 to 5.51). The association between cardiovascular events and intima-media thickness remained significant after adjustment for traditional risk factors, showing increasing risks for each quintile of combined intima-media thickness, from the second quintile (relative risk, 1.54; 95 percent confidence interval, 1.04 to 2.28), to the third (relative risk, 1.84; 95 percent confidence interval, 1.26 to 2.67), fourth (relative risk, 2.01; 95 percent confidence interval, 1.38 to 2.91), and fifth (relative risk, 3.15; 95 percent confidence interval, 2.19 to 4.52). The results of separate analyses of myocardial infarction and stroke paralleled those for the combined end point. Increases in the thickness of the intima and media of the carotid artery, as measured noninvasively by ultrasonography, are directly associated with an increased risk of myocardial infarction and stroke in older adults without a history of cardiovascular disease.

The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-Aged Men

Article

Full-text available

Jan 2003

The metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, mild dyslipidemia, and hypertension, is associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (CVD). Despite its high prevalence, little is known of the prospective association of the metabolic syndrome with cardiovascular and overall mortality. To assess the association of the metabolic syndrome with cardiovascular and overall mortality using recently proposed definitions and factor analysis. The Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based, prospective cohort study of 1209 Finnish men aged 42 to 60 years at baseline (1984-1989) who were initially without CVD, cancer, or diabetes. Follow-up continued through December 1998. Death due to coronary heart disease (CHD), CVD, and any cause among men with vs without the metabolic syndrome, using 4 definitions based on the National Cholesterol Education Program (NCEP) and the World Health Organization (WHO). The prevalence of the metabolic syndrome ranged from 8.8% to 14.3%, depending on the definition. There were 109 deaths during the approximately 11.4-year follow-up, of which 46 and 27 were due to CVD and CHD, respectively. Men with the metabolic syndrome as defined by the NCEP were 2.9 (95% confidence interval [CI], 1.2-7.2) to 4.2 (95% CI, 1.6-10.8) times more likely and, as defined by the WHO, 2.9 (95% CI, 1.2-6.8) to 3.3 (95% CI, 1.4-7.7) times more likely to die of CHD after adjustment for conventional cardiovascular risk factors. The metabolic syndrome as defined by the WHO was associated with 2.6 (95% CI, 1.4-5.1) to 3.0 (95% CI, 1.5-5.7) times higher CVD mortality and 1.9 (95% CI, 1.2-3.0) to 2.1 (95% CI, 1.3-3.3) times higher all-cause mortality. The NCEP definition less consistently predicted CVD and all-cause mortality. Factor analysis using 13 variables associated with metabolic or cardiovascular risk yielded a metabolic syndrome factor that explained 18% of total variance. Men with loadings on the metabolic factor in the highest quarter were 3.6 (95% CI, 1.7-7.9), 3.2 (95% CI, 1.7-5.8), and 2.3 (95% CI, 1.5-3.4) times more likely to die of CHD, CVD, and any cause, respectively. Cardiovascular disease and all-cause mortality are increased in men with the metabolic syndrome, even in the absence of baseline CVD and diabetes. Early identification, treatment, and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle.

Cardiovascular Reactivity to Psychological Challenge: Conceptual and Measurement Considerations

Article

Full-text available

Jan 2003
PSYCHOSOM MED

Objective and methods: This article is a selective review of recent findings bearing on the conceptualization and measurement of cardiovascular reactivity to psychological challenge, with a focus on several issues relevant to the reliability, content validity, construct validity, and criterion validity of these measures. Results and conclusions: With respect to reliability, use of standardized task demands and aggregated scores are associated with enhanced short-term reliability, but the long-term reliability of cardiovascular reactivity has not been sufficiently documented. With respect to content validity, existing evidence suggests that "vascular" or "cardiac" tasks may evoke responses that reflect similar distributions of individual difference, whereas associations between responses to "physical" and "psychological" tasks are modest. The evidence is not clear at present with respect to the importance of including affective or interpersonal stimuli as part of trait reactivity assessments. With respect to construct validity, existing data show that cardiovascular reactivity to psychological challenge is largely independent of standard measures of autonomic function. With respect to criterion validity, recent studies point to a number of methodological limitations that may have restricted our ability to detect lab-to-life generalizability of reactivity measures in the past. Continued progress in understanding and measuring reactivity as an individual difference dimension is essential in helping us to evaluate emerging evidence examining the relationship between reactivity and disease risk.

Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events

Article

Full-text available

Jun 2004
ARCH INTERN MED

Primary prevention of coronary heart disease is most appropriate for patients at relatively high risk. Measurement of coronary artery calcium has been proposed as a way to improve risk assessment, but it is unknown whether it adds predictive information to standard risk factor assessment. We systematically searched electronic databases for relevant articles published between January 1, 1980, and March 19, 2003, and hand searched bibliographies. We included studies that reported measuring the coronary artery calcium score by electron beam computed tomography in asymptomatic subjects and subsequent follow-up of those patients for coronary events and that presented score-specific relative risks, adjusted for established risk factors. Two abstractors verified inclusion criteria and abstracted data from each study. We estimated adjusted relative risks associated with 3 standard categories of coronary artery calcium scores (1-100, 101-400, and >400), compared with a score of 0, and used a random-effects model for meta-analysis. Meta-analysis of the 4 studies meeting inclusion criteria yielded a summary adjusted relative risk of 2.1 (95% confidence interval, 1.6-2.9) for a coronary artery calcium score of 1 to 100. Relative risk estimates for higher calcium scores were higher, ranging from 3.0 to 17.0 but varied significantly among studies. Subgroup analyses suggested that differences among studies in outcome adjudication (blinded or not), measurement of other risk factors (direct or by patient history), tomographic slice thickness (3 or 6 mm), and/or proportion of female study subjects may account for this heterogeneity. The coronary artery calcium score is an independent predictor of coronary heart disease events.

Quantification of Coronary Artery Calcium Using Ultrafast Computed Tomography

Article

Nov 1989
J AM COLL CARDIOL

Psychological stress and the progression of carotid artery disease

Article

Jan 1997

Background: We examined the relation between cardiovascular reactivity (the response of the cardiovascular system to psychological stress) and the severity and progression of carotid atherosclerosis. Methods: Using duplex ultrasonography, we measured the change in the area of all detectable plaques in the extracranial carotid arteries during 2 years. Cardiovascular reactivity was assessed by measuring changes in hemodynamics during a frustrating cognitive task (the Stroop Color Word Interference Task). Established risk factors for atherosclerosis were measured by interviewing patients, a physical examination, and blood assays for 351 subjects with a wide range of types of atherosclerotic disease. Results: Atherosclerotic plaques were present in the carotid arteries of 273 (78%) subjects. In a forward stepwise multiple regression analysis, it was found that greater age (β = 0.46), a history of hypertension (β = 0.20), use of lipid level-lowering agents (β = 0.18), a longer history of smoking (β = 0.13), a larger cholesterol: high-density lipoprotein ratio (β = 0.13), a smaller change in heart rate during the task (β = -0.12), and a higher resting systolic blood pressure (SBP; β = 0.11) were associated significantly with a greater plaque area (R2 = 0.35). In 136 untreated subjects who were followed up for 2 years, a greater change in SBP during the task (b = 0.28), a higher total cholesterol: high-density lipoprotein ratio (β = 0.23), a shorter resting preejection period (β = -0.19), and a lower body mass index (β = -0.17) were significant predictors of the change in atherosclerosis, after controlling for age and initial plaque area in a stepwise multiple regression analysis (R2 = 0.24). Conclusions: These results support the hypothesis that hemodynamic responses under conditions of mental stress may influence the progression of atherosclerosis.

Handbook of Stress, Reactivity, and Cardiovascular Disease

Book

Jan 1986

Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 11, 1245-1249

Article

Sep 1991
Arterioscler Thromb

As ultrasonographically assessed carotid arteriosclerosis is being used as a surrogate measure for coronary arteriosclerosis, we performed a prospective longitudinal study of the association of our high-resolution ultrasound assessment of extracranial carotid morphology with the risk of acute coronary events in 1,288 eastern Finnish men. The presence of any structural changes in the common carotid arteries or carotid bulbs was associated with a 3.29-fold (95% confidence interval, 1.31-8.29; p = 0.0074), intimal-medial thickening with a 2.17-fold (95% confidence interval, 0.70-6.74; p = NS), small carotid plaques with a 4.15-fold (95% confidence interval, 1.51-11.47; p less than 0.01), and large ("stenotic") plaques with a 6.71-fold (95% confidence interval, 1.33-33.91; p less than 0.01) risk of acute myocardial infarction compared with men free of any structural changes in the carotid artery wall at baseline. These data confirm the close relation between carotid artery wall morphology and coronary heart disease.

Alcohol intake and blood pressure in young adults: The CARDIA study

Article

Feb 1990
J CLIN EPIDEMIOL

Associations between self-reported average daily alcohol intake and blood pressure were assessed in 5031 black and white men and women ages 18-30 from the Coronary Artery Risk Development in Young Adults Study (CARDIA). In general, intake was positively but weakly related to both systolic and diastolic blood pressure. Associations with systolic pressure were generally stronger than those with diastolic pressure. With average daily alcohol intake categorized as none, 0.1-9.9 ml, 10.0-19.9 ml, 20.0-29.9 ml, and 30.0+ ml, mean systolic pressure, adjusted for age, body mass index, education, smoking, and physical activity, increased progressively with increasing intake in black and white men and in white women. Mean diastolic pressure increased progressively with increasing intake only in white men and women, but was highest for those averaging 30.0+ ml per day in black women as well as white men and women. Mean pressures were also compared for those averaging 75.0+ ml per day (men) or 50.0+ ml per day (women) vs those reporting no intake. Differences in adjusted mean pressures for white men were 3.2 mmHg (95% confidence limits (CL) -0.3, 6.8) for systolic pressure and 1.7 mmHg (-1.6, 5.0) for diastolic pressure. In black men differences were 4.4 mmHg (1.4, 7.4) and 3.4 mmHg (0.6, 6.3), respectively. Differences in white women were 1.4 mmHg (-2.5, 5.3) for systolic pressure and 0.9 mmHg (-2.7, 4.5) for diastolic pressure and for black women, -0.2 mmHg (-4.3, 3.8) and 1.9 mmHg (-1.9, 5.8). Separate analyses in smokers and nonsmokers of the associations between alcohol intake and blood pressure suggested that associations may differ by smoking status in some sex-race groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15, 827-832

Article

Apr 1990
J AM COLL CARDIOL

Ultrafast computed tomography was used to detect and quantify coronary artery calcium levels in 584 subjects (mean age 48 +/- 10 years) with (n = 109) and without (n = 475) clinical coronary artery disease. Fifty patients who underwent fluoroscopy and ultrafast computed tomography were also evaluated. Twenty contiguous 3 mm slices were obtained of the proximal coronary arteries. Total calcium scores were calculated based on the number, areas and peak Hounsfield computed tomographic numbers of the calcific lesions detected. In 88 subjects scored by two readers independently, interobserver agreement was excellent with identical total scores obtained in 70. Ultrafast computed tomography was more sensitive than fluoroscopy, detecting coronary calcium in 90% versus 52% of patients. There were significant differences (p less than 0.0001) in mean total calcium scores for those with versus those without clinical coronary artery disease by decade: 5 versus 132, age 30 to 39 years; 27 versus 291, age 40 to 49 years; 83 versus 462, age 50 to 59 years; and 187 versus 786, age 60 to 69 years. Sensitivity, specificity and predictive values for clinical coronary artery disease were calculated for several total calcium scores in each decade. For age groups 40 to 49 and 50 to 59 years, a total score of 50 resulted in a sensitivity of 71% and 74% and a specificity of 91% and 70%, respectively. For age group 60 to 69 years, a total score of 300 gave a sensitivity of 74% and a specificity of 81%. The negative predictive value of a 0 score was 98%, 94% and 100% for age groups 40 to 49, 50 to 59 and 60 to 69 years, respectively. Ultrafast computed tomography is an excellent tool for detecting and quantifying coronary artery calcium.

Behaviorally elicited heart rate reactivity in female cynomolgus monkeys (Macaca Fasciscularis)

Article

May 1989

We previously reported that the coronary atherosclerosis of cholesterol-fed, male cynomolgus monkeys (Macaca fascicularis) was exacerbated among animals that exhibited the largest heart rate (HR) reactions to a standard laboratory stressor. Here we report a similar relationship between behaviorally induced HR reactivity and atherosclerosis in females of the same species. Twenty-one female monkeys were fed a moderately atherogenic diet for 30 months. Near the end of this period, animals were fitted with electrocardiogram telemetry devices and their HRs were recorded under baseline and stressed conditions. Stress period HR measurements were obtained during a standard challenge involving threatened capture and physical handling of the animals. At necropsy, sections taken from the left anterior descending, left circumflex, and right coronary arteries were examined histologically. Mean intimal area measurements were then compared between animals identified as High (n = 7) and Low (n = 7) HR reactors. High HR reactive animals were found to have significantly greater coronary artery atherosclerosis than Low reactors; atherosclerosis at the right carotid bifurcation also differed significantly between High and Low reactive monkeys. Groups did not differ in baseline HR, blood pressure, and total or HDL cholesterol concentrations. Relative to Low HR reactors, however, High reactive animals weighed less and were less ponderous, had greater heart weights (adjusted for differences in body weight), were behaviorally less aggressive, and had lower luteal phase progesterone concentrations. These relationships were corroborated in correlation analyses employing data of all 21 study animals.

CARDIA: Study Design, Recruitment, and Some Characteristics of the Examined Subjects

Article

Feb 1988
J CLIN EPIDEMIOL

In 1984, a prospective cohort study, Coronary Artery Risk Development in Young Adults (CARDIA) was initiated to investigate life-style and other factors that influence, favorably and unfavorably, the evolution of coronary heart disease risk factors during young adulthood. After a year of planning and protocol development, 5,116 black and white women and men, age 18-30 years, were recruited and examined in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. The initial examination included carefully standardized measurements of major risk factors as well as assessments of psychosocial, dietary, and exercise-related characteristics that might influence them, or that might be independent risk factors. This report presents the recruitment and examination methods as well as the mean levels of blood pressure, total plasma cholesterol, height, weight and body mass index, and the prevalence of cigarette smoking by age, sex, race and educational level. Compared to recent national samples, smoking is less prevalent in CARDIA participants, and weight tends to be greater. Cholesterol levels are representative and somewhat lower blood pressures in CARDIA are probably, at least in part, due to differences in measurement methods. Especially noteworthy among several differences in risk factor levels by demographic subgroup, were a higher body mass index among black than white women and much higher prevalence of cigarette smoking among persons with no more than a high school education than among those with more education.

Propranolol inhibits coronary atherosclerosis in behaviorally predisposed monkeys fed an atherogenic diet

Article

Jan 1988

We studied the effect of propranolol on the diet-induced coronary artery atherosclerosis (CAA) in 30 adult male cynomolgus monkeys living in social groupings of five animals each. Animals in the "treated" segment (n = 15) consumed propranolol, which was mixed into an atherogenic diet. Animals in the "untreated" group (n = 15) consumed only the atherogenic diet. Finally, the social groupings were subjected to disruption through monthly redistribution of monkeys among the groups within each treatment segment. The experiment lasted 26 months, following which all animals underwent autopsy during which the coronary arteries were evaluated for atherosclerosis. Regarding atherosclerosis, we observed a significant interaction between social status and experimental condition (p less than .03). Socially dominant animals had (as in previous studies) significantly exacerbated CAA, but only in the untreated segment; the effect of social dominance on CAA was abolished by long-term administration of propranolol. The antiatherogenic effect of propranolol on dominant animals was independent of the influences of serum lipid concentrations, blood pressure, and resting heart rate. We conclude that treatment with beta-adrenergic-blocking agents may confer a degree of protection against CAA among individuals behaviorally predisposed to coronary heart disease.

Enzymatic Methods for Quantification of Lipoprotein Lipids

Article

Feb 1986
METHOD ENZYMOL

G. Russell Warnick

This chapter presents enzymatic methods for quantification of lipoprotein lipids. The methods described are primarily developed for cholesterol measurement in human plasma and lipoprotein fractions and are well suited for high-volume screening applications. Two reagents are described, one a commercial kit method 14 (Boehringer-Mannheim High Performance) and one prepared in-house from the constituents (modified Centers for Disease Control (CDC)). For both reagents an application for the ABA 200 chemical analyzer and a manual procedure are given. Enzymatic methods have significant advantages. Among these are improved specificity, which permits in many cases direct measurement of the analyte without pretreatment, i.e., hydrolysis or extraction. Although the direct enzymatic methods are not totally free from interference effects, with reasonable precautions they can give acceptable results for most specimens. The enzymatic methods are usually more sensitive, permit measurement in small specimen volumes, and are versatile with a variety of different color reactions. The reagents are generally mild and well suited to modern chemical analyzers.

Coronary Artery Calcium Area by Electron-Beam Computed Tomography and Coronary Atherosclerotic Plaque Area : A Histopathologic Correlative Study

Article

Oct 1995

Coronary calcium identified by electron-beam computed tomography (EBCT) correlates poorly with luminal atherosclerotic narrowing, but calcium, an intimate part of coronary plaque, may be more directly related to atheromatous plaque area. Thirty-eight coronary arteries from 13 autopsy hearts were dissected, straightened, and scanned with EBCT in 3-mm contiguous increments. Coronary calcium area was defined as one or more pixels with a density > 130 Hounsfield units (0.18 mm2/pixel). Each artery was divided into corresponding 3-mm segments, representative histological sections were stained, and atherosclerotic plaque area per segment (mm2) was quantified. Coronary artery calcium and coronary artery plaque areas were correlated for the hearts as a whole, for individual coronary arteries, and for individual coronary artery segments. The sums of histological plaque areas versus the sums of calcium areas were highly correlated for each heart and for each coronary artery. However, coronary plaque area was on the order of five times greater than calcium area. Furthermore, minimal diffuse segmental coronary plaque could be present despite the absence of coronary calcium detectable by EBCT. This histopathologic study confirms an intimate relation between whole heart, coronary artery, and segmental coronary atherosclerotic plaque area and EBCT coronary calcium area but suggests that there is a threshold value for plaque area below which coronary calcium is either absent or not detectable by this methodology.

Coronary Artery Calcification: Assessment with Electron Beam CT and Histomorphometric Correlation

Article

Oct 1994

To assess the reliability of electron beam computed tomography (CT) in the detection of calcific deposits in coronary arteries. The authors quantitatively evaluated a total of 4,298 segments of coronary arteries with electron beam CT and histomorphometry. Regression analysis of the electron beam CT calcium score versus histomorphometric calcium area produced an r2 value of .92 (r = .96; P < .0001). Ninety-three percent (78 of 84) of all coronary arteries with stenosis of 76%-100% contained calcific deposits, and 20% (17 of 83) of all coronary arteries with stenosis of 0%-50% contained calcific deposits. The amount of calcific deposits detected with electron beam CT correlates highly with histomorphometric measurements. Also, the amount of calcific deposits correlates well with the degree of coronary artery stenosis. Electron beam CT, therefore, is a promising noninvasive technique that can help depict the presence and extent of atherosclerotic plaques.

Predictive Value of Electron Beam Computed Tomography of the Coronary Arteries : 19-Month Follow-up of 1173 Asymptomatic Subjects

Article

Jul 1996

Coronary electron beam computed tomography (EBCT) detects atherosclerotic coronary artery disease by measuring calcium deposition in the walls of coronary arteries. EBCT-derived coronary artery calcium (CAC) scores correlate with the severity of underlying coronary artery disease. We followed 1173 asymptomatic patients who underwent EBCT between September 1993 and March 1994. During average follow-up of 19 months, 18 subjects had 26 cardiovascular events: 1 death, 7 myocardial infarctions, 8 coronary artery bypass graft procedures, 9 coronary angioplasties, and 1 nonhemorrhagic stroke. For CAC score thresholds of 100, 160, and 680, EBCT had sensitivities of 89%, 89%, and 50% and specificities of 77%, 82%, and 95%, respectively. Odds ratios ranged from 20.0 to 35.4 (P < .0001 for all). Coronary EBCT predicts future atherosclerotic cardiovascular disease events in asymptomatic subjects.

Prognostic Significance of Coronary Calcific Deposits in Asymptomatic High-Risk Subjects

Article

May 1997
AM J MED

To determine the predictive value of coronary calcifications for coronary heart disease events in high-risk, asymptomatic adults: A prospective cohort study of 1,461 high-risk, asymptomatic subjects were followed for 55 months with a 98% success rate. Coronary risk factor assessment and cardiac fluoroscopy with digital subtraction enhancement were performed to determine the number of calcified coronary arteries. Fifty-eight percent of this cohort (852 subjects) had fluoroscopically detectable coronary calcification: 437 (30%) had calcium in one, 253 (17%) in two, and 162 (11%) in all three coronary vessels. There were 90 (6%) deaths, 35 (39%) attributable to coronary heart disease, and 43 (3%) nonfatal myocardial infarctions. Subjects with calcification in more than one major coronary artery were 2.2 times more likely to suffer coronary death or nonfatal infarction (P = 0.001) than were subjects with one or no calcified arteries. Multivariable logistic regression analysis showed that only the number of calcified arteries, age, total cholesterol, history of diabetes, and left ventricular hypertrophy by electrocardiogram were associated independently with the incidence of coronary death or infarction in these subjects. Coronary calcification predicts coronary heart disease death or infarction in high-risk asymptomatic adults as well as do standard risk factors.

Behaviorally Elicited Heart Rate Reactivity and Atherosclerosis in Ovariectomized Cynomolgus Monkeys (Macaca fascicularis)

Article

Sep 1997

It has been hypothesized that atherogenesis is accelerated among individuals who exhibit heightened cardiovascular reactions to psychologic stress. We have reported previously that the coronary atherosclerosis of cholesterol-fed, male and reproductively intact (premenopausal) female cynomolgus monkeys was exacerbated in animals that experienced the largest heart rate (HR) reactions to a fear-eliciting laboratory stressor. In this article, we report a similar relationship among 20 female monkeys that were rendered estrogen-deficient (by ovariectomy) and subsequently treated with replacement of both estrogen and progesterone. At the beginning of a 30-month study period, animals were fitted with ECG telemetry devices, and their HRs were recorded under baseline and stressed conditions. Stress HR measurements were obtained during a standard challenge involving threatened capture and physical handling of the animals. As part of a related experiment, monkeys were then ovariectomized and, for the remainder of the study, administered 17 beta-estradiol (continuously) and progesterone (cyclically) by subcutaneous Silastic implant (Dow Corning). Animals consumed a cholesterol-containing diet throughout, and HR measurements were repeated in the 24th month. At necropsy, the magnitude of animals' HR responses to stress correlated significantly with intimal area measurements in the left anterior descending and circumflex coronary arteries (r = .59 and r = .57, respectively; P < .009). This association was due to a marked exacerbation of coronary atherosclerosis in animals comprising the upper third of the reactivity distribution. Although total and HDL cholesterol concentrations also covaried with HR reactivity, the greater atherosclerosis of "high" HR reactors persisted after statistical adjustment for concomitant variability in plasma lipids. HR reactivity was unrelated to blood pressure, body weight, or social behavior.

Exaggerated Blood Pressure Responses During Mental Stress Are Associated With Enhanced Carotid Atherosclerosis in Middle-Aged Finnish Men Findings From the Kuopio Ischemic Heart Disease Study

Article

Jan 1998

Exaggerated cardiovascular reactivity to mental stress is hypothesized to increase atherosclerotic risk. We examined this hypothesis using cross-sectional data from the Kuopio Ischemic Heart Disease study, a population-based epidemiological sample. 901 Eastern Finnish men from four age cohorts (age, 42 to 60 years) were administered a standardized testing battery to assess cardiovascular reactivity to mental stress. Ultrasound measures of intima-medial thickness (IMT) and plaque height from the common carotid arteries were used as noninvasive markers of atherosclerosis. Diastolic blood pressure (DBP) responses to mental stress were significantly associated with mean IMT (b=.021, P=.006), maximum IMT (b=.026, P=.013), and mean plaque height (b=.017, P=.041). Significant associations were also shown between stress-related systolic blood pressure (SBP) reactivity and mean IMT (b=.0151, P=.042). When examined separately by age, associations with IMT were significant only in the youngest half of the sample (age, 46 and 52 years, n=433; for mean IMT, DBP b=.033, P=.0002, SBP b=.0266, P=.003; for maximum IMT, DBP b=.039, P=.002, SBP b=.032, P=.011). Results remained significant in the younger subjects after adjustment for smoking, lipid profiles, fasting glucose, and resting blood pressure (b=.024, P=.011); results also remained significant in a subgroup of unmedicated younger subjects without symptomatic cardiovascular disease (n=135; for SBP reactivity, b=.031, P=.036; for DBP, b=.037, P=.007). The tendency to show exaggerated pressor responses to mental stress is a significant independent correlate of atherosclerosis in this population sample of Finnish men. The effect does not appear to be accounted for by the confounding influence of other risk factors or preexisting clinical disease.

Stress-Induced Pulse Pressure Change Predicts Women's Carotid Atherosclerosis

Article

Aug 1998

Individuals who exhibit large increases in blood pressure and heart rate during mental stress may be at risk for accelerated atherosclerosis. This report evaluates the association between stress-induced hemodynamic responses and carotid atherosclerosis in 254 healthy postmenopausal women. The magnitude of change in blood pressure and heart rate from rest to public speaking and mirror image tracing, two stressful tasks, was measured. Average intima-media thickness (IMT) and focal plaque in the common carotid artery, bulb, and internal carotid artery were measured with the use of duplex ultrasonography on average 2.3 years later. The average IMT was 0.77 mm, with a range of 0.60 to 1.37; 52.5% had at least one plaque. Correlational analysis showed that greater IMT was associated with greater pulse pressure change during mental stress (r = 0.17, P < 0.01). Statistical adjustments for possible confounders (age, hormone replacement therapy use, resting pulse pressure, smoking status, and triglyceride levels) did not alter the results. The plaque index was associated with greater pulse pressure change during the mirror image tracing task (odds ratio = 1.47, P = 0.01) for women with a plaque score of > or = 2 versus 1 or 0, adjusted for possible confounders. Mental stress-induced pulse pressure changes may influence the development of early atherosclerosis in the carotid artery of women. Widening of pulse pressure during stress, as well as at rest, may be a marker of compromised compliance in the vessel wall.

Detection of Subclinical Cardiovascular Disease: The Emerging Role of Electron Beam Computed Tomography

Article

Feb 2002

Although extraordinary advances have been made in the management of advanced coronary artery disease, little progress has been made in its prevention. Traditional screening methods utilizing risk factor profiles and exercise treadmill tests have failed to identify populations who will subsequently have coronary events with a high degree of predictive accuracy. We review the pathobiologic basis and clinical utility of electron beam computed tomography (EBCT) to detect coronary artery calcium as a screening tool for subclinical coronary artery disease. Because EBCT is able to perform subsecond imaging of the heart, it can detect and quantitate coronary artery calcium with a high degree of precision. Coronary artery calcium is a marker of complex atherosclerosis. Over 4,000 asymptomatic patients in several series have been studied with EBCT and followed prospectively for an average of 42 months (range 37-72 months). A positive scan is associated with a risk ratio for future coronary events of 8.7 (95% confidence interval 2.67 to 28.13). These data indicate that EBCT has the ability to detect subclinical coronary artery disease and predict future coronary events better than any previous existing method or technology. EBCT coronary artery screening may prove to be a valuable adjunct to the traditional methods for the detection of subclinical coronary artery disease and to identify those who would benefit from focused preventive therapies.

Cardiovascular Reactivity and Development of Preclinical and Clinical Disease States

Article

Jan 2003
PSYCHOSOM MED

The objective of this review is to evaluate the evidence for the hypothesis that cardiovascular reactivity can predict the development of preclinical (elevated blood pressure, ventricular remodeling, carotid atherosclerosis) and/or clinical cardiovascular disease states. A review of the literature was conducted examining prospective studies. Three large epidemiological studies with long-term follow-up periods (20 years or more) have found blood pressure responses to the cold pressor task to be predictive of subsequent essential hypertension in initially normotensive samples. Studies showing less consistent results have tended to use shorter-term follow-up periods. A larger body of literature demonstrates consistent associations between stress-related cardiovascular reactivity and blood pressure elevations in youth over the course of 1 to 6 years; such relationships have not been consistently shown among adult samples. Moderately consistent evidence points to a positive relationship between reactivity and other measures of subclinical disease (increased left ventricular mass and carotid atherosclerosis) among the few prospective studies that have examined these issues to date. A number of additional factors, however, such as baseline levels of disease risk and exposure to psychosocial stress, seem to moderate these relationships. Health status at baseline also seems to moderate the association between reactivity and clinical coronary heart disease in recent reports: two of three existing studies in initially healthy samples show no evidence of a relationship between reactivity and clinical outcomes, whereas three of four studies in samples with preexisting coronary heart disease or essential hypertension show a positive relationship between reactivity and subsequent disease states. There is reasonable evidence to suggest that cardiovascular reactivity can predict the development of some preclinical states (eg, increased left ventricular mass and blood pressure) states and perhaps even new clinical events in some patients with essential hypertension or coronary heart disease. However, much more information is needed concerning moderating and potentially confounding variables before the robustness of the positive relationships can become clinically useful.

Blood Pressure Reactivity to Psychological Stress Predicts Hypertension in the CARDIA Study

Article

Jul 2004
CIRCULATION

A longstanding but controversial hypothesis is that individuals who exhibit frequent, large increases in blood pressure (BP) during psychological stress are at risk for developing essential hypertension. We tested whether BP changes during psychological stress predict incident hypertension in young adults. We used survival analysis to predict hypertensive status during 13 years of follow-up in a sample of >4100 normotensive black and white men and women (age at entry, 18 to 30 years) enrolled in the CARDIA study. BP responses to 3 psychological challenges--cold pressor, star tracing, and video game tasks--were measured. Hypertensive status was defined as use of antihypertensive medication or measured BP > or =140/90 mm Hg. After adjustment for race, gender, covariates (education, body mass index, age, and resting pressure), and their significant interactions, the larger the BP responses were to each of the 3 tasks, the earlier hypertension occurred (P<0.0001 to <0.01). The systolic BP effect for the cold pressor task was apparent for women and for whites in race- and gender-specific models, whereas the diastolic BP effect for the video game was apparent for men. Young adults who show a large BP response to psychological stress may be at risk for hypertension as they approach midlife.

Exaggerated Blood Pressure Responses During Mental Stress Are Prospectively Related to Enhanced Carotid Atherosclerosis in Middle-Aged Finnish Men

Article

Nov 2004
CIRCULATION

Hemodynamic reactions to mental stress may contribute to atherosclerosis. We previously observed cross-sectional relationships between blood pressure reactions to a standardized stress battery and carotid intima-media thickness (IMT) in the Kuopio Ischemic Heart Disease (KIHD) study. These are the first prospective results on this relationship. Men from 4 age cohorts (42 to 60 years old at study onset) were challenged with a standardized mental stress battery, and heart rate and blood pressure reactions were assessed. Ultrasound measures of common carotid IMT were collected at this time and 7 years later as noninvasive markers of atherosclerosis. Data were collected from a sample of 756 men at both times. Systolic blood pressure reactions to mental stress at study onset were positively related to mean carotid IMT 7 years later (beta=0.035, P=0.001, by blood pressure quartile, IMT=0.91, 0.93, 0.96, 1.00 mm) and to the progression of IMT (beta=0.020, P=0.006, by blood pressure quartile, DeltaIMT=0.08, 0.09, 0.11, 0.11 mm). Similar significant relations were shown for maximal IMT and plaque height. Diastolic blood pressure responses were less strongly related to carotid IMT than were systolic responses. Heart-rate responses were unrelated. Adjustment for standard risk factors did not substantially reduce the relation between systolic blood pressure reactivity and the progression of mean carotid IMT (standardized beta=0.059, P=0.026), maximal carotid IMT (standardized beta=0.084, P=0.006), or plaque height (standardized beta=0.093, P=0.008). The degree of systolic blood pressure reactivity to mental challenge is prospectively related to carotid IMT in middle-aged and older men, independent of known risk factors.

Calcified Coronary Artery Plaque Measurement with Cardiac CT in Population-based Studies: Standardized Protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) Study1

Article

Feb 2005

Calcified coronary artery plaque, measured at cardiac computed tomography (CT), is a predictor of cardiovascular disease and may play an increasing role in cardiovascular disease risk assessment. The Multi-Ethnic Study of Atherosclerosis (MESA) and the Coronary Artery Risk Development in Young Adults (CARDIA) study of the National Heart, Lung, and Blood Institute are population-based studies in which calcified coronary artery plaque was measured with electron-beam and multi-detector row CT and a standardized protocol in 6814 (MESA) and 3044 (CARDIA study) participants. The studies were approved by the appropriate institutional review board from the study site or agency, and written informed consent was obtained from each participant. Participation in the CT examination was high, image quality was good, and agreement for the presence of calcified plaque was high (kappa = 0.92, MESA; kappa = 0.77, CARDIA study). Extremely high agreement was observed between and within CT image analysts for the presence (kappa > 0.90, all) and amount (intraclass correlation coefficients, >0.99) of calcified plaque. Measurement of calcified coronary artery plaque with cardiac CT is well accepted by participants and can be implemented with consistently high-quality results with a standardized protocol and trained personnel. If predictive value of calcified coronary artery plaque for cardiovascular events proves sufficient to justify screening a segment of the population, then a standardized cardiac CT protocol is feasible and will provide reproducible results for health care providers and the public.

A Greater Reduction in High-Frequency Heart Rate Variability to a Psychological Stressor is Associated With Subclinical Coronary and Aortic Calcification in Postmenopausal Women

Article

Aug 2005
PSYCHOSOM MED

Reduced cardiac parasympathetic activity, as indicated by a reduced level of clinic or ambulatory high-frequency heart rate variability (HF-HRV), is associated with an increased risk for atherosclerosis and coronary artery disease. We tested whether the reduction in HF-HRV to a psychological stressor relative to a baseline level is also associated with subclinical coronary or aortic atherosclerosis, as assessed by calcification in these vascular regions. Spectral estimates of 0.15 to 0.40 Hz HF-HRV were obtained from 94 postmenopausal women (61-69 years) who engaged in a 3-minute speech-preparation stressor after a 6-minute resting baseline. A median of 282 days later, electron beam tomography (EBT) was used to measure the extent of coronary and aortic calcification. In univariate analyses, a greater reduction in HF-HRV from baseline to speech preparation was associated with having more extensive calcification in the coronary arteries (rho = -0.29, p = .03) and in the aorta (rho = -0.22, p = .06). In multivariate analyses that controlled for age, education level, smoking status, hormone therapy use, fasting glucose, high-density lipoproteins, baseline HF-HRV, and the stressor-induced change in respiration rate, a greater stressor-induced reduction in HF-HRV was associated with more calcification in the coronary arteries (B = -1.21, p < .05), and it was marginally associated with more calcification in the aorta (B = -0.92, p = .09). In postmenopausal women, a greater reduction in cardiac parasympathetic activity to a psychological stressor from baseline may be an independent correlate of subclinical atherosclerosis, particularly in the coronary arteries.

Blood Pressure Reactivity to Psychological Stress and Coronary Calcification in the Coronary Artery Risk Development in Young Adults Study

Abstract

No full-text available

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