Lipids in psychological research: the last decade

Effects of portable pedal machines at work on lipoprotein subfraction profile in sedentary workers - the REMOVE study

BACKGROUND

Sedentary behaviour at work is a major cause of atherosclerosis, particularly in tertiary workers. However, no studies have ever assessed the effect of active workstation on lipoprotein subfraction profile. This study aimed to evaluate the effect of 12-week portable pedal machines (PPMs) on lipoprotein subfraction profile among healthy sedentary workers.

METHODS

Healthy administrative workers were randomized into an intervention group using PPMs for 12 weeks or a control group using normal-desk. Lipoprotein subfractions were assessed using Lipoprint® electrophoresis. Main outcomes were explored using mixed models with sensitivity analyses (four models).

RESULTS

We included 40 participants (43.7 ± 8.6 years old, 100% women, BMI 23.8 ± 3.4 kg/m2; sedentary time at work 7.7 ± 1.8 h/day). Groups did not differ at baseline in any outcomes. 32 participants finished the trial. Changes in lipoprotein subfractions were especially marked for LDL profile. There was an interaction time x group for all parameters related to LDL and their subfractions: total LDL-cholesterol (p = 0.012), LDL particle size (p = 0.027), large LDL subfractions 1 and 2 (p = 0.001), and small dense LDL subfractions 3 to 7 (p = 0.046), using the crude model. The interaction reflects difference in the direction of changes between groups. The LDL particle size significantly increased in the intervention group (from 271.9 ± 2.5 at t0 to 272.8 ± 1.9 Ångström at t1, p = 0.037) while it did not change in the control group (272.5 ± 1.7 at t0 to 271.8 ± 1.5Å at t1, p = 0.52). All interactions were constantly significant whatever the models. Influencing variables were mainly stress at work that was associated with an increase in total LDL-cholesterol (coefficient 3.15, 95CI 0.20 to 6.11 mg/dl, p = 0.038), and BMI that was associated with Large-LDL, Large-HDL, IDL-C and triglycerides.

CONCLUSIONS

Lipoprotein profile was improved after a 12-week PPMs intervention at work in healthy administrative workers. Changes were mainly showed for LDL and LDL subfractions. Lipoprotein profile was worsened by stress at work, BMI and age.

TRIAL REGISTRATION

NCT04153214.

Testing lipid markers as predictors of all-cause morbidity, cardiac disease, and mortality risk in captive western lowland gorillas (Gorilla gorilla gorilla)

Great apes and humans develop many of the same health conditions, including cardiac disease as a leading cause of death. In humans, lipid markers are strong predictors of morbidity and mortality risk. To determine if they similarly predict risk in gorillas, we measured five serum lipid markers and calculated three lipoprotein ratios from zoo-housed western lowland gorillas (aged 6-52 years, n = 61 , subset with routine immobilizations only: n = 47 ): total cholesterol (TC), triglycerides (TGs), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A1 (apoA1), TC / HDL , LDL / HDL , and TG / HDL . We examined each in relation to age and sex, then analyzed whether they predicted all-cause morbidity, cardiac disease, and mortality using generalized linear models (GLMs). Older age was significantly associated with higher TG, TC / HDL , LDL / HDL , and TG / HDL , and lower HDL and apoA1. With all ages combined, compared to females, males had significantly lower TG, TC / HDL , LDL / HDL , and TG / HDL , and higher HDL. Using GLMs, age, sex, and lower LDL / HDL were significant predictors of all-cause morbidity; this is consistent with research demonstrating lower LDL in humans with arthritis, which was the second most prevalent condition in this sample. In contrast to humans, lipid markers were not better predictors of cardiac disease and mortality risk in gorillas, with cardiac disease best predicted by age and sex alone, and mortality risk only by age. Similar results were observed when multimodel inference was used as an alternative analysis strategy, suggesting it can be used in place of or in addition to traditional methods for predicting risk.

Tracking weight change, insulin resistance, stress, and aerobic fitness over 4 years of college

OBJECTIVE

To determine if weight gain is accompanied by development of insulin resistance (IR) during 4 years in college.

PARTICIPANTS

Two cohorts of college students were enrolled in fall semesters 2009 and 2010 and tracked for 4 years.

METHODS

Following a 12-hour fast, subjects reported for measurement of body mass index (BMI), perceived stress (PSS), aerobic fitness, and blood glucose, insulin, and lipids.

RESULTS

In the first year, 33% of subjects were overweight or obese, and 20% were hyperinsulinemic. Year 4 had 29 remaining subjects with disproportionate attrition of overweight and obese individuals. Just over half the subjects gained weight (WI), whereas nearly 30% lost considerable amounts (WD). WD showed significant decline in fasting insulin, low-density lipoprotein (LDL) cholesterol, and PSS from year 1. WI was primarily highly fit men who did not demonstrate increased IR.

CONCLUSION

WI was not associated with IR over 4 years of college.

Cholesterol and depressive symptoms in older men across time

This study aimed to examine reciprocal relations between cholesterol and depression. We assessed cholesterol and depressive symptoms twice over a 3-year interval, using 842 men from the Veterans Affairs Normative Aging Study (M = 64, standard deviation = 8). Because depressive symptoms were skewed, we used zero-inflated Poisson analyses. Cross-lagged models showed that cholesterol levels at T1 predicted the existence of depressive symptoms at T2, covarying T1 depressive symptoms, age, smoking status, body mass index, and medications. Depressive symptoms at T1 did not predict cholesterol at T2. Low cholesterol levels may be risk factors for development of depressive symptoms in late life.

Attributional styles and stress-related atherogenic plasma lipid reactivity in essential hypertension

OBJECTIVE

Hypertension and an atherogenic lipid profile are known risk factors for coronary heart disease (CHD). Hypertensives show greater changes in atherogenic plasma lipids to acute stress than normotensives. In this study, we investigated whether attribution of failure is associated with lipid stress reactivity in hypertensive compared with normotensive men.

METHODS

18 normotensive and 17 hypertensive men (mean±SEM; 45±2.2 years) underwent an acute standardized psychosocial stress task that can be viewed as a situation of experimentally induced failure. We assessed external-stable (ES), external-variable (EV), internal-stable (IS), and internal-variable (IV) attribution of failure and psychological control variables (i.e. extent of depression and neuroticism). Moreover, total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and norepinephrine were measured immediately before and several times after stress.

RESULTS

ES moderated TC- and LDL-C-stress reactivity in hypertensives as compared to normotensives (interaction mean arterial pressure [MAP]-by-ES for TC: F=3.71, p=.015; for LDL-C: F=3.61, p=.016). TC and LDL-C levels were highest in hypertensives with low ES immediately after stress (p≤.039). In contrast, hypertensives with high ES did not differ from normotensives in TC and LDL-C immediately after stress (p's>.28). Controlling for norepinephrine, depression, and neuroticism in addition to age and BMI did not significantly change results. There were no significant associations between lipid baseline levels or aggregated lipid secretion and IS, IV, or EV (p's>.23).

CONCLUSION

Our data suggest that ES may independently protect from elevated lipid stress reactivity in hypertensive individuals. ES thus might be a protective factor against CHD in hypertension.

The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies

Chronic psychosocial stress has been proposed as a risk factor for the development of the metabolic syndrome (MES). This review gives a systematic overview of prospective cohort studies investigating chronic psychosocial stress as a risk factor for incident MES and the individual elements of MES. Thirty-nine studies were included. An association between chronic psychosocial stress and the development of MES was generally supported. Regarding the four elements of MES: i) weight gain: the prospective studies supported etiological roles for relationship stress, perceived stress, and distress, while the studies on work-related stress (WS) showed conflicting results; ii) dyslipidemi: too few studies on psychosocial stress as a risk factor for dyslipidemia were available to draw a conclusion; however, a trend toward a positive association was present; iii) type 2 diabetes mellitus (DM2): prospective studies supported perceived stress and distress as risk factors for the development of DM2 among men, but not among women, while WS was generally not supported as a risk factor among neither men nor women; iv) hypertension: marital stress and perceived stress might have an influence on blood pressure (BP), while no association was found regarding distress. Evaluating WS the results were equivocal and indicated that different types of WS affected the BP differently between men and women. In conclusion, a longitudinal association between chronic psychosocial stress and the development of MES seems present. However, the number of studies with sufficient quality is limited and the design of the studies is substantially heterogeneous.

Self-rated stress is noncontributory to coronary artery disease in higher socioeconomic strata

Stress and its attendant psychosocial and lifestyle variables have been associated with coronary artery disease (CAD), yet the contribution of socioeconomic status (SES) has not been addressed. The aim of this study is to determine if stress assessment is associated with CAD independent of SES, and is incremental to the Framingham Score. The study group consisted of 325 executive patients undergoing comprehensive health assessment. Stress was assessed utilizing the validated "Self-Rated Stress" (SRS) instrument. Coronary artery calcification (CAC) served to assess the degree of atherosclerosis, a CAD equivalent and risk assessment tool. The relationship between SRS and CAC was assessed, with adjustment by potential confounders. CAC was modeled by a variety of cut points (>0, ≥5, ≥100, ≥200) for the test of trend across stress levels per Mantel-Haenszel chi-square (1 df) with nonsignificant P values of 0.9960, 0.5242, 0.1692, 0.3233, respectively. A logistic regression model with SRS as a categorically ranked and continuous variable to predict binary outcome of calcification yielded P values of 0.2366 and 0.9644; this relationship, further adjusted by age, fruit and vegetable consumption, exercise, and education, yielded no statistically significant association. No improvement of fit was observed for the established Framingham Score to CAC relation utilizing SRS. The study concluded that SRS did not play a role in early CAD when focusing on a population in higher socioeconomic strata, and SRS did not add predictive value beyond patient age or calculated Framingham risk. Future studies should focus on additional validated instruments of stress to differentiate between subtypes of stress for varying SES strata.

Role of sudarshan kriya and pranayam on lipid profile and blood cell parameters during exam stress: A randomized controlled trial

BACKGROUND

Yoga is a science practiced in India over thousands of years. It produces constituent physiological changes and has sound scientific basis.

AIM

Since exam stress modifies lipid profile and hematological parameters, we conducted an investigation on the effect of sudarshan kriya (SK and P) program on these parameters.

MATERIALS AND METHODS

Blood samples of 43 engineering students were collected at four intervals namely baseline (BL), exam stress (ES), three and six weeks practice of SK and P during exam stress. Lipid profile and hematological parameters were measured at all four intervals.

RESULTS

ES elevated total cholesterol (TC), triglycerides (TGL) and very low density lipoprotein (VLDL) levels. Hematological parameters affected by ES included neutrophil, lymphocytes, platelet count, packed cell volume (PCV) and mean cell volume (MCV). Three and six weeks practice of SK and P reduced the elevated lipid profile, hematological parameters and improved lymphocyte levels.

CONCLUSION

Our study indicates that SK and P practice has the potential to overcome ES by improving lipid profile and hematological parameters.

Family cohesion moderates the relation between free testosterone and delinquent behaviors in adolescent boys and girls

PURPOSE

This study examined the associations of free testosterone and family environment with delinquent and aggressive behaviors among adolescent boys and girls with elevated low-density lipoprotein (LDL)-cholesterol levels.

METHODS

Participants were 164 boys and 180 girls 11-14 years of age. The female parent provided ratings of family cohesion and of child aggressive and delinquent behaviors. Tanner ratings of pubertal development were obtained during physical examination, and a blood sample was drawn for assessment of serum levels of free testosterone.

RESULTS

Hierarchical regression analyses revealed significant two-way interactions of free testosterone and family cohesion on delinquent behaviors among adolescent boys and girls. Specifically, under conditions of low family cohesion, free testosterone was positively associated with delinquent behaviors among boys, whereas in families with high cohesion no association between free testosterone and delinquent behavior was observed. In contrast, free testosterone was negatively associated with delinquent behaviors among adolescent girls in low-cohesion families. For girls, family cohesion was negatively associated with aggressive behaviors; for boys, LDL-C was positively associated with aggressive behaviors.

CONCLUSIONS

Child gender and family environment factors appear to modify the associations between free testosterone and delinquent behaviors in adolescent boys and girls.

Changes in plasma lipids with psychosocial stress are related to hypertension status and the norepinephrine stress response

Hypertension is a known risk factor for cardiovascular disease. Hypertensive individuals show exaggerated norepinephrine (NE) reactivity to stress. Norepinephrine is a known lipolytic factor. It is unclear if, in hypertensive individuals, stress-induced increases in NE are linked with the elevations in stress-induced circulating lipid levels. Such a mechanism could have implications for atherosclerotic plaque formation. In a cross-sectional, quasi-experimentally controlled study, 22 hypertensive and 23 normotensive men (mean +/- SEM, 45 +/- 3 years) underwent an acute standardized psychosocial stress task combining public speaking and mental arithmetic in front of an audience. We measured plasma NE and the plasma lipid profile (total cholesterol [TC], low-density-lipoprotein cholesterol [LDL-C], high-density-lipoprotein cholesterol, and triglycerides) immediately before and after stress and at 20 and 60 minutes of recovery. All lipid levels were corrected for stress hemoconcentration. Compared with normotensives, hypertensives had greater TC (P = .030) and LDL-C (P = .037) stress responses. Independent of each other, mean arterial pressure (MAP) upon screening and immediate increase in NE predicted immediate stress change in TC (MAP: beta = .41, P = .003; NE: beta = .35, P = .010) and LDL-C (MAP: beta = .32, P = .024; NE: beta = .38, P = .008). Mean arterial pressure alone predicted triglycerides stress change (beta = .32, P = .043) independent of NE stress change, age, and BMI. The MAP-by-NE interaction independently predicted immediate stress change of high-density-lipoprotein cholesterol (beta = -.58, P < .001) and of LDL-C (beta = -.25, P < .08). We conclude that MAP and NE stress reactivity may elicit proatherogenic changes of plasma lipids in response to acute psychosocial stress, providing one mechanism by which stress might increase cardiovascular risk in hypertension.

The stress of chess players as a model to study the effects of psychological stimuli on physiological responses: an example of substrate oxidation and heart rate variability in man

We have studied the physiological consequences of the tension caused by playing chess in 20 male chess players, by following heart rate, heart rate variability, and respiratory variables. We observed significant increase in the heart rate (75-86 beats/min), in the ratio low frequency (LF)/high frequency (HF) of heart rate variability (1.3-3.0) and also a decrease in mean heart rate variability with no changes in HF throughout the game. These results suggest a stimulation of the sympathetic nervous system with no changes in the parasympathetic system. The respiratory exchange ratio was rather elevated (over 0.89) at the start and significantly decreased during the game (0.75 at the end), indicating that energy expenditure progressively switched from carbohydrate to lipid oxidation. The changes in substrate oxidation and the sympathetic system seem to be due to high cognitive demands and bring new insight into adaptations to mental strain.

Coping, affect, and the metabolic syndrome in older men: how does coping get under the skin?

The metabolic syndrome is a complex construct with interrelated factors of obesity, blood pressure, lipids, and glucose. It is a risk factor for a number of chronic diseases in late life. This study tested a model in which the relationship between stress and the metabolic syndrome was mediated by appraisal, coping, and affect. Data were collected from 518 male participants in the Normative Aging Study (X(age) = 68.17 years). The model was partially confirmed. Relationships among stress, appraisal, coping, and affect were valenced along positive and negative pathways. However, affect was not directly related to the metabolic syndrome. The metabolic syndrome was related to positive coping as operationalized by self-regulatory strategies. The results of this study suggest that the influence of coping on physical health may occur through emotional regulation.

Possible connections among job stress, depressive symptoms, lipid modulation and antioxidants

BACKGROUND

Oxidative/antioxidative status may be related to psychological stress or pathogenesis of depression.

SUBJECTS AND METHODS

Participants were selected from 381 female nurses working in a university hospital, and the Brief Job Stress Questionnaire was utilized to assess them. Nurses with high job stress (JS) (n = 18) and with low JS (n = 15) consented to participate in this study. Depressive symptoms were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D). Cholesterols, lipid peroxidation (malondialdehyde, MDA) and antioxidants in the plasma were measured.

RESULTS

High JS participants exhibited significantly higher CES-D scores (t = 3.34, p < 0.005), and significantly lower concentrations of total cholesterol (TC), low density+very low density lipoprotein cholesterols (LDL+VLDL), alpha-tocopherol, and beta-carotene compared with low JS participants (t = 2.69, p < 0.05; t = 3.46, p < 0.005; t = 2.96, p < 0.05; t = 2.98, p < 0.05, respectively). However, the reductions in plasma indicators were substantially weakened after controlling for lifestyle factors with the exception of LDL+VLDL and alpha-tocopherol. In addition, the significance of alpha-tocopherol concentrations appeared to depend on cholesterol levels. CES-D scores correlated positively with plasma MDA levels, the MDA/TC ratio and the MDA/LDL+VLDL ratio among the low JS group (r = 0.69, p < 0.001; r = 0.79, p < 0.001; r = 0.75, p < 0.005, respectively), whereas there were no correlations among the high JS group. After controlling for lifestyle covariates, the relationship between CES-D scores and the MDA/LDL+VLDL ratio remained significant (beta = 0.95, p < 0.05) using a multiple linear regression model (F = 3.61, p < 0.05).

LIMITATIONS

Sample numbers in each JS group were relatively small.

CONCLUSIONS

Psychological stress may reduce the plasma levels of LDL+VLDL accompanying an alpha-tocopherol decrease. There appeared to be a correlation between elevated MDA and depressive symptoms in low JS participants.

Effects of academic examination stress on eating behavior and blood lipid levels

The influence of academic examination stress on eating behavior and lipid profiles and the moderating effect of dietary restraint, trait anxiety, and social support availability was assessed in university students. One hundred and seventy-nine students were divided into exam-stress groups (51 women, 64 men) and control groups (48 women, 16 men) and were assessed at baseline and then within 2 weeks of exams or an equivalent point for the control group. Perceived stress, emotional well-being, and fasting lipid profiles were measured, and dietary information was collected by interview. The exam-stress group reported significant increases in perceived stress and deterioration in emotional well-being at the exam sessions compared with baseline sessions. No general effects of exam stress on food intake were observed, and there was no interaction between stress and dietary restraint. However, students in the exam-stress group with high trait anxiety and low social support showed significant increases in total energy intake between baseline and exam sessions, whereas individuals with low trait anxiety and high social support showed a reduction in energy intake. Students with high trait anxiety and low social support showed increases between baseline and exam sessions in the amount of fat and saturated fat consumed. Women in the exam-stress group taking oral contraceptives showed a significant increase in total cholesterol between baseline and exam sessions. The results are discussed in relation to the effects of naturally occurring episodic stress on health behavior and on lipid profiles.

Serum cholesterol concentrations and non-physical aggression in healthy adults

Although physical aggression in humans and other primates appears to be negatively associated with total serum cholesterol (TSC) concentrations, the relationship between other forms of aggression and TSC is less clear. A plurality of studies have reported a positive association, some have reported no association, and a minority have reported a negative association. Some authors have speculated that the variability in findings is attributable to inconsistencies in the definitions and measurement of what has often been termed "verbal" aggression. Buss and Perry have developed the Aggression Questionnaire, a theoretically-derived and empirically validated self-report measure of aggression that breaks aggression into subcomponents. One hundred and seventy-one college students and university personnel were recruited to participate in a cholesterol screening health initiative and then invited to participate in a study of mood and cholesterol. They completed a Demographic Questionnaire, and the Aggression Questionnaire. Regression analyses with age and Body Mass Index (BMI) as covariates revealed that anger, hostility, and verbal aggression significantly predicted TSC. Physical aggression did not. This finding suggests that non-physical forms of aggression may constitute a risk factor for coronary artery disease and one that may be worthy of targeting through behavioral interventions such as anger management training.

Psychosocial factors in the development of coronary artery disease

The fact that traditional risk factors only account for approximately two thirds of cases of coronary artery disease (CAD) has stimulated increasing interest in the relationship between CAD and psychosocial factors. Five areas--chronic stress, socioeconomic status (SES), personality, depression, and social support--have been most thoroughly examined. There is evidence to support a causal relationship between chronic stress, SES, depression, and social support and development of CAD. In this article, we discuss the epidemiologic evidence linking psychosocial factors and CAD, and review the effects of psychosocial factors on several pathophysiologic mechanisms that have been proposed as potential mediators of CAD. The hypothalamic-pituitary-adrenal axis, hypertension and cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen, lipids, glucose metabolism, and lifestyle factors have all been implicated in this process. Recently, the first intervention trials have been carried out, although with initially disappointing results. Reducing the cardiovascular risk due to these psychosocial factors will be one of the major health care challenges in the future.

Increases in lipids and immune cells in response to exercise and mental stress in patients with suspected coronary artery disease: effects of adjustment for shifts in plasma volume

This study examined the role of shifts in plasma volume on lipid and immune reactions to stress. Lipid, immune, rheological, and cardiovascular reactions to exercise and mental stress in 51 patients with suspected coronary artery disease were determined. Blood pressure and heart rate were measured during and blood samples taken at the end of each rest and task. Lipids (total cholesterol, triglycerides, HDL, LDL) and immune cells (lymphocytes, monocytes, granulocytes) increased with exercise, whereas cholesterol, LDL, and lymphocytes increased with mental stress. Plasma volume decreased by 1 and 5% following mental and exercise stress, respectively. The task-induced increases in lipids were no longer statistically significant following adjustment for changes in plasma volume, whereas the increases in immune cell numbers survived such correction. This study provides evidence that, in coronary artery disease patients, exercise and mental stress-induced increases in lipids but not immune cells can be largely accounted for by shifts in plasma volume.

Is caregiving hazardous to one's physical health? A meta-analysis

Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

Serum lipids responses to a respite from occupational and domestic demands in subjects with varying levels of stress

OBJECTIVES

To investigate the effect of a temporary respite from domestic and job demands on serum lipid concentrations in subjects with high and low levels of perceived demands.

METHODS

111 females and 42 males (mean age 57.1+/-9.8) staying at a health resort for 3 weeks and receiving spa treatments participated in the study. Serum cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG) and LDL/HDL were measured at the beginning and end of the stay. In addition, levels of perceived demands were assessed. Data were analysed with MANCOVA for repeated measures with known confounding variables as covariates.

RESULTS

Subjects with a higher level of perceived demands had higher levels of CHOL, LDL/HDL and TG and lower levels of HDL-c. In response to the respite, subjects experiencing more demands showed a greater decrease of LDL-c (P<.01) and LDL/HDL (P<.001). Sex moderated these stress-related respite effects for HDL-c (P<.01) and LDL/HDL (P<.005), high demand males showing a smaller decrease in HDL and a greater decrease in LDL/HDL than females in response to the respite.

CONCLUSIONS

The results indicate that a respite from chronic demands may reduce LDL-c and LDL/HDL in chronically stressed individuals.

Are changes in blood pressure and total cholesterol related to changes in mood? An 18-month study of men and women

The authors investigated the within-person association of reported mood with blood pressure and total cholesterol (TC) levels, each assessed 4 times over an 18-month period in 128 men and 154 women. Change over time in tense arousal was significantly positively associated with changes over time in systolic blood pressure (SBP) and diastolic blood pressure (DBP) but not TC. A change in hedonic tone was significantly associated with SBP (an increase in negative affect was associated with an increase in SBP) but not with DBP or TC. There were no sex differences in associations of mood with SBP or TC. However, increases in tense arousal and negative affect were significantly associated with an increase in DBP for women but not men.

Stress and the inflammatory response: a review of neurogenic inflammation

The subject of neuroinflammation is reviewed. In response to psychological stress or certain physical stressors, an inflammatory process may occur by release of neuropeptides, especially Substance P (SP), or other inflammatory mediators, from sensory nerves and the activation of mast cells or other inflammatory cells. Central neuropeptides, particularly corticosteroid releasing factor (CRF), and perhaps SP as well, initiate a systemic stress response by activation of neuroendocrinological pathways such as the sympathetic nervous system, hypothalamic pituitary axis, and the renin angiotensin system, with the release of the stress hormones (i.e., catecholamines, corticosteroids, growth hormone, glucagons, and renin). These, together with cytokines induced by stress, initiate the acute phase response (APR) and the induction of acute phase proteins, essential mediators of inflammation. Central nervous system norepinephrine may also induce the APR perhaps by macrophage activation and cytokine release. The increase in lipids with stress may also be a factor in macrophage activation, as may lipopolysaccharide which, I postulate, induces cytokines from hepatic Kupffer cells, subsequent to an enhanced absorption from the gastrointestinal tract during psychologic stress. The brain may initiate or inhibit the inflammatory process. The inflammatory response is contained within the psychological stress response which evolved later. Moreover, the same neuropeptides (i.e., CRF and possibly SP as well) mediate both stress and inflammation. Cytokines evoked by either a stress or inflammatory response may utilize similar somatosensory pathways to signal the brain. Other instances whereby stress may induce inflammatory changes are reviewed. I postulate that repeated episodes of acute or chronic psychogenic stress may produce chronic inflammatory changes which may result in atherosclerosis in the arteries or chronic inflammatory changes in other organs as well.

Links between body mass index, total body fat, cholesterol, high-density lipoprotein, and insulin sensitivity in patients with obesity related to depression, anger, and anxiety

OBJECTIVE

Define links between psychosocial parameters and metabolic variables in obese females before and after a low-calorie diet.

METHOD

Nine female obese patients (age 36.1 +/- 7.1 years, body mass index [BMI] > 30 kg/m2) were investigated before and after a 6-week low-calorie diet accompanied by behavior therapy. Blood lipids, insulin sensitivity (Bergman protocol), fat distribution (by dual-energy X-ray absorptiometry [DEXA]), as well as psychological parameters such as depression, anger, anxiety, symptom load, and well-being, were assessed before and after the dieting period.

RESULTS

The females lost 9.6 +/- 2.8 kg (p < .0001) of body weight, their BMI was reduced by 3.5 +/- 0.3 kg/m2 (p < .0001), and insulin sensitivity increased from 3.0 +/- 1.8 to 4.3 +/- 1.5 mg/kg (p = .05). Their abdominal fat content decreased from 22.3 +/- 5.5 to 18.9 +/- 4.5 kg (p < .0001). In parallel, psychological parameters such as irritability (p < .05) and cognitive control (p < .0001) increased, whereas feelings of hunger (p < .05), externality (p < .05), interpersonal sensitivity (p < .01), paranoid ideation (p < .05), psychoticism (p < .01), and global severity index (p < .01) decreased. Prospectively, differences in body fat (percent) were correlated to nervousness (p < .05). Waist-to-hip ratio (WHR) differences were significantly correlated to sociability (p < .05) and inversely to emotional instability (p < .05), whereas emotional instability was inversely correlated to differences in insulin sensitivity (p < .01).

DISCUSSION

Weight reduction may lead to better somatic risk factor control. Women with more nervousness and better sociability at the beginning of a diet period may lose more weight than others.

A path model of chronic stress, the metabolic syndrome, and coronary heart disease

OBJECTIVE

We tested a theoretical stress model cross-sectionally and prospectively that examined whether relationships of chronic stress, psychophysiology, and coronary heart disease (CHD) varied in older adult men (N = 47), older adult women not using hormone replacement therapy (HRT) (N = 64), and older adult women using HRT (N = 41).

METHOD

Structural equations examined relationships of CHD with 1) chronic stress (caring for a spouse with Alzheimer's disease and patient functioning), 2) vulnerability (anger and hostility), 3) social resources (supports), 4) psychological distress (burden, sleep problems, and low uplifts), 5) poor health habits (high-caloric, high-fat diet and limited exercise), and 6) the metabolic syndrome (MS) (blood pressure, obesity, insulin, glucose, and lipids).

RESULTS

Caregiver men had a greater prevalence of CHD (13/24) than did noncaregiver men (6/23) (p <.05) 27 to 30 months after study entry. This was influenced by pathways from caregiving to distress, distress to the MS, and the MS to CHD. In men, poor health habits predicted the MS 15 to 18 months later, and the MS predicted new CHD cases over 27 to 30 months. In women, no "caregiving-CHD" relationship occurred; however, 15 to 18 months after study entry women not using HRT showed "distress-MS" and "MS-CHD" relationships. In women using HRT, associations did not occur among distress, the MS, and CHD, but poor health habits and the MS were related.

CONCLUSIONS

In older men, pathways occurred from chronic stress to distress to the metabolic syndrome, which in turn predicted CHD. Older women not using HRT showed fewer pathways than men; however, over time, distress, the MS, and CHD were related. No psychophysiological pathways occurred in older women using HRT.

Oral contraceptive use is associated with increased cardiovascular reactivity in nonsmokers

Women who smoke and take oral contraceptives (OCs) have significantly increased risk of cardiovascular disease, but the exact mechanismsfor the increased risk are not known. Cardiovascular reactivity to psychological stress may be one mechanism for the enhanced risk, but the small number of studies examining whether OC users who smoke have greater reactivity have produced mixed results. The purpose of this study was to examine the effect of chronic cigarette smoking, acute nicotine administration, and OC use on cardiovascular and lipid reactivity. Sixty healthy women, half of whom had been using OCs for at least the previous 6 months, participated in the study. Approximately two thirds were smokers and were randomized to be tested after either a 12-hr nicotine deprivation or administration of nicotine gum. One third were nonsmokers. Heart rate, blood pressure, and lipid measures were taken at rest, during a videotaped speech task, and during recovery from the task. Results indicated that, among OC nonusers, there was no effect of smoking status or nicotine administration on cardiovascular reactivity. However, among OC users, nonsmokers had significantly greater heart rate and diastolic blood pressure reactivity to stress. These data show that acute nicotine administration, in the form of nicotine gum, has no effect on cardiovascular or lipid stress reactivity in women. However OC use among nonsmoking women is associated with greater cardiovascular reactivity to stress.

Stress, inflammation and cardiovascular disease

Various psychosocial factors have been implicated in the etiology and pathogenesis of certain cardiovascular diseases such as atherosclerosis, now considered to be the result of a chronic inflammatory process. In this article, we review the evidence that repeated episodes of acute psychological stress, or chronic psychologic stress, may induce a chronic inflammatory process culminating in atherosclerosis. These inflammatory events, caused by stress, may account for the approximately 40% of atherosclerotic patients with no other known risk factors. Stress, by activating the sympathetic nervous system, the hypothalamic-pituitary axis, and the renin-angiotensin system, causes the release of various stress hormones such as catecholamines, corticosteroids, glucagon, growth hormone, and renin, and elevated levels of homocysteine, which induce a heightened state of cardiovascular activity, injured endothelium, and induction of adhesion molecules on endothelial cells to which recruited inflammatory cells adhere and translocate to the arterial wall. An acute phase response (APR), similar to that associated with inflammation, is also engendered, which is characterized by macrophage activation, the production of cytokines, other inflammatory mediators, acute phase proteins (APPs), and mast cell activation, all of which promote the inflammatory process. Stress also induces an atherosclerotic lipid profile with oxidation of lipids and, if chronic, a hypercoagulable state that may result in arterial thromboses. Shedding of adhesion molecules and the appearance of cytokines, and APPs in the blood are early indicators of a stress-induced APR, may appear in the blood of asymptomatic people, and be predictors of future cardiovascular disease. The inflammatory response is contained within the stress response, which evolved later and is adaptive in that an animal may be better able to react to an organism introduced during combat. The argument is made that humans reacting to stressors, which are not life-threatening but are "perceived" as such, mount similar stress/inflammatory responses in the arteries, and which, if repetitive or chronic, may culminate in atherosclerosis.

Depressive mood accompanies hypercholesterolemia in young Japanese adults

Screening of young hypercholesterolemics is important because they are highly susceptible to atherosclerotic diseases. However, in some cases, serum cholesterol level may be elevated temporarily due to stress or other psychological factors. This study examined the effects of mood states on 'persistent' hypercholesterolemia in comparison with 'temporary' hypercholesterolemia among students entering a university. The subjects were 114 untreated first-year students aged 18 to 20 years old. All had been screened positive for hypercholesterolemia (serum total cholesterol > or = 220 mg/dl) upon enrolling in the university. Three months after the screening, they were divided into two groups according to the re-examined serum total cholesterol level; a persistent hypercholesterolemic group (n=41) with >220 mg/dl and a temporary hypercholesterolemic group (n=73) with <220 mg/dl. At that time, they completed the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigor, fatigue and confusion scales. The POMS depression scores and the female ratio were higher (both p<0.01) and body mass index was lower (p<0.05) in the persistent hypercholesterolemic subjects than in the temporary hypercholesterolemic subjects; the POMS depression scores were still higher (p<0.05) after controlling for the effects of gender, body mass index, and other POMS scales by multiple logistic regression analysis. Depressive mood appeared to relate to hypercholesterolemia when the university students were screened. Assessment of mood states may be important in screening young hypercholesterolemic patients.

Serum cholesterol in patients with obsessive compulsive disorder during treatment with behavior therapy and SSRI or placebo

OBJECTIVE

Patients with panic disorder are reported to have elevated cholesterol levels. There is also some evidence that cholesterol elevation is not so much a specific condition in panic disorder but is generally associated with anxiety. So far, there is little data on cholesterol levels in patients with obsessive compulsive disorders (OCD) which is also classified as anxiety disorder.

METHOD

Thirty-three patients with OCD participated in the study. Serum cholesterol was measured as pretreatment and at the end of a ten-week treatment-period. All patients received behavior therapy and, in a double-blind fashion, fluvoxamine or placebo. Severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

RESULTS

Pretreatment cholesterol values of OCD patients were compared with cholesterol levels of thirty panic disorder patients and thirty normal controls. OCD patients had elevated cholesterol levels comparable with those of panic disorder patients. Cholesterol levels decreased significantly from pre- to posttreatment. OCD patients with high cholesterol levels (> or = 240 mg/dl, n = 7) could make best use of the treatment whereas patients with desirable cholesterol levels (< 200 mg/dl, n = 11) did not change their cholesterol during treatment.

CONCLUSIONS

Our data support the assumption that not only panic disorder but also other anxiety disorders, e.g., obsessive compulsive disorders, may be associated with serum cholesterol elevations. Effective treatment (behavior therapy and/or treatment with a selective serotonin reuptake inhibitor [SSRI]) seems to decrease cholesterol levels, especially in patients with pathological cholesterol elevations.

The terrible twos--anger and anxiety. Hazardous to your health

Anxiety and anger are hazardous to health. This article offers a selective review of research that illustrates how anxiety and anger increase vulnerability to illnesses, compromise the immune system, increase lipid levels, exacerbate pain, and increase the risk of death from cardiovascular disease and from all sources of death. Possible mechanisms for such effects are identified, including the role of cardiovascular reactivity. Finally, data are provided on Anxiety Management Training, a brief, structured psychological intervention that has proven effective in anxiety as well as anger management.

Job strain and risk indicators for cardiovascular disease in young female nurses

This study examined the possible effects of job demands, decision latitude, and job-related social support on risk indicators for cardiovascular disease (CVD) in 165 female nurses. Job strain was measured with the Job Content Questionnaire; CVD risk was measured with insulin, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fibrinogen, tissue-type plasminogen activator (tPA) antigen, tPA activity, plasminogen activator inhibitor-1 antigen, and blood pressure. Multivariate analysis of covariance and regression analyses revealed no effects of either job strain or social support on these risk indicators. All risk indicators deteriorated with age and body mass index. Oral contraceptive use improved fibrinolytic potential and increased HDL-C but had adverse effects on TG levels. Results suggest that in healthy young women job strain is not associated with an unfavorable metabolic or fibrinolytic risk profile.

Positive and negative life events: the relationship with coronary heart disease risk factors in young adults

OBJECTIVE

to investigate the influence of positive and negative life events (including daily uplifts and daily hassles) on several biological and lifestyle coronary heart disease (CHD) risk factors.

METHODS

from the Amsterdam Growth and Health Longitudinal Study (AGHLS), a cross-section sample of 207 males and 231 females aged 32/33 years was used.

RESULTS

hardly any associations were found between both positive and negative life events and biological CHD risk factors. On the other hand, daily uplifts and positive life events were positively related to lifestyle. For both positive and negative life events coping behaviour played a role in these relationships. Furthermore, it was shown that the associations of health-related variables with daily uplifts and hassles were comparable to those found for major positive and negative life events.

CONCLUSION

This study could not fully determine whether or not different mechanisms play a role in the health benefits of positive life events compared to the health burdens of negative life events.

Work stress and metabolic and hemostatic risk factors

OBJECTIVE

A high level of work stress has been associated with cardiovascular disease. However, the pathophysiological mechanisms underlying this association remain unclear. This study examined the effect of work stress on a cluster of metabolic and hemostatic risk factors.

METHODS

Blood was collected three times, on the first, third, and fifth day of a work week, from 124 middle-aged, white-collar workers. Metabolic measures were insulin, glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol. Hemostatic measures were fibrinogen, tissue-type plasminogen activator activity, tissue-type plasminogen activator antigen, and type 1 plasminogen activator inhibitor antigen. Chronic work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (effort-reward imbalance) or 2) high overcommitment (an exhaustive work-related coping style).

RESULTS

Overcommitment, but not imbalance or the imbalance-overcommitment interaction, was associated with an impaired fibrinolytic system, as reflected in decreased tissue-type plasminogen activator activity levels and increased type 1 plasminogen activator inhibitor antigen levels on all three measurement occasions. After controlling for body mass index, total cholesterol, triglycerides, high-density lipoprotein/low-density lipoprotein cholesterol ratio, glucose, and insulin, the relation between overcom-mitment and the fibrinolytic factors was attenuated but remained significant.

CONCLUSIONS

The results suggest that individuals with an exhaustive coping style at work have an impaired fibrinolytic capacity that is possibly due to the effects of chronic stress on insulin resistance.

Life stress, social support and coronary heart disease

OBJECTIVE

The aim of this paper is to review the relationship between life-event stress, social support and coronary heart disease.

METHOD

A literature search from 1978 to early 1999 using Medline, PsychINFO and EMBASE databases was performed. It focused largely on prospective studies.

RESULTS

Both life-event stressors and inadequate social supports assessed by a variety of indicators are risk factors for acute coronary heart disease events. Poor social support does not particularly appear to moderate the relationship of life stress to coronary heart disease but rather both appear to be independent risk factors.

CONCLUSION

While life-event stress and poor social supports are risk factors, the exact mechanism by which they impact on heart disease is not as yet well elicited, although disturbance in mood would appear to be the most likely intervening variable.

Plasma lipid concentrations during episodic occupational stress

The possibility that stress affects plasma lipid concentrations has been the subject of recent investigation, but the findings are equivocal in nonlaboratory settings. To determine whether psychological stress contributes to variability in plasma lipid concentrations and concomitant changes in health behaviors, the effect of increased work load on plasma lipids and apolipoproteins was examined in 173 lawyers. Plasma cholesterol, triglyceride, and apolipoprotein concentrations were studied during periods of high work load (corresponding to impending tax deadlines) and during periods of usual work load. Self-reports of stress, work load, and time pressure, and cortisol, blood pressure, and heart rate were measured to verify that impending deadlines were associated with increased stress levels. Health behaviors which may affect plasma lipoprotein concentrations, including dietary intake and exercise, were also examined. High work load was accompanied by increases in self-reported work load among lawyers most directly affected by the impending deadlines. Plasma apolipoprotein B and triglycerides increased during periods of high work load (M = 1.9 mg/dL, SD = 10.1 and M = 5.3, SD = 34.4, respectively). No changes in dietary intake and exercise were observed. Psychological stress (high work load) is associated with potentially atherogenic changes in plasma lipid concentrations. While the lipoprotein effect of this short-term work stress is small, the effects of longer-term stress on multiple rise factors including triglycerides and apolipoprotein B could have significance for the development of coronary artery disease.

Neuroticism, other personality variables, and serum lipid levels in patients with anxiety disorders and normal controls

OBJECTIVE

This study evaluates the association between certain personality variables, especially neuroticism, and serum lipid levels in patients suffering from anxiety disorders as opposed to normal control individuals. It addresses the question whether in anxiety disorder patients neuroticism is associated with elevated serum cholesterol and serum LDL cholesterol levels.

METHOD

Thirty (15 male, 15 female) patients with anxiety disorders as defined by DSM-IV and thirty normal matched controls were enrolled in this study. The patients were either admitted for inpatient treatment or referred to the behavioral therapy outpatient clinic at the Department of Psychiatry of the University Hospital Eppendorf (Hamburg/Germany). Control individuals were selected on a voluntary basis and recruited from the authors' colleagues and peers. Matching included Body-Mass-Index, age, and gender.

RESULTS

This study showed a significant positive association of neuroticism and serum cholesterol (r = .29) and serum LDL cholesterol (r = .35) within the entire cohort of participants. An even higher significant positive relation (r = .43) could be detected between neuroticism and serum LDL cholesterol within the psychiatric patient group. As far as differences of personality variables between patients and normal controls are concerned, patients seemed to be significantly less satisfied with life, more generally inhibited, more irritable, more stressed, and more emotionally labile than controls. Anxiety disorder patients also tended to complain significantly more often about physical problems.

CONCLUSIONS

Our data suggest that high scores of neuroticism in anxiety disorders patients may be involved in elevated serum LDL cholesterol levels and, thereby, may lead to an increased risk of coronary heart disease.

Der Einfluß von Ärger, Persönlichkeit und Beschwerdensymptomatik auf die Lipidkonzentration

Zusammenfassung. In neuerer Zeit wurden wiederholt Berichte über einen positiven Zusammenhang zwischen Ärgerausdruck und Serum-Lipiden bei gesunden Männern veröffentlicht. Ein solcher Zusammenhang wird als relevantes physiologisches Bindeglied bei der Entstehung von Herz-Kreislauf-Erkrankungen betrachtet. Wir wollten den Befund an einer großen Stichprobe von Patienten unserer Klinik überprüfen und gleichzeitig den Beitrag von Aspekten des Ärgerausdrucks in Relation zu anderen psychologischen und klinischen Konstrukten sowie weiteren moderierenden Einflüssen betrachten. Bei 1701 Patienten wurden Zusammenhänge zwischen Lipid-Konzentrationen und dem Ärgerausdruck (STAXI) sowie zu Persönlichkeitsvariablen (FPI), zur Beschwerdesymptomatik (GBB), zu Ängstlichkeit (STAI) und zu Depressivität (ADS) untersucht. Weiblich waren 1197 Patienten, männlich 504 (Alter 40 ± 7 Jahre). Für die Gesamtstichprobe fanden sich, entgegen der Erwartung, negative Korrelationen zwischen Ärger-Ausdruck und Serum-Lipiden. Der Zusammenhang, obwohl signifikant, war so gering, daß lediglich 2 %-3 % der Varianz erklärt wurden. Die getrennte Betrachtung von Männern und Frauen sowie von verschiedenen Subdiagnosen ergab dasselbe Muster. Die Zusammenhänge zwischen Serum-Lipiden und den anderen psychologischen und klinischen Personencharakteristika waren durchweg stärker ausgeprägt als die mit Ärgerausdruck. Weder für die beiden Geschlechter noch für verschiedene diagnostische Entitäten zeigte sich der erwartete Zusammenhang zwischen Serum-Lipiden und Ärgerausdruck.

Changes in daily hassles and life events and the relationship with coronary heart disease risk factors: a 2-year longitudinal study in 27-29-year-old males and females

To investigate the relationship between changes in daily hassles and life events and biological (lipoproteins, blood pressure, body fat, and body fat distribution) and lifestyle (physical activity, smoking and alcohol consumption) risk factors for coronary heart disease (CHD) 166 subjects were measured twice, at 27 and 29 years of age. The results showed that changes in daily hassles were positively related to changes in lipoprotein levels, daily physical activity, and to smoking behavior. These relationships were more pronounced for subjects with a "rigid" coping style and subjects with type A behavior. Changes in life events were also positively related to lipoprotein levels, but only for subjects with a "rigid" coping style and only when the subjective appraisal of life events was taken into account. It was concluded that the relationships seemed to be mediated by different coping styles and type A behavior, that daily hassles were more important in these relationships than life events, and that the relationships with biological CHD risk factors were not influenced by lifestyle.

Clinically relevant cholesterol elevation in anxiety disorders: A comparison with normal controls

Recently, several studies reported elevated cholesterol levels in panic disorder, agoraphobia, and general anxiety disorder, but the clinical relevance is still unsettled. All studies so far have disregarded the possible influence of dietary and physical exercise factors. In this study, 30 patients with different anxiety disorders and 30 normal controls were compared for total cholesterol, low-density lipoprotein (LDL), and cholesterol high-density lipoprotein (HDL) ratio. Dietary and physical exercise habits were measured by self-rating questionnaires. Patients with anxiety disorders had significantly elevated total cholesterol, LDL, and cholesterol/HDL ratios. Patients showed borderline-high or high cholesterol levels almost 3 times as often as control participants. Anxiety-specific avoidance of physical exercise and special dietary habits of anxiety patients had a significant but minor impact on differences in cholesterol between both groups. Our data support the assumption that serum cholesterol elevations in anxiety disorder patients are within a clinically relevant range.

Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence

The purpose of this review is to examine the epidemiological, psychological, and experimental evidence for an association between anxiety and coronary heart disease (CHD). Papers published during the years 1980-1996 on anxiety and CHD and relevant publications from earlier years were selected for this review. Epidemiologic evidence suggests that anxiety may be a risk factor for the development of CHD. Chronic anxiety may increase the risk of CHD by: (a) influencing health behaviors (e.g. smoking); (b) promoting atherogenesis (e.g. via increased risk of hypertension); and (c) triggering fatal coronary events, either through arrhythmia, plaque rupture, coronary vasospasm, or thrombosis. Electrophysiologic evidence is particularly compelling: anxiety appears to be associated with abnormal cardiac autonomic control, which may indicate increased risk of fatal ventricular arrhythmias. The strength, consistency, and dose-response gradient of the association between anxiety and CHD, together with the biologic plausibility of the experimental evidence, suggest that anxiety may contribute to risk of CHD and that the relationship warrants further investigation.

The relation of hostility to lipids and lipoproteins in women: evidence for the role of antagonistic hostility

We examined the relation of antagonistic, neurotic, and cynical hostility to lipids and lipoproteins in 77 healthy women (aged 18-26) selected for having high (> 17) or low (< 12) scores on the Cook-Medley Hostility (Ho) scale. Fasting lipids were determined during the luteal phase of the menstrual cycle for oral contraceptive (OC) non-users (N = 41), and during pills 15-21 for OC users (N = 36). Factor scores for antagonistic and neurotic hostility were derived from a principal component of the Buss-Durkee Hostility Inventory, Spielberger's Anger Expression, and the NEO-Personality Inventory. High Ho scores were significantly associated with higher cholesterol. Antagonistic hostility significantly predicted cholesterol, low density lipoprotein cholesterol, triglycerides, and the ratio of cholesterol to high density lipoprotein cholesterol, with higher antagonistic hostility scores associated with higher levels. Neurotic hostility did not predict lipids. Results suggest a potential pathophysiological mechanism that may contribute to the association between hostility and coronary heart disease. Moreover, a measure of antagonistic hostility, relative to cynical and neurotic hostility, was the best predictor of lipid levels.

Cholesterol concentrations and cardiovascular reactivity to stress in African American college volunteers

Cholesterol levels and cardiovascular responses to emotionally arousing stimuli were examined in 60 healthy African American males and females. Cardiac output, stroke volume, contractile force, heart rate, and blood pressure were measured as the participants viewed two racially noxious scenes on videotape. Total serum cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), and triglycerides were measured within 2 weeks of viewing the scenes. Multiple regression analysis showed that LDL and HDL were significant predictors of blood pressure responses. A correlation analysis revealed that total serum cholesterol and LDL were positively correlated with stroke volume, contractile force, and blood pressure reactivity. A possible relationship among stress, beta-adrenergic activity, and nonmetabolized free fatty acids is discussed. These findings suggest that cardiovascular reactivity to stress may be a new risk factor for heart and vascular diseases.

Relation between the longitudinal development of personality characteristics and biological and lifestyle risk factors for coronary heart disease

OBJECTIVE

This study was undertaken to assess the stability of personality characteristics (ie, inadequacy, rigidity, dominance, self-sufficiency, and social inadequacy) over a 15-year period covering adolescence and young adulthood and to analyze the longitudinal relationships between personality characteristics and both biological (ie, lipoproteins, blood pressure, and body fatness) and lifestyle (ie, physical activity, dietary intake, smoking, and alcohol consumption) risk factors for coronary heart disease (CHD).

METHODS

The data were derived from the Amsterdam Growth and Health Study, an observational longitudinal study in which, over a period from 13 to 27 years of age, six repeated measurements were performed on 181 subjects. Both the stability analysis and the analysis of the longitudinal relationships were performed by generalized estimating equations (GEE). This method is suitable for both continuous and dichotomous outcome variables, by using all available longitudinal data.

RESULTS

Stability coefficients for the personality characteristics varied between 0.39 for self-sufficiency and dominance and 0.53 for social inadequacy. Self-sufficiency was inversely related to total serum cholesterol (only male subjects) and body fatness; inadequacy was inversely related to systolic blood pressure. Dominance (female subjects) was positively related to body fatness and social inadequacy (male subjects) was positively related to total serum cholesterol. Furthermore, inadequacy was positively related to smoking behavior. Social inadequacy and rigidity were inversely related to smoking behavior. Self-sufficiency was inversely related to alcohol consumption.

CONCLUSIONS

Over a period of 15 years, personality characteristics showed marginal stability. Weak relationships were found between personality characteristics and both biological and lifestyle CHD risk factors.

Negative association between reported life events and cardiovascular disease risk factors in employed men: the CORDIS Study. Cardiovascular Occupational Risk Factors Determination in Israel

There is evidence of a link between stressful life events and risk of cardiovascular disease, but the pathway has not been fully explored. The present study of 1859 employed men tested the association between reported intensity of life events and blood pressure and serum lipid levels, risk behaviors, and psychological distress symptoms. The findings revealed a striking disparity in the outcomes. Life events were negatively associated with systolic (p = 0.001) and diastolic (p = 0.038) blood pressure, triglycerides (p = 0.011), and uric acid (p = 0.05), even after controlling for job strain and other possible confounders. In contrast, life events were positively associated with somatic complaints (p < 0.0001), anxiety (p < 0.0001), irritability (p < 0.0001), and depression (p < 0.0001). In addition there was a linear trend between intensity level of life events and low exercise (p = 0.006), smoking (p = 0.007), and alcoholic intake (p = 0.035). The possibility that the above disparity is a product of powerful biases, such as repressive coping and negative affectivity disposition, is discussed.

Industrial noise exposure, noise annoyance, and serum lipid levels in blue-collar workers--the CORDIS Study

Chronic noise exposure may constitute a risk factor for cardiovascular disease, but the exact mechanism is unclear. The authors studied the association between industrial noise exposure, noise annoyance, and serum lipid/lipoprotein levels in male (n = 1,455) and female (n = 624) blue-collar workers. The authors found that young men (i.e., < or = 44 y of age) exposed to high noise levels (> or = 80 dB[A]) had higher total levels of cholesterol (p = .023) and triglycerides (p = .001), as well as a higher cholesterol ratio (p = .038), than men exposed to low noise levels, even after controlling for confounding variables. In women or in older (> 45 y) men, noise did not affect serum lipid/lipoprotein levels. The authors found no interaction between noise exposure level and noise annoyance (except for high-density lipoprotein in women). However, noise annoyance covaried independently with total cholesterol (p = .022) and high-density lipoprotein (p = .0039) levels in young men and with total cholesterol (p = .035), triglyceride (p = .035), and high-density lipoprotein levels in women (under high noise exposure conditions)(p = .048) levels in women. Noise annoyance and noise exposure levels had an additive effect on cholesterol levels. Young men who scored high on both variables had a 15-mg/dl higher mean cholesterol level (95 % confidence interval [CI] = 7.2, 22.8; p = .0003) than those who scored low on both variables; in women, the corresponding difference was 23 mg/dl (95% CI = 1.5, 42.9; p = .019). The authors concluded that the examination of serum lipid/lipoprotein levels may be useful in studies of the health effects of noise, and particular attention should be paid to noise-annoyed individuals.

Temporal stability of lipid responses to acute psychological stress in middle-aged men

The purpose of this study was to establish the temporal stability of lipid responses to acute psychological stress. Eighteen men were tested twice an average of 16.2 months apart in identical laboratory reactivity protocols. Total cholesterol, triglycerides, high- and low-density lipoprotein-cholesterol, plasma volume, heart rate, and blood pressure were assessed during rest, serial subtraction, and speech. After correction for changes in plasma volume, significant elevations were recorded for all variables during the speech task, but fewer variables showed changes during the serial subtraction task. Strong intersession associations were found when considering levels of the variables during baseline and stress (rs > or = .58). Correlations for the change scores ranged from .36 to .52 for the atherogenic lipids and from .39 to .87 for the cardiovascular variables. Little evidence was found for stability of plasma volume changes. There is moderate to high temporal stability of the atherogenic lipids when considering rest and stress levels and small to moderate temporal stability when considering change scores.

Nicotine and stress: effect on sex hormones and lipid profile in female rats

This work aimed to study the changes in sex hormones and lipid profile in adult female albino rats subjected to treatment with nicotine (N), immobilization stress (S), or their combinations (N+S). These treatments were applied either for one day (T1) or daily for 10 days (T10), after which rats in the estrus stage were used for the determination of plasma corticosterone (CS), serum sex hormones as progesterone (P), estrogen (E), FSH, LH and serum lipid profile including total cholesterol (TC), HDL-C, LDL-C, triacylglycerol (TG) and non esterified fatty acids (NEFA). It was clear that either N or S raised plasma CS and serum P levels in both the treatment regimens and that N+S induced a higher level of these hormones compared to each treatment alone. Serum E level was only elevated during T10 regimen only. An increase in serum LH level was only observed after a single exposure to either N or S, however their combination abolished the stimulatory effect induced by each treatment alone. Serum FSH was not altered by exposure to either N or S alone in both regimens, but in the T10 regimen their combination significantly lowered FSH level. Regarding the effect on serum lipid profile, serum TC was increased in all T10 regimen groups. LDL-C was increased by N+S treatment in both regimens, however no change in HDL-C level was observed in all groups. Serum NEFA was increased in all the treated groups during T10 regimen, while in the T1 regimen NEFA level was only elevated by the combination N+S. Serum TG was insignificantly altered in all the treated groups. The observed changes in the lipid pattern were attributed to the alterations occurred in CS and female sex hormones that caused by N, S or their combinations.