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Ebong IA, Quesada O, Fonkoue IT, Mattina D, Sullivan S, Oliveira GMMD, Spikes T, Sharma J, Commodore Y, Ogunniyi MO, Aggarwal NR, Vaccarino V. The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:298-314. [PMID: 38986672 DOI: 10.1016/j.jacc.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 07/12/2024]
Abstract
Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.
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Affiliation(s)
- Imo A Ebong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California, USA.
| | - Odayme Quesada
- Women's Heart Center, Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; Carl and Edyth Lindner Center for Research and Education, Christ Hospital, Cincinnati, Ohio, USA
| | - Ida T Fonkoue
- Divisions of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Deirdre Mattina
- Division of Regional Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samaah Sullivan
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center-Houston, Houston, Texas, USA
| | | | - Telisa Spikes
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jyoti Sharma
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Yvonne Commodore
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Beydoun MA, Georgescu MF, Hossain S, Beydoun HA, Fanelli-Kuczmarski MT, Evans MK, Zonderman AB. Life's simple 7 and its association with trajectories in depressive symptoms among urban middle-aged adults. J Affect Disord 2023; 333:447-458. [PMID: 37094659 PMCID: PMC10255627 DOI: 10.1016/j.jad.2023.04.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The American Heart Association Life's Simple 7 (LS7) is a composite metric assessing cardiovascular health on a scale of 0-14 comprised of nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol and glucose. METHODS Using data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study [n = 1465, Age at visit 1 (v1: 2004-2009): 30-66 y, 41.7 % male, 60.6 % African American], we investigated associations of trajectories in depressive symptoms (2004-2017) with Life's simple 7 scores after ∼8.6 years follow-up (2013-2017). Analyses used group-based zero-inflated Poisson trajectory (GBTM) models and multiple linear or ordinal logistic regression. GBTM analyses generated two classes of depressive symptoms trajectories ("low declining" and "high declining"), based on intercept and slope direction and significance. RESULTS Overall, "high declining depressive symptoms" vs. the "low declining" group was associated with -0.67 ± 0.10 lower scores on LS7 total score (P < 0.001) in analyses adjusted for age, sex, race and the inverse mills ratio. This effect was markedly attenuated to -0.45 ± 0.10 score-points (P < 0.001) upon adjustment for socio-economic factors and to -0.27 ± 0.10 score-points (P < 0.010) in fully adjusted analyses, with a stronger association detected among women (β ± SE: -0.45 ± 0.14, P = 0.002). An association between elevated depressive symptoms over time ("high declining" vs "low declining") and LS7 total score was detected among African American adults (β ± SE: -0.281 ± 0.131, p = 0.031, full model). Moreover, the "high declining" vs. "low declining" depressive symptoms group was associated with a lower score on LS7 physical activity (β ± SE: -0.494 ± 0.130, P < 0.001). CONCLUSIONS Poorer cardiovascular health was linked to higher depressive symptoms over time.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States of America.
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States of America
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States of America
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Marie T Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States of America
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States of America
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States of America
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Sullivan S, Young A, Garcia M, Almuwaqqat Z, Moazzami K, Hammadah M, Lima BB, Hu Y, Jajeh MN, Alkhoder A, Elon L, Lewis TT, Shah AJ, Mehta PK, Bremner JD, Quyyumi AA, Vaccarino V. Sex Differences in Vascular Response to Mental Stress and Adverse Cardiovascular Events Among Patients With Ischemic Heart Disease. Arterioscler Thromb Vasc Biol 2023; 43:e112-e120. [PMID: 36857628 PMCID: PMC10164352 DOI: 10.1161/atvbaha.122.318576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Microvascular measures of vascular dysfunction during acute mental stress may be important determinants of major adverse cardiovascular events (MACE), especially among younger and middle-aged women survivors of an acute myocardial infarction. METHODS In the MIMS2 study (Myocardial Infarction and Mental Stress 2), individuals who had been hospitalized for a myocardial infarction in the past 8 months were prospectively followed for 5 years. MACE was defined as a composite index of cardiovascular death and first/recurring events for nonfatal myocardial infarction and hospitalizations for heart failure. Reactive hyperemia index and flow-mediated dilation were used to measure microvascular and endothelial function, respectively, before and 30 minutes after a public-speaking mental stress task. Survival models for recurrent events were used to examine the association between vascular response to stress (difference between poststress and resting values) and MACE. Reactive hyperemia index and flow-mediated dilation were standardized in analyses. RESULTS Of 263 patients (the mean age was 51 years; range, 25-61), 48% were women, and 65% were Black. During a median follow-up of 4.3 years, 64 patients had 141 adverse cardiovascular events (first and repeated). Worse microvascular response to stress (for each SD decrease in the reactive hyperemia index) was associated with 50% greater risk of MACE (hazard ratio, 1.50 [95% CI, 1.05-2.13]; P=0.03) among women only (sex interaction: P=0.03). Worse transient endothelial dysfunction in response to stress (for each SD decrease in flow-mediated dilation) was associated with a 35% greater risk of MACE (hazard ratio, 1.35 [95% CI, 1.07-1.71]; P=0.01), and the association was similar in women and men. CONCLUSIONS Peripheral microvascular dysfunction with mental stress was associated with adverse events among women but not men. In contrast, endothelial dysfunction was similarly related to MACE among both men and women. These results suggest a female-specific mechanism linking psychological stress to adverse outcomes.
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Affiliation(s)
- Samaah Sullivan
- Department of Epidemiology, Human Genetics and
Environmental Sciences, The University of Texas Health Science Center at Houston,
Dallas, TX
- Department of Epidemiology, Emory University, Atlanta,
GA
| | - An Young
- Department of Epidemiology, Emory University, Atlanta,
GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Mariana Garcia
- Department of Epidemiology, Emory University, Atlanta,
GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Zakaria Almuwaqqat
- Department of Epidemiology, Emory University, Atlanta,
GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Kasra Moazzami
- Department of Epidemiology, Emory University, Atlanta,
GA
- Department of Medicine, Emory University, Atlanta, GA
| | | | - Bruno B. Lima
- Department of Medicine, Emory University, Atlanta, GA
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Emory
University, Atlanta, GA
| | | | | | - Lisa Elon
- Department of Biostatistics and Bioinformatics, Emory
University, Atlanta, GA
| | - Tené T. Lewis
- Department of Epidemiology, Emory University, Atlanta,
GA
| | - Amit J. Shah
- Department of Epidemiology, Emory University, Atlanta,
GA
- Department of Medicine, Emory University, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
| | - Puja K. Mehta
- Department of Medicine, Emory University, Atlanta, GA
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory
University, Atlanta, GA
- Atlanta VA Medical Center, Atlanta, GA
| | | | - Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta,
GA
- Department of Medicine, Emory University, Atlanta, GA
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Kottilil S, Mathur P. The influence of inflammation on cardiovascular disease in women. Front Glob Womens Health 2022; 3:979708. [PMID: 36304737 PMCID: PMC9592850 DOI: 10.3389/fgwh.2022.979708] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
The onset of cardiovascular disease in women is almost a decade later than men, partly due to the protective effect of estrogen prior to menopause. Recently, it was noted that while there have been advances in improving the morbidity and mortality from CVD in women older than 55 years, the improvement in younger women has been stagnant. The mechanism behind this lag is unclear. This manuscript reviews the literature available on the sex-specific inflammatory response in the context of traditional and non-traditional cardiovascular disease risk factors. Our review suggests that women have a differential inflammatory response to various disease states that increases their risk for CVD and warrants a distinct prioritization from men when calculating cardiovascular disease risk.
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Affiliation(s)
| | - Poonam Mathur
- Insitute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States,Correspondence: Poonam Mathur
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5
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Mosarla RC, Wood M. Implications of Sex Differences on Behavioral and Cardiovascular Health. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20211223-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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6
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Mehta PK, Sharma A, Bremner JD, Vaccarino V. Mental Stress-Induced Myocardial Ischemia. Curr Cardiol Rep 2022; 24:2109-2120. [PMID: 36322365 PMCID: PMC9628301 DOI: 10.1007/s11886-022-01821-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To summarize recent evidence on mental stress-induced myocardial ischemia (MSIMI), its mechanisms, and clinical significance. RECENT FINDINGS MSIMI can occur in patients with normal cardiac stress testing, is only weakly related to severity of coronary artery disease (CAD), and it is often silent. Among patients with CAD, MSIMI is associated with a twofold increased risk of major adverse cardiovascular events compared to those who do not have MSIMI. Certain groups such as young women with myocardial infarction and those with psychological comorbidities are more susceptible to MSIMI. Abnormal microvascular vasoreactivity and inflammation are implicated mechanisms in MSIMI. Increased brain activity in regions that modulate autonomic reactivity to emotional stress and fear is associated with MSIMI. MSIMI has important prognostic implications in patients with CAD. Stress can no longer be ignored as a risk factor in cardiology care. Clinical trials testing effective strategies to target MSIMI are needed.
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Affiliation(s)
- Puja K. Mehta
- grid.189967.80000 0001 0941 6502Division of Cardiology, Emory Women’s Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Ashish Sharma
- grid.259906.10000 0001 2162 9738Internal Medicine Residency Program, Mercer University School of Medicine, Macon, GA USA
| | - J. Douglas Bremner
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA ,grid.414026.50000 0004 0419 4084Atlanta VA Medical Center, Decatur, GA USA
| | - Viola Vaccarino
- grid.189967.80000 0001 0941 6502Division of Cardiology, Emory Women’s Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322 USA ,grid.189967.80000 0001 0941 6502Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
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7
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Mosarla RC, Wood M. The Impact of Depression and Anxiety on Cardiovascular Disease Risk and Outcomes in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00889-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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8
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Bousquet-Santos K, Chen R, Kubzansky LD. A sad heart: Depression and favorable cardiovascular health in Brazil. Prev Med 2021; 142:106378. [PMID: 33346038 DOI: 10.1016/j.ypmed.2020.106378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/18/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Depression is associated with poor cardiovascular health (CVH) and increased risk of cardiovascular disease in high-income countries. However, it is unclear whether depression, particularly somatic depressive symptoms, may similarly contribute to poor CVH in a different socioeconomic context. Our aim was to investigate the association between depression and CVH in Brazil, a middle-income country. 49,658 participants (≥18 years) from the 2013 National Health Survey-Brazil. Favorable CVH was defined by meeting recommended levels on five CVH components (blood pressure, body mass index, diabetes or hypercholesterolemia status, smoking status). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9; depressed if score ≥ 10). Two PHQ-9 sub-domain scores (somatic or cognitive symptoms) were also considered. Covariates included age, sex, race, income, education, region of residence, marital status, chronic diseases, diet and physical activity. Depression was associated with a 27% lower odds of having favorable CVH (OR 0.73; 95%CI 0.62-0.86), and the association was stronger among women (OR 0.72; 95%CI 0.60-0.86). Both somatic and cognitive depression symptoms were inversely associated with lower odds of having favorable CVH. In conclusion, depression is associated with lower odds of having favorable CVH in Brazil, and associations are evident across both somatic and cognitive components of depression. Moreover, the relationship was independent of socioeconomic factors, chronic diseases, and was not strongly explained by diet or physical activity. Overall, our findings suggest that the greater odds of having poor CVH among depressed individuals is not unique to high-income countries.
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Affiliation(s)
- Kelb Bousquet-Santos
- Department of Biological and Health Sciences, University of Brasilia, Campus Universitario - Centro Metropolitano, Ceilandia Campus. Brasilia, FD 72220-275, Brazil; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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9
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Mahmood Z, Davidsson A, Olsson E, Leanderson P, Lundberg AK, Jonasson L. The effect of acute exercise on interleukin-6 and hypothalamic-pituitary-adrenal axis responses in patients with coronary artery disease. Sci Rep 2020; 10:21390. [PMID: 33288784 PMCID: PMC7721799 DOI: 10.1038/s41598-020-78286-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Vulnerability to stress-induced inflammation has been linked to a dysfunctional hypothalamus-pituitary-adrenal (HPA) axis. In the present study, patients with known or suspected coronary artery disease (CAD) were assessed with respect to inflammatory and HPA axis response to acute physical exercise. An exercise stress test was combined with SPECT myocardial perfusion imaging. Plasma and saliva samples were collected before and 30 min after exercise. Interleukin (IL)-6 and adrenocorticotropic hormone (ACTH) were measured in plasma, while cortisol was measured in both plasma and saliva. In total, 124 patients were included of whom 29% had a prior history of CAD and/or a myocardial perfusion deficit. The levels of exercise intensity and duration were comparable in CAD and non-CAD patients. However, in CAD patients, IL-6 increased after exercise (p = 0.019) while no differences were seen in HPA axis variables. Conversely, patients without CAD exhibited increased levels of ACTH (p = 0.003) and cortisol (p = 0.004 in plasma, p = 0.006 in saliva), but no change in IL-6. We conclude that the IL-6 response to acute physical exercise is exaggerated in CAD patients and may be out of balance due to HPA axis hypoactivity. It remains to be further investigated whether this imbalance is a potential diagnostic and therapeutic target in CAD.
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Affiliation(s)
- Zeid Mahmood
- Unit of Cardiovascular Medicine, Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anette Davidsson
- Unit of Cardiovascular Medicine, Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Olsson
- Unit of Cardiovascular Medicine, Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Leanderson
- Unit of Clinical Medicine, Occupational and Environmental Medicine Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna K Lundberg
- Unit of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lena Jonasson
- Unit of Cardiovascular Medicine, Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping University, 581 85, Linköping, Sweden.
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10
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Bremner JD, Gurel NZ, Jiao Y, Wittbrodt MT, Levantsevych OM, Huang M, Jung H, Shandhi MH, Beckwith J, Herring I, Rapaport MH, Murrah N, Driggers E, Ko YA, Alkhalaf ML, Soudan M, Song J, Ku BS, Shallenberger L, Hankus AN, Nye JA, Park J, Vaccarino V, Shah AJ, Inan OT, Pearce BD. Transcutaneous vagal nerve stimulation blocks stress-induced activation of Interleukin-6 and interferon-γ in posttraumatic stress disorder: A double-blind, randomized, sham-controlled trial. Brain Behav Immun Health 2020; 9:100138. [PMID: 34589887 PMCID: PMC8474180 DOI: 10.1016/j.bbih.2020.100138] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 01/02/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a highly disabling condition associated with alterations in multiple neurobiological systems, including increases in inflammatory function. Vagus nerve stimulation (VNS) decreases inflammation, however few studies have examined the effects of non-invasive VNS on physiology in human subjects, and no studies in patients with PTSD. The purpose of this study was to assess the effects of transcutaneous cervical VNS (tcVNS) on inflammatory responses to stress. Thirty subjects with a history of exposure to traumatic stress with (N = 10) and without (N = 20) PTSD underwent exposure to stressful tasks immediately followed by active or sham tcVNS and measurement of multiple biomarkers of inflammation (interleukin-(IL)-6, IL-2, IL-1β, Tumor Necrosis Factor alpha (TNFα) and Interferon gamma (IFNγ) over multiple time points. Stressful tasks included exposure to personalized scripts of traumatic events on day 1, and public speech and mental arithmetic (Mental Stress) tasks on days 2 and 3. Traumatic scripts were associated with a pattern of subjective anger measured with Visual Analogue Scales and increased IL-6 and IFNγ in PTSD patients that was blocked by tcVNS (p < .05). Traumatic stress had minimal effects on these biomarkers in non-PTSD subjects and there was no difference between tcVNS or sham. No significant differences were seen between groups in IL-2, IL-1β, or TNFα. These results demonstrate that tcVNS blocks behavioral and inflammatory responses to stress reminders in PTSD.
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Affiliation(s)
- J. Douglas Bremner
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Radiology, and Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yunshen Jiao
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew T. Wittbrodt
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Minxuan Huang
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Hewon Jung
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - MdMobashir H. Shandhi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joy Beckwith
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Isaias Herring
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark H. Rapaport
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy Murrah
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Emily Driggers
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Yi-An Ko
- Departments of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Majd Soudan
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Jiawei Song
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Benson S. Ku
- Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucy Shallenberger
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Allison N. Hankus
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Jonathon A. Nye
- Departments of Radiology, and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeanie Park
- Departments of Renal Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Viola Vaccarino
- Departments of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Amit J. Shah
- Departments of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Coulter Department of Bioengineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Bradley D. Pearce
- Departments of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
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11
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Sullivan S, Young A, Hammadah M, Lima BB, Levantsevych O, Ko YA, Pearce BD, Shah AJ, Kim JH, Moazzami K, Driggers EG, Haffar A, Ward L, Herring I, Hankus A, Lewis TT, Mehta PK, Bremner JD, Raggi P, Quyyumi A, Vaccarino V. Sex differences in the inflammatory response to stress and risk of adverse cardiovascular outcomes among patients with coronary heart disease. Brain Behav Immun 2020; 90:294-302. [PMID: 32916271 PMCID: PMC7872132 DOI: 10.1016/j.bbi.2020.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/18/2022] Open
Abstract
Stress may contribute to progression of coronary heart disease (CHD) through inflammation, especially among women. Thus, we sought to examine whether increased inflammatory response to stress among patients with CHD is associated with a greater risk of cardiovascular events and whether this risk is higher in women. We examined inflammatory biomarkers known to increase with mental stress (speech task), including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and matrix metallopeptidase-9 (MMP-9) among 562 patients with stable CHD. Inflammatory response, the difference between post-stress and resting values, was examined as a predictor of major adverse cardiovascular events (MACE) using subdistribution hazards models for competing risks adjusting for demographics, cardiovascular risk factors, and medications. MACE was defined as a composite endpoint of cardiovascular death, myocardial infarction, unstable angina with revascularization, and heart failure. All biomarkers were standardized. The mean age was 63 years (range 34-79) and 24% were women. During a median follow-up of 3 years, 71 patients experienced MACE. Overall, there was no significant association between inflammatory response to stress and risk of MACE, but there were sex-based interactions for IL-6 (p = 0.001) and MCP-1 (p = 0.01). The risk of MACE increased 56% (HR: 1.56; 95% CI: 1.21, 2.01; p = 0.001) and 30% (HR: 1.30; 95% 1.09, 1.55; p = 0.004) for each standard deviation increase in IL-6 and MCP-1 response to mental stress for women, respectively, while there was no association among men. Increased inflammation in response to stress is associated with future adverse cardiovascular outcomes among women with CHD.
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Affiliation(s)
- Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - An Young
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Bruno B. Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Oleksiy Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Brad D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States,Atlanta VA Medical Center, Decatur, Georgia, 30322, United States
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Emily G. Driggers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | | | - Allison Hankus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - J. Douglas Bremner
- Atlanta VA Medical Center, Decatur, Georgia, 30322, United States,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arshed Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States
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12
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Research progress regarding the diagnosis and treatment of mental stress-induced myocardial ischemia. Anatol J Cardiol 2020; 24:126-136. [PMID: 32870175 PMCID: PMC7585978 DOI: 10.14744/anatoljcardiol.2020.69447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myocardial ischemia resulting from psychological stress [mental stress-induced myocardial ischemia (MSIMI)] refers to the condition wherein psychosocial and psychological stimulations cause myocardial ischemia in patients with coronary heart disease, which is different from drug-induced myocardial ischemia. Therefore, this condition often escapes diagnosis, portends clinical risk, and affects the quality of life of MSIMI survivors. MSIMI is closely related to the poor prognosis of cardiovascular diseases, especially in young women, according to recent randomized, controlled trials (RCTs) on MSIMI. These RCTs involved different sample sizes, interventional measures, and detection techniques. Moreover, differences exist regarding the prevalence rate, distribution characteristics, possible pathogenesis, and clinical significance. Nevertheless, currently, the diagnostic criteria, pathogenesis, and treatment of MSIMI are still in the clinical exploration stage. Hence, considering recent RCTs, this paper summarizes the research status of MSIMI from the aspects of pathogenesis, diagnosis, and treatment strategies to provide a theoretical basis for the follow-up diagnostic methods and treatment guidelines for MSIMI.
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13
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Pimple P, Lima BB, Hammadah M, Wilmot K, Ramadan R, Levantsevych O, Sullivan S, Kim JH, Kaseer B, Shah AJ, Ward L, Raggi P, Bremner JD, Hanfelt J, Lewis T, Quyyumi AA, Vaccarino V. Psychological Distress and Subsequent Cardiovascular Events in Individuals With Coronary Artery Disease. J Am Heart Assoc 2020; 8:e011866. [PMID: 31055991 PMCID: PMC6512132 DOI: 10.1161/jaha.118.011866] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Higher symptom levels of a variety of measures of emotional distress have been associated with cardiovascular disease ( CVD ), especially among women. Here, our goal was to investigate the association between a composite measure of psychological distress and incident cardiovascular events. Methods and Results In a prospective cohort study, we assessed 662 individuals (28% women; 30% blacks) with stable coronary artery disease. We used a composite score of psychological distress derived through summation of Z-transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress) as a predictor of an adjudicated composite end point of adverse events (cardiovascular death, myocardial infarction, stroke, heart failure, or unstable angina). During a mean follow-up of 2.8 years, 120 (18%) subjects developed CVD events. In the overall population, there was no association between the psychological distress measure and CVD events, but there was a sex-based interaction ( P=0.004). In women, higher psychological distress was associated with a higher incidence of CVD events; each SD increase in the composite score of psychological distress was associated with 1.44 times adjusted hazard of CVD events (95% CI, 1.09-1.92). No such association was found in men. Conclusions Among patients with coronary artery disease, higher psychological distress is associated with future cardiovascular events in women only.
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Affiliation(s)
- Pratik Pimple
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Bruno B Lima
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Muhammad Hammadah
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Kobina Wilmot
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Ronnie Ramadan
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | | | - Samaah Sullivan
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Jeong Hwan Kim
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Belal Kaseer
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Amit J Shah
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Laura Ward
- 3 Department of Biostatistics & Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Paolo Raggi
- 4 Mazankowski Alberta Heart Institute University of Alberta Edmonton Alberta Canada
| | - J Douglas Bremner
- 5 Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta GA
| | - John Hanfelt
- 3 Department of Biostatistics & Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Tene Lewis
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Arshed A Quyyumi
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Viola Vaccarino
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University Atlanta GA
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14
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Sullivan S, Hammadah M, Wilmot K, Ramadan R, Pearce BD, Shah A, Kaseer B, Gafeer MM, Lima BB, Kim JH, Ward L, Ko YA, Lewis TT, Hankus A, Elon L, Li L, Bremner JD, Raggi P, Quyyumi A, Vaccarino V. Young Women With Coronary Artery Disease Exhibit Higher Concentrations of Interleukin-6 at Baseline and in Response to Mental Stress. J Am Heart Assoc 2019; 7:e010329. [PMID: 30571600 PMCID: PMC6405549 DOI: 10.1161/jaha.118.010329] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Young women with coronary artery disease (CAD), a group with high psychosocial burden, were previously shown to have higher levels of interleukin‐6 (IL‐6) compared with men of similar age. We sought to examine IL‐6 response to acute stress in CAD patients across sex and age, and contrast results to healthy controls and other biomarkers known to increase with mental stress (monocyte chemoattractant protein‐1 and matrix metallopeptidase‐9) and known limited stress‐reactivity (high‐sensitivity C‐reactive protein). Methods and Results Inflammatory biomarkers were measured at rest and 90 minutes after mental stress (speech task) among 819 patients with CAD and 89 healthy controls. Repeated‐measures models were used to investigate age (continuous) and sex differences across time, before and after adjusting for demographics, CAD risk factors, depressive symptoms, medication use, and CAD severity. Among patients with CAD, the mean age was 60 years (range, 25–79) and 31% were women. Younger women with CAD had significantly higher concentrations of IL‐6 at rest, 90 minutes after mental stress, as well as a higher response to stress, compared with similarly aged men (P<0.05 for sex by age interactions). In contrast, IL‐6 increased with age, and there were no sex differences in IL‐6 levels or response to stress among controls. Inflammatory responses to stress for high‐sensitivity C‐reactive protein, monocyte chemoattractant protein‐1, and matrix metallopeptidase‐9 among CAD patients were similar in women and men. Conclusions IL‐6 response to mental stress are higher in young women with CAD than men of similar age.
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Affiliation(s)
- Samaah Sullivan
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Muhammad Hammadah
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Kobina Wilmot
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Ronnie Ramadan
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Brad D Pearce
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Amit Shah
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,3 Atlanta VA Medical Center Decatur GA
| | - Belal Kaseer
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Mohamad Mazen Gafeer
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Bruno B Lima
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jeong Hwan Kim
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Laura Ward
- 4 Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Yi-An Ko
- 4 Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Tené T Lewis
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Allison Hankus
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Lisa Elon
- 4 Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Lian Li
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - J Douglas Bremner
- 3 Atlanta VA Medical Center Decatur GA.,5 Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta GA
| | - Paolo Raggi
- 6 Mazankowski Alberta Heart Institute University of Alberta Edmonton Alberta Canada
| | - Arshed Quyyumi
- 2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Viola Vaccarino
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
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15
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Sullivan S, Kelli HM, Hammadah M, Topel M, Wilmot K, Ramadan R, Pearce BD, Shah A, Lima BB, Kim JH, Hardy S, Levantsevych O, Obideen M, Kaseer B, Ward L, Kutner M, Hankus A, Ko YA, Kramer MR, Lewis TT, Bremner JD, Quyyumi A, Vaccarino V. Neighborhood poverty and hemodynamic, neuroendocrine, and immune response to acute stress among patients with coronary artery disease. Psychoneuroendocrinology 2019; 100:145-155. [PMID: 30336337 PMCID: PMC6530548 DOI: 10.1016/j.psyneuen.2018.09.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 12/29/2022]
Abstract
Living in neighborhoods characterized by poverty may act as a chronic stressor that results in physiological dysregulation of the sympathetic nervous system. No previous study has assessed neighborhood poverty with hemodynamic, neuroendocrine, and immune reactivity to stress. We used data from 632 patients with coronary artery disease. Patients' residential addresses were geocoded and merged with poverty data from the 2010 American Community Survey at the census-tract level. A z-transformation was calculated to classify census tracts (neighborhoods) as either having 'high' or 'low' poverty. Systolic blood pressure, diastolic blood pressure, heart rate, rate-pressure product, epinephrine, interleukin-6, and high-sensitivity C-reactive protein were measured before and after a public speaking stress task. Multilevel models were used for repeated measures and accounting for individuals nested within census tracts. Adjusted models included demographics, lifestyle and medical risk factors, and medication use. Another set of models included propensity scores weighted by the inverse probability of neighborhood status for sex, age, race, and individual-level income. The mean age was 63 years and 173 were women. After adjusting for potential confounders, participants living in high (vs. low) poverty neighborhoods had similar hemodynamic values at rest and lower values during mental stress for systolic blood pressure (157 mmHg vs. 161 mmHg; p = 0.07), heart rate (75 beats/min vs. 78 beats/min; p = 0.02) and rate-pressure product (11839 mmHg x beat/min vs 12579 mmHg x beat/min; p = 0.01). P-values for neighborhood poverty-by-time interactions were <0.05. Results were similar in the propensity weighted models. There were no significant differences in inflammatory and epinephrine responses to mental stress based on neighborhood poverty status. A blunted hemodynamic response to mental stress was observed among participants living in high poverty neighborhoods. Future studies should explore whether neighborhood poverty and blunted hemodynamic response to stress translate into differences in long-term cardiovascular outcomes.
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Affiliation(s)
- Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Heval M Kelli
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Matthew Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ronnie Ramadan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Atlanta VA Medical Center, Decatur, GA, United States
| | - Bruno B Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Shakia Hardy
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Oleksiy Levantsevych
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Malik Obideen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Belal Kaseer
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Allison Hankus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - J Douglas Bremner
- Atlanta VA Medical Center, Decatur, GA, United States; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Arshed Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
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16
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Weather and risk of ST-elevation myocardial infarction revisited: Impact on young women. PLoS One 2018; 13:e0195602. [PMID: 29630673 PMCID: PMC5891074 DOI: 10.1371/journal.pone.0195602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background During the last decade, the incidence and mortality rates of ST-elevation myocardial infarction (STEMI) has been steadily increasing in young women but not in men. Environmental variables that contribute to cardiovascular events in women remain ill-defined. Methods and results A total of 2199 consecutive patients presenting with acute ST-elevation myocardial infarction (STEMI, 25.8% women, mean age 62.6±12.4 years) were admitted at the Montreal Heart Institute between June 2010 and December 2014. Snow fall exceeding 2cm/day was identified as a positive predictor for STEMI admission rates in the overall population (RR 1.28, 95% CI 1.07–1.48, p = 0.005), with a significant effect being seen in men (RR 1.30, 95% CI 1.06–1.53, p = 0.01) but not in women (p = NS). An age-specific analysis revealed a significant increase in hospital admission rates for STEMI in younger women ≤55 years, (n = 104) during days with higher outside temperature (p = 0.004 vs men ≤55 years) and longer daylight hours (p = 0.0009 vs men ≤55 years). Accordingly, summer season, increased outside temperature and sunshine hours were identified as strong positive predictors for STEMI occurrence in women ≤55 years (RR 1.66, 95% CI 1.1–2.5, p = 0.012, RR 1.70, 95% CI 1.2–2.5, p = 0.007, and RR 1.67, 95% CI 1.2–2.5, p = 0.011, respectively), while an opposite trend was observed in men ≤55 years (RR for outside temperature 0.8, 95% CI 0.73–0.95, p = 0.01). Conclusion The impact of environmental variables on STEMI is age- and sex-dependent. Higher temperature may play an important role in triggering such acute events in young women.
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17
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Hammadah M, Sullivan S, Pearce B, Mheid IA, Wilmot K, Ramadan R, Tahhan AS, O’Neal WT, Obideen M, Alkhoder A, Abdelhadi N, Kelli HM, Ghafeer MM, Pimple P, Sandesara P, Shah AJ, Hosny KM, Ward L, Ko YA, Sun YV, Weng L, Kutner M, Bremner JD, Sheps DS, Esteves F, Raggi P, Vaccarino V, Quyyumi AA. Inflammatory response to mental stress and mental stress induced myocardial ischemia. Brain Behav Immun 2018; 68:90-97. [PMID: 28986223 PMCID: PMC5808921 DOI: 10.1016/j.bbi.2017.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/17/2017] [Accepted: 10/02/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mental stress-induced myocardial ischemia (MSIMI) is associated with increased risk of adverse cardiovascular outcomes, yet the underlying mechanisms are not well understood. We measured the inflammatory response to acute laboratory mental stress in patients with coronary artery disease (CAD) and its association with MSIMI. We hypothesized that patients with MSIMI would have a higher inflammatory response to mental stress in comparison to those without ischemia. METHODS Patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during mental stress testing using a public speaking stressor. MSIMI was determined as impaired myocardial perfusion using a 17-segment model. Inflammatory markers including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), matrix metallopeptidase 9 (MMP-9) and high-sensitivity C reactive protein (hsCRP) were measured at rest and 90 min after mental stress. Results were validated in an independent sample of 228 post-myocardial infarction patients. RESULTS Of 607 patients analyzed in this study, (mean age 63 ± 9 years, 76% male), 99 (16.3%) developed MSIMI. Mental stress resulted in a significant increase in IL-6, MCP-1, and MMP-9 (all p <0.0001), but not hsCRP. However, the changes in these markers were similar in those with and without MSIMI. Neither resting levels of these biomarkers, nor their changes with mental stress were significantly associated with MSIMI. Results in the replication sample were similar. CONCLUSION Mental stress is associated with acute increases in several inflammatory markers. However, neither the baseline inflammatory status nor the magnitude of the inflammatory response to mental stress over 90 min were significantly associated with MSIMI.
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Affiliation(s)
- Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Brad Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ibhar Al Mheid
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ronnie Ramadan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ayman Samman Tahhan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Wesley T. O’Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Malik Obideen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Ayman Alkhoder
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Naser Abdelhadi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Heval Mohamed Kelli
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Mazen Ghafeer
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Pratik Sandesara
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Amit J. Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Atlanta VA Medical Center, Decatur, GA, United States
| | - Kareem Mohammed Hosny
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Laura Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yi-An Ko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lei Weng
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - J. Douglas Bremner
- Atlanta VA Medical Center, Decatur, GA, United States,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - David S. Sheps
- University of Florida Health Science Center, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States
| | - Fabio Esteves
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States,Corresponding authors at: Emory University, Department of Cardiology, Emory University School of medicine, 1462 Clifton Road N.E. Suite 507, Atlanta GA 30322. (V. Vaccarino), (A.A. Quyyumi)
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18
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Mathews L, Ogunmoroti O, Nasir K, Blumenthal RS, Utuama OA, Rouseff M, Das S, Veledar E, Feldman T, Agatston A, Zhao D, Michos ED. Psychological Factors and Their Association with Ideal Cardiovascular Health Among Women and Men. J Womens Health (Larchmt) 2018; 27:709-715. [PMID: 29377738 DOI: 10.1089/jwh.2017.6563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The cardiovascular effects of stress and other psychological factors may be different between women and men. We assessed whether self-perceived adverse psychological factors were associated with achievement of ideal cardiovascular health (CVH) as measured by the American Heart Association's Life's Simple Seven (LS7) and whether this differed by sex. METHODS This was a cross-sectional study of employees from a large healthcare organization. The LS7 metrics (smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose) were each scored as ideal (2), intermediate (1), or poor (0). Total scores were categorized as optimal (11-14), average (9-10), and inadequate (0-8). Using logistic regression, we tested whether psychological factors obtained by questionnaire (self-perceived stress, low life satisfaction, hopelessness, sadness, depression, and anxiety) were associated with CVH, after adjustment for age, ethnicity, and education. RESULTS Among 9,056 participants, the mean (SD) age was 43 (12) years, 74% were women, 57% Hispanic/Latino, 17% white, and 16% black. Stress was associated with reduced odds of having optimal/average CVH [OR 0.58 (95% CI 0.50-0.66) and 0.63 (0.50-0.81), for women and men, respectively]. Similarly, depression was associated with reduced odds of optimal/average CVH [0.58 (0.43-0.78) and 0.44 (0.26-0.76), for women and men, respectively]. Low life satisfaction, hopelessness, sadness, and anxiety were also associated with statistically significantly lower odds of optimal/average CVH in women, but not in men; however, there were no interactions by sex. CONCLUSIONS In an ethnically diverse population, both women and men with several adverse self-perceived psychological factors were less likely to have optimal or adequate CVH. Future studies are needed to determine whether addressing psychological stressors can improve CVH.
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Affiliation(s)
- Lena Mathews
- 1 Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Oluseye Ogunmoroti
- 2 Center for Healthcare Advancement and Outcomes , Baptist Health South Florida, Miami, Florida
| | - Khurram Nasir
- 1 Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine , Baltimore, Maryland.,2 Center for Healthcare Advancement and Outcomes , Baptist Health South Florida, Miami, Florida
| | - Roger S Blumenthal
- 1 Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ovie A Utuama
- 3 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida , Tampa, Florida
| | - Maribeth Rouseff
- 4 Wellness Advantage Administration, Baptist Health South Florida , Miami, Florida
| | - Sankalp Das
- 4 Wellness Advantage Administration, Baptist Health South Florida , Miami, Florida
| | - Emir Veledar
- 2 Center for Healthcare Advancement and Outcomes , Baptist Health South Florida, Miami, Florida
| | - Theodore Feldman
- 2 Center for Healthcare Advancement and Outcomes , Baptist Health South Florida, Miami, Florida
| | - Arthur Agatston
- 2 Center for Healthcare Advancement and Outcomes , Baptist Health South Florida, Miami, Florida
| | - Di Zhao
- 1 Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine , Baltimore, Maryland.,5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Erin D Michos
- 1 Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine , Baltimore, Maryland.,5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
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Sullivan S, Hammadah M, Al Mheid I, Wilmot K, Ramadan R, Alkhoder A, Isakadze N, Shah A, Levantsevych O, Pimple PM, Kutner M, Ward L, Garcia EV, Nye J, Mehta PK, Lewis TT, Bremner JD, Raggi P, Quyyumi AA, Vaccarino V. Sex Differences in Hemodynamic and Microvascular Mechanisms of Myocardial Ischemia Induced by Mental Stress. Arterioscler Thromb Vasc Biol 2017; 38:473-480. [PMID: 29269515 PMCID: PMC5785428 DOI: 10.1161/atvbaha.117.309535] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/24/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate sex-specific vascular mechanisms for mental stress-induced myocardial ischemia (MSIMI). APPROACH AND RESULTS Baseline data from a prospective cohort study of 678 patients with coronary artery disease underwent myocardial perfusion imaging before and during a public speaking stressor. The rate-pressure product response was calculated as the difference between the maximum value during the speech minus the minimum value during rest. Peripheral vasoconstriction by peripheral arterial tonometry was calculated as the ratio of pulse wave amplitude during the speech over the resting baseline; ratios <1 indicate a vasoconstrictive response. MSIMI was defined as percent of left ventricle that was ischemic and as a dichotomous variable. Men (but not women) with MSIMI had a higher rate-pressure product response than those without MSIMI (6500 versus 4800 mm Hg bpm), whereas women (but not men) with MSIMI had a significantly lower peripheral arterial tonometry ratio than those without MSIMI (0.5 versus 0.8). In adjusted linear regression, each 1000-U increase in rate-pressure product response was associated with 0.32% (95% confidence interval, 0.22-0.42) increase in inducible ischemia among men, whereas each 0.10-U decrease in peripheral arterial tonometry ratio was associated with 0.23% (95% confidence interval, 0.11-0.35) increase in inducible myocardial ischemia among women. Results were independent of conventional stress-induced myocardial ischemia. CONCLUSIONS Women and men have distinct cardiovascular reactivity mechanisms for MSIMI. For women, stress-induced peripheral vasoconstriction with mental stress, and not increased hemodynamic workload, is associated with MSIMI, whereas for men, it is the opposite. Future studies should examine these pathways on long-term outcomes.
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Affiliation(s)
- Samaah Sullivan
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Muhammad Hammadah
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Ibhar Al Mheid
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Kobina Wilmot
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Ronnie Ramadan
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Ayman Alkhoder
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Nino Isakadze
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Amit Shah
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Oleksiy Levantsevych
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Pratik M Pimple
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Michael Kutner
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Laura Ward
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Ernest V Garcia
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Jonathon Nye
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Puja K Mehta
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Tené T Lewis
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - J Douglas Bremner
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Paolo Raggi
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Arshed A Quyyumi
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.)
| | - Viola Vaccarino
- From the Department of Epidemiology (S.S., A.S., P.M.P., T.T.L., V.V.) and Department of Biostatistics and Bioinformatics (M.K., L.W.), Rollins School of Public Health, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA (A.S., J.D.B.); Department of Psychiatry and Behavioral Sciences (J.D.B.), Department of Radiology (E.V.G., J.N.), and Department of Medicine, Division of Cardiology (M.H., I.A.M., K.W., R.R., A.A., N.I., A.S., O.L., P.K.M., A.A.Q., V.V.), Emory University School of Medicine, Atlanta, GA; and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (P.R.).
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Deak T, Kudinova A, Lovelock DF, Gibb BE, Hennessy MB. A multispecies approach for understanding neuroimmune mechanisms of stress. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 28566946 PMCID: PMC5442363 DOI: 10.31887/dcns.2017.19.1/tdeak] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The relationship between stress challenges and adverse health outcomes, particularly for the development of affective disorders, is now well established. The highly conserved neuroimmune mechanisms through which responses to stressors are transcribed into effects on males and females have recently garnered much attention from researchers and clinicians alike. The use of animal models, from mice to guinea pigs to primates, has greatly increased our understanding of these mechanisms on the molecular, cellular, and behavioral levels, and research in humans has identified particular brain regions and connections of interest, as well as associations between stress-induced inflammation and psychiatric disorders. This review brings together findings from multiple species in order to better understand how the mechanisms of the neuroimmune response to stress contribute to stress-related psychopathologies, such as major depressive disorder, schizophrenia, and bipolar disorder.
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Affiliation(s)
- Terrence Deak
- Center for Affective Science and Department of Psychology, Binghamton University-State University of New York (SUNY), Binghamton, New York, USA
| | - Anastacia Kudinova
- Center for Affective Science and Department of Psychology, Binghamton University-State University of New York (SUNY), Binghamton, New York, USA
| | - Dennis F Lovelock
- Center for Affective Science and Department of Psychology, Binghamton University-State University of New York (SUNY), Binghamton, New York, USA
| | - Brandon E Gibb
- Center for Affective Science and Department of Psychology, Binghamton University-State University of New York (SUNY), Binghamton, New York, USA
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22
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Humphries KH, Izadnegahdar M, Sedlak T, Saw J, Johnston N, Schenck-Gustafsson K, Shah RU, Regitz-Zagrosek V, Grewal J, Vaccarino V, Wei J, Bairey Merz CN. Sex differences in cardiovascular disease - Impact on care and outcomes. Front Neuroendocrinol 2017; 46:46-70. [PMID: 28428055 PMCID: PMC5506856 DOI: 10.1016/j.yfrne.2017.04.001] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/31/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Affiliation(s)
- K H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, Canada; BC Centre for Improved Cardiovascular Health, Vancouver, Canada.
| | - M Izadnegahdar
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - T Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - J Saw
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - N Johnston
- Department of Medical Sciences, Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - K Schenck-Gustafsson
- Department of Medicine, Cardiac Unit and Centre for Gender Medicine, Karolinska University Hospital and Karolinska Institutet, Sweden
| | - R U Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, USA
| | - V Regitz-Zagrosek
- Institute of Gender in Medicine (GIM) and Center for Cardiovascular Research (CCR) Charité, University Medicine Berlin and DZHK, Partner Site Berlin, Germany
| | - J Grewal
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - V Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - J Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - C N Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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Deak T. A multispecies approach for understanding neuroimmune mechanisms of stress. DIALOGUES IN CLINICAL NEUROSCIENCE 2017; 19:37-53. [PMID: 28566946 PMCID: PMC5442363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
The relationship between stress challenges and adverse health outcomes, particularly for the development of affective disorders, is now well established. The highly conserved neuroimmune mechanisms through which responses to stressors are transcribed into effects on males and females have recently garnered much attention from researchers and clinicians alike. The use of animal models, from mice to guinea pigs to primates, has greatly increased our understanding of these mechanisms on the molecular, cellular, and behavioral levels, and research in humans has identified particular brain regions and connections of interest, as well as associations between stress-induced inflammation and psychiatric disorders. This review brings together findings from multiple species in order to better understand how the mechanisms of the neuroimmune response to stress contribute to stress-related psychopathologies, such as major depressive disorder, schizophrenia, and bipolar disorder.
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Affiliation(s)
- Terrence Deak
- Center for Affective Science and Department of Psychology, Binghamton University-State University of New York (SUNY), Binghamton, New York, USA
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Vaccarino V, Wilmot K, Al Mheid I, Ramadan R, Pimple P, Shah AJ, Garcia EV, Nye J, Ward L, Hammadah M, Kutner M, Long Q, Bremner JD, Esteves F, Raggi P, Quyyumi AA. Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease. J Am Heart Assoc 2016; 5:JAHA.116.003630. [PMID: 27559072 PMCID: PMC5079026 DOI: 10.1161/jaha.116.003630] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress-induced myocardial ischemia (MSIMI). METHODS AND RESULTS We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent (99m)Tc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more-adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. CONCLUSIONS Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kobina Wilmot
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ibhar Al Mheid
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ronnie Ramadan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Jonathon Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Muhammad Hammadah
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Fabio Esteves
- Department of Radiology, Emory University School of Medicine, Atlanta, GA
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Radiology, Emory University School of Medicine, Atlanta, GA Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arshed A Quyyumi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev 2016; 74:297-309. [PMID: 27496672 DOI: 10.1016/j.neubiorev.2016.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023]
Abstract
Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.
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