Serum lipids and their relationships with hostility and angry affect and behaviors in men

The sex-dependent response to psychosocial stress and ischaemic heart disease

Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.

Frontal lobe regulation of blood glucose levels: support for the limited capacity model in hostile violence-prone men

Hostile men have reliably displayed an exaggerated sympathetic stress response across multiple experimental settings, with cardiovascular reactivity for blood pressure and heart rate concurrent with lateralized right frontal lobe stress (Trajanoski et al., in Diabetes Care 19(12):1412-1415, 1996; see Heilman et al., in J Neurol Neurosurg Psychiatry 38(1):69-72, 1975). The current experiment examined frontal lobe regulatory control of glucose in high and low hostile men with concurrent left frontal lobe (Control Oral Word Association Test [verbal]) or right frontal lobe (Ruff Figural Fluency Test [nonverbal]) stress. A significant interaction was found for Group × Condition, F (1,22) = 4.16, p ≤ .05 with glucose levels (mg/dl) of high hostile men significantly elevated as a function of the right frontal stressor (M = 101.37, SD = 13.75) when compared to the verbal stressor (M = 95.79, SD = 11.20). Glucose levels in the low hostile group remained stable for both types of stress. High hostile men made significantly more errors on the right frontal but not the left frontal stressor (M = 17.18, SD = 19.88) when compared to the low hostile men (M = 5.81, SD = 4.33). These findings support our existing frontal capacity model of hostility (Iribarren et al., in J Am Med Assoc 17(19):2546-2551, 2000; McCrimmon et al., in Physiol Behav 67(1):35-39, 1999; Brunner et al., in Diabetes Care 21(4):585-590, 1998), extending the role of the right frontal lobe to regulatory control over glucose mobilization.

Hostility and quality of life among Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study

OBJECTIVE

The purpose of this study was to determine if hostility is associated with physical and mental health-related quality of life (QoL) in US. Hispanics/Latinos after accounting for depression and anxiety.

METHODS

Analyses included 5313 adults (62% women, 18-75 years) who completed the ancillary sociocultural assessment of the Hispanic Community Health Study/Study of Latinos. Participants completed the Center for Epidemiological Studies Depression Scale, Spielberger Trait Anxiety Scale, Spielberger Trait Anger Scale, Cook-Medley Hostility cynicism subscale and Short Form Health Survey. In a structural regression model, associations of hostility with mental and physical QoL were examined.

RESULTS

In a model adjusting for age, sex, disease burden, income, education and years in the US., hostility was related to worse mental QoL, and was marginally associated with worse physical QoL. However, when adjusting for the influence of depression and anxiety, greater hostility was associated with better mental QoL, and was not associated with physical QoL.

CONCLUSIONS

Results indicate observed associations between hostility and QoL are confounded by symptoms of anxiety and depression, and suggest hostility is independently associated with better mental QoL in this population. Findings also highlight the importance of differentiating shared and unique associations of specific emotions with health outcomes.

Association of Psychosocial Work Hazards With Depression and Suboptimal Health in Executive Employees

OBJECTIVES

This study aims to investigate whether psychosocial work-related hazards, measured by workplace justice and employment insecurity, are associated with depression and suboptimal health status in Taiwan's executive-level employees.

METHODS

There were 365 executives who have received a series of cardiovascular health examinations, blood sampling, and self-reported questionnaires, which included the psychosocial work-related hazards and the CES-D scale. Suboptimal health status was defined as the presence of dyslipidemia or prediabetes.

RESULTS

Executive-level employees perceived lower workplace justice and higher employment insecurity and had a significantly higher risk of depression (CES-D scores ≥16 or ≥23). However, workplace justice was identified as a significant determinant factor that was negative for dyslipidemia but protective for prediabetes.

CONCLUSION

This study supports the fact that psychosocial work-related hazards can independently contribute to the risk of developing depression, prediabetes, and dyslipemia in executives.

Personality and Serum Lipids: Does Lifestyle Account for Their Concurrent and Long–Term Relationships

This study evaluates concurrent and over time associations of personality with measures of three serum lipids associated coronary heart disease morbidity, namely, high–density lipoprotein cholesterol (HDL–C), low–density lipoprotein cholesterol and triglyceride (TRI). Participants were individuals who underwent a health examination at two points of time, T1 (N = 3835) and T2 (N = 2283), about 2.5 years apart. Personality was assessed by the Five–Factor Model. Health, socioeconomic status and healthy lifestyle behaviours (smoking intensity, physical activity and body weight) were controlled. Regression analyses indicate that the personality factors of neuroticism, extraversion and conscientiousness are each significantly associated with HDL–C and TRI, both concurrently and over time. However, most of these associations decreased to marginal significance when adjusted for body weight or physical activity as possible mediators. Both concurrent and over time associations of the openness personality trait with HDL–C and TRI were significant and persisted after adjustment for measures of a healthy lifestyle. This study emphasizes the importance of collecting measures of a healthy lifestyle to better understand how personality might influence serum lipids. Copyright © 2013 European Association of Personality Psychology

Association between blood lipid levels and personality traits in young Korean women

Abnormal lipid levels are important etiological factors associated with the development of atherosclerosis and with increased cardiovascular morbidity and mortality. Lipid levels are also influenced by lifestyle and behavioral factors, which suggests that personality traits might be related to abnormal lipid profiles. Studies on personality traits and lipid levels are relatively scarce in Korea. Therefore, the objective of this study was to examine the association between lipid levels and personality traits in young Korean women. A total of 1,701 young Korean women [mean age  = 24.9±4.6 years (range 17-39)] who volunteered for personality trait evaluation were recruited for this study. Lipid levels, including total cholesterol, high density lipoprotein (HDL) cholesterol, and triglyceride, were measured in all subjects after an overnight fast, and a low density lipoprotein (LDL) cholesterol level was calculated. The study population was divided into abnormal and normal lipid level groups according to the clinical criteria. Personality traits were measured using the Revised NEO Personality Inventory for the Five-Factor Model of personality. High neuroticism was associated with low HDL cholesterol levels. Low extraversion and openness were associated with high levels of triglyceride. At the facet level, the association between personality and lipid levels were generally consistent. Angry hostility, self-consciousness, vulnerability to stress, activity, and straightforwardness were associated with HDL cholesterol levels. Activity, positive emotion, aesthetics, actions, and deliberation were associated with triglyceride. When applying clinical criteria, conscientiousness was less likely to have abnormal total cholesterol levels. Our results showed that the women with the low HDL cholesterol levels are like to be more neurotic and the hyperglycemic women are prone to lower extraversion and openness in Korea. Understanding the associations between blood lipid levels and personality traits may have a beneficial effect for the managing of dyslipidemia.

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

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

Chronic stress-induced oxidative damage and hyperlipidemia are accompanied by atherosclerotic development in rats

Although stress-induced hyperlipidemia and increased oxidative stress have been reported and implicated in etiology of atherosclerosis, experimental evidence for stress-induced atherosclerotic development concomitant with these alterations is lacking. In this study, exposure of adult male albino Wistar rats (Rattus norvegicus) to restraint for 1 h and after a gap of 4 h to forced swimming for 15 min every day for 2, 4, or 24 weeks resulted in a duration of exposure-dependent hyperlipidemia as shown by significant increases in concentrations of blood cholesterol, low-density lipoproteins, and triglycerides and decrease in high-density lipoprotein concomitant with increased oxidative stress as indicated by decrease in hepatic antioxidant enzyme activities and increase in lipid peroxidation in the liver, kidney, and heart. These alterations were accompanied by development of fibrous layer, formation of foam cells, reduction in elastic fibers, and accumulation of Oil-Red-O-positive lipid droplets in the intima of thoracic aorta following 24 weeks of stress exposure, but not after 4 weeks. The study demonstrates for the first time that (i) chronic stress-induced hyperlipidemia and oxidative damage are coupled with atherosclerotic development in rats fed with normal diet and (ii) chronic stress effects prevail even after the cessation of stress exposure as indicated by high concentration of blood cholesterol and reduced hepatic superoxide dismutase activity 20 weeks after 2 or 4 weeks of stress. This study exemplifies long-term allostatic regulation leading to a pathological state, with long-term hyperlipidemia and oxidative damage from chronic stress resulting in atherosclerosis.

Justice at work and psychiatric morbidity among the personnel of an Italian hospital

This study evaluated the association between justice in the workplace (and other psychosocial factors) and mental health among healthcare professionals. It was conducted in a sample of hospital employees in Italy. The prevalence of mental disorders was assessed and the relationships between having a disorder and the level of perceived justice, job control and effort-reward imbalance were investigated. Psychiatric morbidity among professionals with higher perceived justice were 0.3-0.9 times lower than those among those with lower perceived justice. This finding suggests that improving fairness at work does matter for disease prevention and mental health promotion policy.

Gender differences, anger expression, and cardiovascular risk

Research has established the influence of serum cholesterol and anger management style as cardiovascular risk factors. However, mixed and sometimes contradictory results have created uncertainty with respect to contributions of anger. Some incongruities may be accounted for on the basis of gender differences since a number of studies have employed male samples rather than female samples or mixed samples. The present study examined both gender and anger management style in relation to cardiovascular risk. One hundred three (72 men and 31 women) midlevel executives completed questionnaires and a blood draw during a week long, succession training program within a large international organization. Gender, anger expression, and anger expressed outward were significant predictors for levels of high-density lipids, low-density lipids/very low-density lipids, and triglycerides, and cardiovascular risk ratios. Results replicate and extend previous research. Anger held inward and anger control were significant for men but not women, contrary to earlier gender-specific findings.

Premeditated aggression is associated with serum cholesterol in abstinent drug and alcohol dependent men

Relationships between aggressive subtypes and lipids were explored in 18 adult males undergoing treatment for substance dependence. A positive association was observed between a measure of premeditated aggression and total cholesterol. This was in contrast to an inverse association between lower cholesterol and higher impulsivity and anxiety.

Major depressive disorder with anger attacks and cardiovascular risk factors

OBJECTIVE

Depression and anger have been separately associated with cardiovascular risk factors. We investigated if major depressive disorder (MDD) with concomitant anger attacks was associated with cardiovascular risk factors.

METHOD

We measured total serum cholesterol, glycemia, resting blood pressure, and smoking parameters in 333 (52.9% women) MDD nonpsychotic outpatients, mean age of 39.4 years. MDD was diagnosed with the Structured Clinical Interview (SCID) in accordance with the Diagnostic and Statistic Manual of Mental Disorders, Third Edition, Revised (DSM-III-R). The presence of anger attacks was established with the Massachusetts General Hospital Anger Attacks Questionnaire.

RESULTS

In a logistic regression analysis, anger attacks were independently associated with cholesterol levels > or = 200 mg/dL (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.18-3.94) and years of smoking > 11 (OR, 2.59; 95% CI, 1.32-5.04).

CONCLUSIONS

MDD with anger attacks was significantly associated with increased cholesterol levels and years of smoking.

A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors

One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD.

Losing sleep over organizational injustice: attenuating insomniac reactions to underpayment inequity with supervisory training in interactional justice

Self-reports of insomnia were collected among 467 nurses working at 4 hospitals. At 2 of these hospitals, a change in pay policy resulted in reduced pay for all nurses, whereas nurses' pay was unchanged at the other 2 hospitals. Nursing supervisors at 1 hospital in each group received training in promoting interactional justice, whereas no training was provided at the other 2 hospitals. Reflecting the stressful nature of underpayment, insomnia was significantly greater among nurses whose pay was reduced than among those whose pay remained unchanged. However, the degree of insomnia was significantly lower among nurses whose supervisors were trained in interactional justice, both immediately after training and 6 months later. These findings demonstrate the buffering effects of interactionally fair treatment on reactions to underpayment.

Combined effects of uncertainty and organizational justice on employee health: Testing the uncertainty management model of fairness judgments among Finnish public sector employees

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work.

Job decision latitude, organizational justice and health: multilevel covariance structure analysis

A total of 2969 hospital employees from 162 wards participated in a 2-year follow-up study that examined the relationship between job decision latitude, organizational justice and employee health in Finland. We used medically certified sickness absence records as indicators of health problems. Multilevel covariance structure analysis was applied to take into account the hierarchical nature of the data. Responses from individuals within work units seem not always to be independent, and any models that ignore this lack of independence may incorrectly estimate the between individual relationships. Our results suggest that both job decision latitude and organizational justice varied considerably between work units in addition to individual level variation. Furthermore job decision latitude was associated with organizational justice both at individual and work unit level. Justice evaluations predicted sickness absence only at the individual level.

Psychosocial factors in the development of coronary artery disease

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

Sleeping problems and health behaviors as mediators between organizational justice and health

The aim of this longitudinal cohort study was to investigate whether sleeping problems and health behaviors (smoking, alcohol consumption, and sedentary lifestyle) mediate the association between organizational justice and employee health. Health indicators were minor psychiatric morbidity, as assessed by the General Health Questionnaire (U. Werneke, D. P. Goldberg, I. Yalcin, & B. T. Ustun, 2000), and poor self-rated health status. The results of logistic regression analysis of data for 416 male and 3,357 female hospital employees working during the 1998-2000 period in 10 Finnish hospitals suggest that sleeping problems are one of the underlying factors causing the adverse health effects of low organizational justice at work. No support for a mediating role of health behaviors between low organizational justice and health problems was obtained.

Organisational justice and health of employees: prospective cohort study

AIMS

To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees.

METHODS

The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998-2000 in 10 hospitals in Finland.

RESULTS

Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality).

CONCLUSIONS

This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.

Consumer-producer relationship and homeostasis

Notion of consumers-producers co-operation allows better understanding of the basic mechanisms of homeostasis. This concept refers to the biological variables (BV) that are produced by tissues and organs (producers) and used for provision of functional activity of other organs and tissues (consumers). The rate of BV consumption is a major BV down-regulation factor, which participates in two kinds of imbalance: feedback and feedforward. When consumers are activates prior to producers, BV decrease and up-regulation forces are activated to counteract the decrease (feedback imbalance). Feedforward imbalance appears when producers are activated and BV consumption is postponed or suppressed. Prolonged feedforward imbalance is supposed to lead to chronic metabolic disturbances and diseases (obesitas, atherosclerosis, hypertension, NIDDM, Syndrome X, etc.).

Depression, Hostility, and Social Isolation in Patients with Coronary Artery Disease

Psychosocial risk factors such as depression, hostility, and social isolation are substantially more prevalent in patients with coronary artery disease (CAD) than is widely recognized. It has been demonstrated that patients with CAD who have these risk factors, individually or together, may have a substantially increased risk for recurrent ischemic events, as well as cardiac death, when compared with unaffected CAD patients. Numerous adverse physiologic changes that appear to occur as a consequence of these psychosocial risk factors have been identified, including increased platelet aggregation, hyperadrenergic states, elevated cortisol levels, abnormal endothelial function, and an increased propensity towards malignant ventricular arrhythmias. Each of these may explain the increased risk of recurrent coronary events (including death) among afflicted patients. Under-recognition, and hence under-treatment, remains a principal obstacle for improvements in the care of patients with CAD who have psychosocial risk factors. The diagnosis of psychosocial risk factors depends on systematic patient evaluation by experienced clinicians trained in the recognition of these disorders. All clinicians must be aware of the potential importance of these factors, their sometimes subtle presenting characteristics, and the available treatment options. The universal use of comprehensive cardiovascular rehabilitation offers the ideal conduit for such evaluation and management. Nonpharmacologic therapies for psychosocial risk factors include psychotherapy, stress-reduction techniques, and exercise therapy. Studies suggest that the reduction of social isolation among depressed patients with CAD may result in a reduced mortality rate in comparison with those without improvements in isolation. Pharmacologic therapies are mainly for the management of depression, and largely center on the use of selective serotonin reuptake inhibitors (SSRIs). Several SSRIs (paroxetine and sertraline) recently have been shown to be safe and effective for the treatment of depression in patients with ischemic heart disease. Whether use of antidepressants attenuate the increased cardiac risk from depression in the setting CAD remains to be proven; however, their use improves the quality of life in properly selected patients.

Mental stress as a causal factor in the development of hypertension and cardiovascular disease

Chronic mental stress can come in a variety of forms, and may originate in the external environment, as an interaction between the individual and the environment, or from within the individual. Examples of things causing mental stress include earthquakes, job stress, and several measures of negative affect; all have been shown in prospective studies to have adverse effects on the development of hypertension and coronary artery disease. After the Hanshin-Awaji earthquake in Japan, there were increases of blood pressure and deaths from myocardial infarction that persisted for several months. Job strain, which is defined as a combination of low control and high demands at work, has been associated with increased blood pressure and coronary heart disease outcomes, particularly in men. Negative affect, which may manifest itself as depression, anxiety, anger, or hostility, has similarly been related to hypertension and coronary heart disease. Depression is emerging as the most important component with respect to cardiovascular disease. A common link for all these factors is a perceived loss of control over one's environment.