Trait anxiety but not state anxiety level associates with biomarkers for hypertension in the metabolic syndrome

Associations between metabolic syndrome and anxiety, and the mediating role of inflammation: Findings from the UK Biobank

OBJECTIVES

To investigate the association between metabolic syndrome (MetS) and anxiety and to explore the mediating role of inflammation indicators in this relationship based on the UK Biobank prospective cohort.

METHODS

This population-based retrospective cohort study analyzed data from 308,352 participants. MetS was defined according to criteria jointly developed by the American Heart Association, the National Heart, Lung, and Blood Institute, and the International Diabetes Federation. Anxiety was defined using ICD-10 codes. Cox proportional risk regression models were used to explore the hazard ratios (HRs) between MetS, components of MetS, number of MetS components, and anxiety. The mediating effect of inflammation on the association between MetS and anxiety was explored using longitudinal mediation analysis.

RESULTS

A total of 308,352 participants were included in this study. Of these, 9471 (3.071 %) developed anxiety over a mean follow-up of 12.05 years. In the fully adjusted model, MetS increased the risk of anxiety by 13.6 % (HR: 1.136, 95 %CI: 1.085-1.189). All MetS components significantly increased the risk of anxiety, with HRs ranging from 1.066 to 1.165. When MetS was treated as a linear variable, the risk of anxiety increased by 6.5 % per component increment. Age-stratified results showed that the risk of MetS for anxiety was higher among those <55 years (HR: 1.23, 95 %CI: 1.13-1.33) than among those ≥55 years (HR: 1.12, 95 %CI: 1.06-1.18). The mediating effects of platelets, lymphocytes, neutrophils, C-reactive protein, leukocytes, and INFLA scores on the association between MetS and anxiety were significant, with mediating effects of 2.30 %, 7.20 %, 15.9 %, 20.7 %, 22.0 %, and 25.3 %, respectively, and a combined mediating effect of these inflammatory factors was 30.8 % (except for INFLA scores).

CONCLUSIONS

MetS and its components significantly increased the risk of anxiety, which increased with the number of components. This association may be partially mediated by serum inflammatory indicators, suggesting that MetS may increase the risk of anxiety by elevating the level of chronic inflammation.

Efficacy of cognitive-behavioural therapy for lifestyle modification in metabolic syndrome: a randomised controlled trial with a 18-months follow-up

OBJECTIVE

To test the efficacy of cognitive-behavioural therapy (CBT) for lifestyle modification in patients with metabolic syndrome (MetS).

DESIGN

76 MetS patients completed this clinical trial, with 18 months follow-up. 45 participants from the experimental group (EG - CBT) and 31 to the control group (CG - usual care). The CBT programme was performed by a psychologist in a face-to-face group format, during 12 weekly sessions lasting 90 minutes. The intervention for the CG consisted of workshops with basic information about MetS and it's associated cardiovascular risk.

MAIN OUTCOME MEASURES

Efficacy of (CBT) in (MetS) patients.

RESULTS

Results showed reduction in weight (mean difference - MD -2.633, 95%CI [-4.322, -0.943]; p<.003), waist circumference (MD -2.944, 95%CI [-5.090, -0.798]; p<.008), body mass index (MD -0.915, 95%CI [-1.494, -0.335]; p<.003), systolic (MD -0.046, 95%CI [-0.685, -0.023]; p<.0002) diastolic blood pressure (MD -4.777, 95%CI [-7.750, -1.804]; p<.002), and cardiovascular risk score after 18 months. An increase in adherence to the Mediterranean diet and assertiveness and a reduction in anger were observed in EG. The CG did not show any significant differences.

CONCLUSION

The CBT focused on changes in lifestyle seems to be effective in the reduction of MetS and cardiovascular risk factors.

TRIAL REGISTRATION

Registered at clinicaltrials.gov (NCT02949622) - PROMETS (Multimodal Intervention Program for Patients with Metabolic Syndrome).

Validation of a visual analogue scale for the evaluation of the postoperative anxiety: A prospective observational study

AIM

Anxiety affects the perception of pain during the postoperative period. A simple evaluation scale could improve the management of this component. The objective of this study was to evaluate the reproducibility and the consistency of a visual analogue scale for anxiety compared with the reference method, the State-Trait Anxiety Inventory (STAI).

DESIGN

Observational, prospective, monocentric study of 500 patients in the post-anaesthetist care unit. Anxiety was evaluated using both the visual analogue scale for anxiety and the STAI in perioperative patients. Consistency between the visual analogue scale for anxiety and the STAI, detection thresholds and factors predicting anxiety were researched.

RESULTS

A correlation was found between the visual analogue scale for anxiety and the STAI. There was also a correlation between pain and anxiety. Analysis of receiver operating characteristic (ROC) curves showed a visual analogue scale for anxiety threshold of 34/100 allowing the identification of patients with or without anxiety. Predictive factors for anxiety are female gender, use of benzodiazepine in premedication, emergency surgery and significant pain in the post-anaesthetist care unit. In summary, visual analogue scale for anxiety is a useful tool for detecting the anxiety component of postoperative pain. It could be used in association with covariates of interest to improve anxiety management during the postoperative period.

Emotional reactivity and blood pressure elevations: anxiety as a mediator

There is a strong link between emotional reactivity and hypertension, yet little research to date has examined mediators of this relationship. Ourstudy  investigated the mediating roleof anxiety on the relationship between emotional reactivity and blood pressure elevations. Participants were226 hypertensive patients (93 men and 133 women, Mean age = 53.09, SD = 13.88 years), purposivelydrawn from the General Outpatient Department in University of Calabar Teaching Hospital, Calabar, , Nigeria. .  Measures for data collection were Emotional Reactivity Scale, State Trait Anxiety Inventory, and the Mercury Sphygmomanometer. Hayes PROCESS macro for SPSS which uses a regression-based, path-analytical framework, was employed in analysing the data. Results showed that emotional reactivity was positively associated with blood pressure elevations. Anxiety was positively associated with blood pressure elevations. Anxiety also fully mediated the relationship between emotional reactivity and blood pressure elevations, even after adjusting for the control variables (e.g., age, family history of hypertension, and educational status). The finding suggests that being less emotionally reactive is associated with a decrease in disabling influences of anxiety, thereby contributing to lower levels of mean arterial blood pressure. The findings may be helpful  in improving prevention, control and management of hypertension in healthcare.

The Effects of an Exercise Program on Anxiety Levels and Metabolic Functions in Patients With Anxiety Disorders

The purpose of this study was to evaluate the effects of a home-based (HB) exercise program on anxiety levels and metabolic functions in patients with anxiety disorders in Taiwan. Purposive sampling was used to recruit 86 participants for this randomized, experimental study. Participants were asked to complete a pretest before the 3-month exercise program, a posttest at 1 week, and a follow-up test at 3 months after the exercise program. Study measures included four Self-Report Scales and biophysical assessments to collect and assess personal data, lifestyle behaviors, anxiety levels, and metabolic control functions. Of the 86 study participants, 83 completed the posttest and the 3-month follow-up test, including 41 in the experimental group and 42 in the control group. Participants in the experimental group showed significant improvements in body mass index, high-density lipoprotein cholesterol levels, and the level of moderate exercise after the program relative to the control group, as analyzed by generalized estimating equations mixed-model repeated measures. State and trait anxiety levels were also significantly improved from pretest to follow-up test in the experimental group. Finally, the prevalence of metabolic syndrome declined for participants in the experimental group. The HB exercise program produced positive effects on the metabolic indicators and anxiety levels of Taiwanese adults with anxiety disorders. Health providers should consider using similar HB exercise programs to help improve the mental and physical health of patients with anxiety disorders in their communities.

Increased risk of diabetes in patients with anxiety disorders: A population-based study

OBJECTIVE

Few known studies have investigated the epidemiology of diabetes in patients with anxiety disorders. Therefore, the study aimed to determine the prevalence and incidence of diabetes in patients with anxiety disorders.

METHODS

The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample aged 18years and over 766,427 subjects in 2005. Those study subjects who had at least two primary or secondary diagnoses of anxiety disorders were identified. We compared the prevalence of diabetes in anxiety patients with the general population in 2005. Furthermore, we investigated this cohort from 2006 to 2010 to detect the incident cases of diabetes in anxiety patients compared with the general population.

RESULTS

The prevalence of diabetes in patients with anxiety disorders was higher than that in the general population (11.89% vs. 5.92%, odds ratio, 1.23; 95% confidence interval, 1.17-1.28) in 2005. The average annual incidence of diabetes in patients with anxiety disorders was also higher than that in the general population (2.25% vs. 1.11%, risk ratio 1.34; 95% confidence interval, 1.28-1.41) from 2006 to 2010. Compared with the general population, patients with anxiety disorders revealed a higher incidence of diabetes in all age groups among both females and males.

CONCLUSIONS

Patients with anxiety disorders had a much higher prevalence and incidence of diabetes in the younger adult age group than in the general population. The higher incidence of diabetes among anxiety patients was related to increased age, antipsychotic use, hypertension, and hyperlipidemia.

Neuroendocrinological and Epigenetic Mechanisms Subserving Autonomic Imbalance and HPA Dysfunction in the Metabolic Syndrome

Impact of environmental stress upon pathophysiology of the metabolic syndrome (MetS) has been substantiated by epidemiological, psychophysiological, and endocrinological studies. This review discusses recent advances in the understanding of causative roles of nutritional factors, sympathomedullo-adrenal (SMA) and hypothalamic-pituitary adrenocortical (HPA) axes, and adipose tissue chronic low-grade inflammation processes in MetS. Disturbances in the neuroendocrine systems for leptin, melanocortin, and neuropeptide Y (NPY)/agouti-related protein systems have been found resulting directly in MetS-like conditions. The review identifies candidate risk genes from factors shown critical for the functioning of each of these neuroendocrine signaling cascades. In its meta-analytic part, recent studies in epigenetic modification (histone methylation, acetylation, phosphorylation, ubiquitination) and posttranscriptional gene regulation by microRNAs are evaluated. Several studies suggest modification mechanisms of early life stress (ELS) and diet-induced obesity (DIO) programming in the hypothalamic regions with populations of POMC-expressing neurons. Epigenetic modifications were found in cortisol (here HSD11B1 expression), melanocortin, leptin, NPY, and adiponectin genes. With respect to adiposity genes, epigenetic modifications were documented for fat mass gene cluster APOA1/C3/A4/A5, and the lipolysis gene LIPE. With regard to inflammatory, immune and subcellular metabolism, PPARG, NKBF1, TNFA, TCF7C2, and those genes expressing cytochrome P450 family enzymes involved in steroidogenesis and in hepatic lipoproteins were documented for epigenetic modifications.