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Logan JG, Barksdale DJ, Carlson J, Carlson BW, Rowsey PJ. Psychological stress and arterial stiffness in Korean Americans. J Psychosom Res 2012; 73:53-8. [PMID: 22691560 PMCID: PMC3374866 DOI: 10.1016/j.jpsychores.2012.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Arterial stiffness is identified as a causative factor for hypertension. The purpose of this study was to explore the relationship between psychological stress and arterial stiffness in Korean Americans. METHODS A convenience sample of 102 Korean Americans (aged 21-60 years, 60% women) was recruited from North Carolina. Psychological stress was measured by the Perceived Stress Scale, the Social, Attitudinal, Familiar, and Environmental (SAFE) Acculturative Stress Scale, and the Spielberger's State-Trait Anxiety Inventory. Arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (AtCor Medical, Australia). RESULTS This study shows that the emotional stress response, measured by anxiety, significantly predicted arterial stiffness (β=.25, p=.008), independently of such confounding factors as age, mean arterial pressure (MAP), gender, body mass index, smoking, education, and income. Anxiety was neither related to age (r=.12, p=.212) nor MAP (r=.14, p=.151). Additionally, this sample of Korean Americans had higher levels of psychological stress when compared to previous findings from studies of other racial/ethnic groups in the U.S. CONCLUSION Findings demonstrate that anxiety is a significant and independent determinant of arterial stiffness. Given that anxiety was not related to MAP, these findings suggest that arterial stiffness may be a pathway to explain the connection between anxiety and hypertension risk. Studies that scrutinize the relationship between anxiety and arterial stiffness are an important next step for future research. Further studies are also recommended to explore cultural factors and individual characteristics that may affect anxiety in Korean Americans.
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Affiliation(s)
- Jeongok G Logan
- School of Nursing, University of North Carolina at Chapel Hill, 105 Westside Drive, Chapel Hill, NC 27516, USA.
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Hassanein A, Desai A, Verma A, Oparil S, Izzo J, Rocha R, Hilkert R, Seifu Y, Pitt B, Solomon S. EXCEED: Exforge®-intensive control of hypertension to evaluate efficacy in diastolic dysfunction: study rationale, design, and participant characteristics. Ther Adv Cardiovasc Dis 2009; 3:429-39. [DOI: 10.1177/1753944709341301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Both diastolic dysfunction and increased vascular stiffness represent important measures of target-organ damage in hypertension. Whether intensive blood pressure (BP) control can further improve these measures remains unknown. Methods: EXCEED is a prospective, randomized open-label blinded endpoint trial (PROBE) design, aiming to test the hypothesis that more aggressive BP lowering would result in greater improvement in diastolic function among patients with stage II hypertension, evidence of diastolic dysfunction and preserved systolic function (EF ≥ 50%). Patients were randomized to one of two treatment strategies, targeting systolic blood pressure (SBP) <140 mmHg or <130 mmHg using a combination of amlodipine/valsartan with additional antihypertensive medications as needed to achieve the prescribed targets. Diastolic function was assessed using Doppler tissue imaging of early diastolic velocity of lateral mitral annulus (E'), while vascular stiffness was assessed using radial augmentation index (RAI) derived from radial artery tonometry. The study primary endpoint will be the change in lateral E' velocity between baseline and 24 weeks. Results: Two hundred and twenty eight patients (50% female) with mean age of (59.6±9.7) years and mean BP of (162±14/92±13 mmHg) were randomized equally to either treatment strategies. Left ventricular hypertrophy was present among <4% of the enrolled patients. Inspite diastolic function was impaired, baseline lateral E' velocity (7.6±1.2 cm/s) was not related to baseline SBP while baseline RAI was weakly related ( r = 0.2, p <0.01) to SBP even after adjustment to age, gender and heart rate. Conclusion: EXCEED will determine whether intensive BP lowering will further improve diastolic dysfunction and vascular stiffness among patients with uncontrolled hypertension.
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Affiliation(s)
- Amira Hassanein
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA,
| | - Akshay Desai
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Anil Verma
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Suzanne Oparil
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Joseph Izzo
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Richardo Rocha
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Robert Hilkert
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Youdit Seifu
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Bertrand Pitt
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Scott Solomon
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
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Zineh I, Beitelshees AL, Haller MJ. NOS3 polymorphisms are associated with arterial stiffness in children with type 1 diabetes. Diabetes Care 2007; 30:689-93. [PMID: 17327342 DOI: 10.2337/dc06-1697] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is associated with endothelial dysfunction, arterial stiffness, and an increased risk of cardiovascular disease (CVD) events. We previously demonstrated increased arterial stiffness in children with type 1 diabetes compared with control subjects. However, traditional CVD risk factors did not explain the difference in arterial stiffness. Furthermore, children with type 1 diabetes displayed notable within-group variation in arterial stiffness. We hypothesized that polymorphisms in the NOS3 gene may be associated with the differences seen in arterial stiffness within the population of children with type 1 diabetes. RESEARCH DESIGN AND METHODS Thirty-six consecutively enrolled subjects aged 10-21 years with type 1 diabetes were studied. Subjects underwent radial tonometry in a fasting state. A corrected augmentation index (AI75) was the primary measure of arterial stiffness. Genotypes were determined for the NOS3 -786T-->C and Glu298-->Asp polymorphisms by pyrosequencing. AI75 values by genotype groups were compared by ANOVA and multivariate analysis. RESULTS Median (interquartile range) AI75 values for -786TT and -786C carriers were -3.5 (-8.8 to 2.3) and 11.0 (6.0 to 14.4), respectively (P = 0.01); AI75 values for Glu298Glu patients and Asp298 carriers were 2.3 (-4.0 to 13.0) and 7.3 (-2.0 to 11.5), respectively (P = 0.59). In univariate analysis, age, sex, BMI percentile, and -786T-->C genotype were significantly associated with AI75. The multivariate model, which included these four variables, was significantly associated with AI75 (P = 0.002, R2 = 0.40). CONCLUSIONS This is the first reported association between -786T-->C and arterial stiffness in type 1 diabetes. Larger studies are needed to confirm this observation for potential translation to risk assessment.
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Affiliation(s)
- Issam Zineh
- Department of Pharmacy Practice and Center for Pharmacogenomics, University of Florida College of Pharmacy, Gainesville, Florida, USA
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