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Usama SM, Kothari YL, Karthikeyan A, Khan SA, Sarraf M, Nagaraja V. Social Isolation, Loneliness, and Cardiovascular Mortality: The Role of Health Care System Interventions. Curr Cardiol Rep 2024; 26:669-674. [PMID: 38713361 DOI: 10.1007/s11886-024-02066-x] [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] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW The world is proliferating rapidly, with science and technology advancing at an incredible rate. These advances have, however, ushered in an age with a rise in social isolation (SI) and loneliness. SI is an objective term that refers to lacking social contact or support. On the other hand, loneliness is subjective and refers to feeling alone or isolated. These concepts are rapidly gaining prominence mainly due to their negative impact on the physical and psychological health of the population, mainly through behavioural modifications that encompass substance abuse, decreased physical activity and unhealthy food habits, and poor sleep hygiene. This review summarizes the pathophysiology, evaluates the evidence behind impact of SI on cardiovascular mortality, and interventions to overcome SI. RECENT FINDINGS Through proposed mechanisms, such as activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, both SI and loneliness have strong evidence linking them to cardiovascular morbidity and mortality. A systematic review and meta-analysis of 90 prospective cohort studies including 2,205,199 individuals reported that SI was independent predictor of cardiovascular mortality with a point estimate of 1.34 (95% confidence interval:1.25-1.44). The evidence so far is compelling and necessitates urgent action with the implementation of strict policies to tackle this issue. As healthcare professionals, it becomes even more critical to remain vigilant, recognize this insidious pandemic, and take appropriate action.
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Affiliation(s)
| | - Yash Lalit Kothari
- Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | | | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System - Southwest Minnesota Region, Mankato, MN, USA
| | - Mohammad Sarraf
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Vinayak Nagaraja
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
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Ajibewa TA, Kershaw KN, Carr JJ, Terry JG, Gabriel KP, Carnethon MR, Wong M, Allen NB. Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study. Am J Prev Med 2024; 67:24-31. [PMID: 38143043 PMCID: PMC11193648 DOI: 10.1016/j.amepre.2023.12.015] [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: 08/11/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations. METHODS Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables. RESULTS The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05). CONCLUSIONS Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.
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Affiliation(s)
| | - Kiarri N Kershaw
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Jeffrey Carr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - James G Terry
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Mandy Wong
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Norrina B Allen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Quaresma A, Alves E, Fraga S, Henriques A. Stressful life events and heart disease and stroke: A study among Portuguese older adults. Stress Health 2024; 40:e3312. [PMID: 37679906 DOI: 10.1002/smi.3312] [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: 02/06/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
The link between stressful life events (SLE) and cardiovascular diseases (CVD) remains underexplored. This study aimed to examine the association between SLE and the diagnosis of heart disease or stroke, among older adults. Data from 678 participants from the population-based cohort EPIPorto, with ≥60 years and complete information regarding SLE and heart disease or stroke, were analysed. Stressful life events were measured through the 'Stressful Life Events Screening Questionnaire'. A previous diagnosis of heart disease or stroke was self-reported. Adjusted odds ratios (OR) with the respective 95% confidence intervals were computed through logistic regression. Almost a fourth of the participants never experienced any SLE throughout life, 30.0% experienced at least one event, 17.5% experienced two and 27.7% had experienced three or more SLE. A dose-effect association between SLE and the diagnosis of heart disease or stroke was observed, statistically significant for those who had at least 3 types of SLE, independently of confounders (≥3SLE vs. 0SLE: OR = 2.00; 95% CI: 1.12-3.57). This cross-sectional study suggests that cumulative exposure to different types of SLE during the life course was associated with a higher likelihood of having a diagnosis of heart disease or a stroke at a later age. Future longitudinal studies should better deepen this association, particularly by evaluating which type of SLE is more related to a higher prevalence of heart disease and stroke, and how the timing of the SLE influence this relation.
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Affiliation(s)
- Ana Quaresma
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Elisabete Alves
- São João de Deus School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, Évora, Portugal
| | - Silvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Henriques
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Skinner HG, Palma-Gudiel H, Stewart JD, Love SA, Bhatti P, Shadyab AH, Wallace RB, Salmoirago-Blotcher E, Manson JE, Kroenke CH, Belsky DW, Li Y, Whitsel EA, Zannas AS. Stressful life events, social support, and epigenetic aging in the Women's Health Initiative. J Am Geriatr Soc 2024; 72:349-360. [PMID: 38149693 PMCID: PMC10922473 DOI: 10.1111/jgs.18726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Elevated psychosocial stress has been linked with accelerated biological aging, including composite DNA methylation (DNAm) markers that predict aging-related outcomes ("epigenetic age"). However, no study has examined whether stressful life events (SLEs) are associated with epigenetic age acceleration in postmenopausal women, an aging population characterized by increased stress burden and disease risk. METHODS We leveraged the Women's Health Initiative, a large muti-ancestry cohort of postmenopausal women with available psychosocial stress measures over the past year and epigenomic data. SLEs and social support were ascertained via self-report questionnaires. Whole blood DNAm array (450 K) data were used to calculate five DNAm-based predictors of chronological age, health span and life span, and telomere length (HorvathAge, HannumAge, PhenoAge, GrimAge, DNAmTL). RESULTS After controlling for potential confounders, higher SLE burden was significantly associated with accelerated epigenetic aging, as measured by GrimAge (β: 0.34, 95% CI: 0.08, 0.59) and DNAmTL (β: -0.016, 95% CI: -0.028, -0.004). Exploratory analyses showed that SLEs-GrimAge associations were stronger in Black women as compared to other races/ethnicities and in those with lower social support levels. In women with lower social support, SLEs-DNAmTL associations showed opposite association in Hispanic women as compared to other race/ethnicity groups. CONCLUSIONS Our findings suggest that elevated stress burden is associated with accelerated epigenetic aging in postmenopausal women. Lower social support and/or self-reported race/ethnicity may modify the association of stress with epigenetic age acceleration. These findings advance understanding of how stress may contribute to aging-related outcomes and have important implications for disease prevention and treatment in aging women.
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Affiliation(s)
- Harlyn G. Skinner
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Helena Palma-Gudiel
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James D. Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shelly-Ann Love
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Social and Scientific Systems Inc, a DLH Holdings company, Durham, NC, USA
| | - Parveen Bhatti
- Cancer Control Research, British Columbia Cancer Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Robert B. Wallace
- Department of Epidemiology and Internal Medicine, College of Public Health, University of Iowa, Iowa City, IA, USA
| | | | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Candyce H. Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Columbia University, New York, NY USA
- Robert N. Butler Columbia Aging Center, Columbia University, New York, NY USA
| | - Yun Li
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony S. Zannas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Stress Initiative, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zhao SX, Tindle HA, Larson JC, Woods NF, Crawford MH, Hoover V, Salmoirago‐Blotcher E, Shadyab AH, Stefanick ML, Perez MV. Association Between Insomnia, Stress Events, and Other Psychosocial Factors and Incident Atrial Fibrillation in Postmenopausal Women: Insights From the Women's Health Initiative. J Am Heart Assoc 2023; 12:e030030. [PMID: 37646212 PMCID: PMC10547347 DOI: 10.1161/jaha.123.030030] [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: 03/05/2023] [Accepted: 06/23/2023] [Indexed: 09/01/2023]
Abstract
Background The association between psychosocial factors and atrial fibrillation (AF) is poorly understood. Methods and Results Postmenopausal women from the Women's Health Initiative were retrospectively analyzed to identify incident AF in relation to a panel of validated psychosocial exposure variables, as assessed by multivariable Cox proportional hazard regression and hierarchical cluster analysis. Among the 83 736 women included, the average age was 63.9±7.0 years. Over an average of 10.5±6.2 years follow-up, there were 23 954 cases of incident AF. Hierarchical cluster analysis generated 2 clusters of highly correlated psychosocial variables: the Stress Cluster included stressful life events, depressive symptoms, and insomnia, and the Strain Cluster included optimism, social support, social strain, cynical hostility, and emotional expressiveness. Incident AF was associated with higher values in the Stress Cluster (hazard ratio [HR], 1.07 per unit cluster score [95% CI, 1.05-1.09]) and the Strain Cluster (HR, 1.03 per unit cluster score [95% CI, 1.00-1.05]). Of the 8 individual psychosocial predictors that were tested, insomnia (HR, 1.04 [95% CI, 1.03-1.06]) and stressful life events (HR, 1.02 [95% CI, 1.01-1.04]) were most strongly associated with increased incidence of AF in Cox regression analysis after multivariate adjustment. Subgroup analyses showed that the Strain Cluster was more strongly associated with incident AF in those with lower traditional AF risks (P for interaction=0.02) as determined by the cohorts for heart and aging research in genomic epidemiology for atrial fibrillation score. Conclusions Among postmenopausal women, 2 clusters of psychosocial stressors were found to be significantly associated with incident AF. Further research is needed to validate these associations.
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Affiliation(s)
- Susan X. Zhao
- Division of Cardiology, Department of MedicineSanta Clara Valley Medical CenterSan JoseCAUSA
| | - Hilary A. Tindle
- Division of Internal Medicine & Public Health, Vanderbilt Ingram Cancer CenterVanderbilt UniversityNashvilleTNUSA
| | - Joseph C. Larson
- Data Coordinating CenterFred Hutchinson Cancer Research CenterSeattleWAUSA
| | | | - Michael H. Crawford
- Division of Cardiology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Valerie Hoover
- Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCAUSA
| | - Elena Salmoirago‐Blotcher
- Department of Medicine, Department of Psychiatry and Human BehaviorBrown University School of MedicineProvidenceRIUSA
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California, San DiegoLa JollaCAUSA
| | | | - Marco V. Perez
- Division of Cardiovascular Medicine and Department of MedicineStanford UniversityStanfordCAUSA
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Lawrence WR, McDonald JA, Williams F, Shiels MS, Freedman ND, Lin Z, Magnani JW. Stressful Life Events, Social Support, and Incident Breast Cancer by Estrogen Receptor Status. Cancer Prev Res (Phila) 2023; 16:259-267. [PMID: 37067915 PMCID: PMC10159918 DOI: 10.1158/1940-6207.capr-22-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 04/18/2023]
Abstract
Chronic stress affects immune function and hormonal signaling and has been hypothesized to be associated with breast cancer, although results from the few prior studies are mixed and have not examined potential differences by estrogen receptor (ER) status. Using the Women's Health Initiative study, we included 76,951 postmenopausal women followed for events for a median of 16.7 years to investigate the association between baseline self-reported stressful life events and incident breast cancer by ER status and whether the association was modified by social support. We generated Cox proportional hazards models adjusting for demographic, clinical, lifestyle/behavioral, and social factors to estimate HRs and 95% confidence intervals (95%CI). The mean age was 63 (SD, 7.3), and majority of participants were White race (83.5%) and married or in a marriage-like relationship (63.0%). In analyses stratified by ER status, there was no relationship between stressful life events and ER-positive breast cancer. In contrast, compared with women in the lowest quartile, those in higher quartiles had an increased risk of ER-negative breast cancer, where those in quartile 4 had the highest risk (Quartile 4 vs. Quartile 1; HR = 1.30; 95%CI, 1.01-1.68; Ptrend = 0.050). Moreover, associations were stronger for the highest versus lowest quartile of stressful life events among widowed women (HR = 2.39; 95%CI, 1.29-4.44; Pinteraction<0.001). Association between stressful life events and ER-negative breast cancer was not modified by social support. In this cohort of postmenopausal women, higher experiences of prediagnostic stressful life events were associated with increased risk of ER-negative breast cancer. PREVENTION RELEVANCE Epidemiologic studies on the association between psychosocial stress and breast cancer risk remain inconsistent, while investigation of whether the association differs by ER status is limited. In this prospective cohort of postmenopausal women, high experiences of stressful life events were positively associated with ER-negative disease but not ER-positive.
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Affiliation(s)
- Wayne R. Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Jasmine A. McDonald
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ziqiang Lin
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Department of Preventive Medicine, School of Basic Medicine and Public Health, Jinan University, Guangzhou 510632, China
| | - Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Kuo WC, Ersig AL, Johnson HM, Brown RL, Oakley LD, Hagen EW, Barnet JH, Peppard PE. Association between stressful life events and non-optimal lipid levels among women with hyperlipidaemia. Eur J Cardiovasc Nurs 2023; 22:210-219. [PMID: 35714051 DOI: 10.1093/eurjcn/zvac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/14/2022]
Abstract
AIMS Psychological stress has been linked to lipid dysregulation with noticeable gender differences, but it remains unclear whether women are more susceptible to non-optimal lipid levels than men, when experiencing stressful life events. This study aims to examine the association between stressful life events and non-optimal lipid levels among persons with hyperlipidaemia and whether the association differs between men and women. METHODS AND RESULTS A nested case-control study was performed using data from the Wisconsin Sleep Cohort (WSC) Study from 2011 to 2015, including 224 participants with hyperlipidaemia and without a history of myocardial infarction or heart failure. Among them, 63 participants with non-optimal LDL cholesterol or triglyceride levels were identified as cases, and 161 participants with optimal LDL cholesterol and triglyceride levels were identified as controls. Cases and controls were traced back to their self-reported life events collected through the Retirement and Sleep Trajectories study during 2010-11. The association between stressful life events and non-optimal lipid levels was examined using multivariable logistic regression; confounding effects were addressed using propensity score weighting and Mahalanobis distance matching; gender differences were examined using subgroup analysis. Results showed that a higher number of stressful life events during 2010-11 was associated with greater odds of non-optimal lipid levels during 2011-15 (odds ratio = 1.45, P = 0.03) among women with hyperlipidaemia, whereas the association was not significant among men with hyperlipidaemia (P = 0.910). CONCLUSION Future studies are needed to examine the underlying mechanisms that explain gender differences in the association between stressful life events and non-optimal lipid levels. REGISTRATION ClinicalTrials.gov NCT00005557.
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Affiliation(s)
- Wan-Chin Kuo
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Anne L Ersig
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Heather M Johnson
- Christine E. Lynn Women's Health and Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Florida Atlantic University, Boca Raton, FL, USA
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda D Oakley
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Erika W Hagen
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Jodi H Barnet
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul E Peppard
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Thurston RC, Jakubowski KP, Wu M, Aizenstein HJ, Chang Y, Derby CA, Koenen KC, Barinas-Mitchell E, Maki PM. Sexual assault and white matter hyperintensities among midlife women. Brain Imaging Behav 2022; 16:773-780. [PMID: 34553332 PMCID: PMC8940746 DOI: 10.1007/s11682-021-00536-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 01/09/2023]
Abstract
Traumatic experiences have been linked to poor mental and physical health. However, there has been little examination of their relationship to neuroimaging markers of cerebrovascular risk. White matter hyperintensities (WMHs) are markers of brain small vessel disease. WMHs can be detected decades before the onset of dementia and other disorders and can serve as early markers for these brain disorders. We tested whether traumatic experiences were associated with brain WMH volume among midlife women. In the MsBrain study, 145 women (mean age = 59 years) without cardiovascular disease, stroke, or dementia were recruited. Women completed questionnaires [trauma checklist, depression, post-traumatic stress measures]; physical measures [body mass index (BMI), blood pressure (BP)]; phlebotomy; actigraphy sleep measurement, and 3 Tesla magnetic resonance brain imaging for WMHs. Cross-sectional associations between traumatic experiences and WMH volume were assessed in linear regression models. Covariates were age, race/ethnicity, education, BMI, BP, lipids, preeclampsia, sleep, and additionally depressive and post-traumatic stress disorder symptoms. 68% of women endorsed at least one of the traumas assessed. The most common trauma was sexual assault (23% of women). Women with trauma exposure had greater WMH volume than women without trauma [B(SE) = .24 (.09), p = .01, multivariable]. The single trauma most associated with WMH was sexual assault [B(SE) = .25 (.11), p = .02, multivariable]. Results persisted adjusting for depressive or post-traumatic stress symptoms. A trauma history, particularly sexual assault, was associated with greater WMH volume controlling for covariates, including depressive and post-traumatic symptoms. Sexual assault may place women at risk for poor brain health.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA.
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Karen P Jakubowski
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Minjie Wu
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carol A Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Psychological stress, body shape and cardiovascular events: Results from the Whitehall II study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 9:None. [PMID: 35211687 PMCID: PMC8847996 DOI: 10.1016/j.cpnec.2021.100104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background and aim It is known that persistent psychological stress predicts changes in body shape in two different ways: some stressed people lose weight, others gain weight. It is also known that persistent psychological stress predicts adverse health events. But it is unknown what role the body shape plays in this particular network of relationships. We therefore analyzed the Whitehall II dataset to relate body shape to stress and health risk. Methods Data of 4969 men and 2138 women from the Whitehall II cohort were analyzed. Psychological stress (General Health Questionnaire) was measured three times in the years 1991 till 2001. Body shape (BMI, waist and hip circumferences) was measured in the years 1991 till 1994. Childhood adversities were retrospectively assessed by questionnaire. Outcomes included the incidence of non-fatal or fatal CHD events (coronary heart disease) collected up to the years 2012 and 2013 and all-cause mortality collected up to July 2015. Cox proportional hazard models were conducted to estimate the relation between psychological stress and CHD events or all-cause mortality. Results There was an increase in the expected hazard to develop CHD with high psychological stress (men: Exp (B) = 1.25 (1.06–1.47); P = 0.008; women: Exp (B) = 1.34 (1.05–1.70); P = 0.017). We found a clear dose-response relationship for the association between psychological stress and CHD events in both genders. That is, subjects with consistently high psychological stress in all assessments had a 2.4-fold (men) or 2.3-fold (women) higher risk for later CHD events compared to never-stressed subjects. Moreover, subjects with a high sum score of all 13 childhood experiences had a 10% increased hazard to develop fatal or non-fatal CHD events in adulthood. Although we could not find stress or BMI linked to all-cause mortality, the waist-to-hip ratio contributed to the risk of all-cause mortality in both genders (Exp (B) = 34.66 (6.43–186.92); P < 0.001 for men; Exp (B) = 60.65 (9.33–394.22); P < 0.001 for women). Conclusion This analysis supports the notion that psychological stress and childhood adversities are associated with the risk of fatal or non-fatal CHD events. When this relationship is analyzed in more detail, the Whitehall II dataset provides further insights into the role of body shape. That is, stress is also related to changes in body shape, with waist size in particular predicting higher all-cause mortality. We used Whitehall II data and constructed an overall picture of the relations between psychological stress, body shape and adverse health outcomes. We demonstrated a dose-dependent relationship between psychological stress and the risk of fatal or non-fatal CHD events. Stress increases the risk of both CHD events and body shape changes, with waist circumference but not BMI increasing the mortality risk. Body shape –more specifically waist size– is symptomatic of stress and predictive of all-cause mortality.
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Wang J, Zhu J, Yang H, Hu Y, Sun Y, Ying Z, Qu Y, Valdimarsdottir U, Fang F, Song H. Cardiovascular-related deaths at the beginning of the COVID-19 outbreak: a prospective analysis based on the UK Biobank. BMJ Open 2021; 11:e046931. [PMID: 34088708 PMCID: PMC8184350 DOI: 10.1136/bmjopen-2020-046931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the impact of the COVID-19 outbreak on cardiovascular disease (CVD) related mortality and hospitalisation. DESIGN Community-based prospective cohort study. SETTING The UK Biobank. PARTICIPANTS 421 372 UK Biobank participants who were registered in England and alive as of 1 January 2020. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of interest was CVD-related death, which was defined as death with CVD as a cause in the death register. We retrieved information on hospitalisations with CVD as the primary diagnosis from the UK Biobank hospital inpatient data. The study period was 1 January 2020 to June 30 2020, and we used the same calendar period of the three preceding years as the reference period. In order to control for seasonal variations and ageing of the study population, standardised mortality/incidence ratios (SMRs/SIRs) with 95% CIs were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period. RESULTS We observed a distinct increase in CVD-related deaths in March and April 2020, compared with the corresponding months of the three preceding years. The observed number of CVD-related deaths (n=218) was almost double in April, compared with the expected number (n=120) (SMR=1.82, 95% CI 1.58 to 2.07). In addition, we observed a significant decline in CVD-related hospitalisations from March onwards, with the lowest SIR observed in April (0.45, 95% CI 0.41 to 0.49). CONCLUSIONS There was a distinct increase in the number of CVD-related deaths in the UK Biobank population at the beginning of the COVID-19 outbreak. The shortage of medical resources for hospital care and stress reactions to the pandemic might have partially contributed to the excess CVD-related mortality, underscoring the need of sufficient healthcare resources and improved instructions to the public about seeking healthcare in a timely way.
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Affiliation(s)
- Junren Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Jianwei Zhu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huazhen Yang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Yajing Sun
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Yuanyuan Qu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Unnur Valdimarsdottir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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11
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Hendryx M, Nicholson W, Manson JE, Kroenke CH, Lee J, Weitlauf JC, Garcia L, Jonasson JM, Wactawski-Wende J, Luo J. Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women. J Gerontol B Psychol Sci Soc Sci 2021; 75:1597-1608. [PMID: 31112615 DOI: 10.1093/geronb/gbz047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women. METHOD 139,924 postmenopausal women aged 50-79 years without prevalent diabetes at baseline were followed for a mean of 14 years. 19,240 women developed diabetes. Multivariable Cox proportional hazard models tested associations between social relationship variables and diabetes incidence after consideration of demographics, depressive symptoms, and lifestyle behaviors. We also examined moderating effects of obesity and race/ethnicity, and we tested whether social variable associations were mediated by lifestyle or depressive symptoms. RESULTS Compared with the lowest quartile, women in the highest social support quartile had lower risk of diabetes after adjusting for demographic factors, health behaviors, and depressive symptoms (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.89-0.97). Social strain (HR = 1.09, 95% CI = 1.04-1.13) and stressful life events (HR = 1.10, 95% CI = 1.05-1.15) were associated with higher diabetes risks. The association between diabetes and social strain was stronger among African American women. Social relationship variables had direct relationships to diabetes, as well as indirect effects partially mediated by lifestyle and depressive symptoms. DISCUSSION Social support, social strain, and stressful life events were associated with diabetes risk among postmenopausal women independently of demographic factors and health behaviors. In addition to healthy behaviors such as diet and physical activity, healthy social relationships among older women may be important in the prevention of diabetes.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, Diabetes and Obesity Core, Center for Women's Health Research, University of North Carolina, Durham.,Center for Health Promotion and Disease Prevention, University of North Carolina, Durham
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jennifer Lee
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University, Palo Alto, California
| | - Julie C Weitlauf
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine University of California-Davis
| | - Junmei M Jonasson
- Department of Public Health and Community Medicine at Institute of Medicine Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Buffalo, New York
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington
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12
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Wang C, Lê‐Scherban F, Taylor J, Salmoirago‐Blotcher E, Allison M, Gefen D, Robinson L, Michael YL. Associations of Job Strain, Stressful Life Events, and Social Strain With Coronary Heart Disease in the Women's Health Initiative Observational Study. J Am Heart Assoc 2021; 10:e017780. [PMID: 33618543 PMCID: PMC8174284 DOI: 10.1161/jaha.120.017780] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The association between psychosocial stress and coronary heart disease (CHD) may be stronger in women than men and may differ across types of stressors. In this study, we assessed associations of psychosocial stressors, including job strain, stressful life events, and social strain with the incidence of CHD in women. Methods and Results We used longitudinal data from 80 825 WHI‐OS (Women's Health Initiative Observational Study) participants with a mean age of 63.4 years (7.3 years) at baseline. Job strain was assessed through linkage of Standard Occupational Classification codes to the Occupational Information Network. Stressful life events and social strain were assessed via validated self‐reported questionnaires. Cox proportional hazard models were used to evaluate associations of each stressor with CHD separately and jointly. A total of 3841 (4.8%) women developed CHD during an average of 14.7 years of follow‐up. After adjustment for age, other stressors, job tenure, and socioeconomic factors, high stressful life events score was associated with a 12% increased CHD risk, and high social strain was associated with a 9% increased CHD risk. Job strain was not independently associated with CHD risk, but we observed a statistically significant interaction between job strain and social strain (P=0.04), such that among women with high social strain, passive job strain was associated with a 21% increased CHD risk. Conclusions High stressful life events and social strain were each associated with higher CHD risk. Job strain and social strain work synergistically to increase CHD risk.
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Affiliation(s)
- Conglong Wang
- Dornsife School of Public HealthDrexel UniversityPhiladelphiaPA
| | | | - Jennifer Taylor
- Dornsife School of Public HealthDrexel UniversityPhiladelphiaPA
| | - Elena Salmoirago‐Blotcher
- The Miriam HospitalCenters for Behavioral and Preventive Medicine Warren Alpert School of Medicine of Brown UniversityProvidenceRI
| | | | - David Gefen
- LeBow College of BusinessDrexel UniversityPhiladelphiaPA
| | - Lucy Robinson
- Dornsife School of Public HealthDrexel UniversityPhiladelphiaPA
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13
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Breathett K, Kohler LN, Eaton CB, Franceschini N, Garcia L, Klein L, Martin LW, Ochs-Balcom HM, Shadyab AH, Cené CW. When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African American and Hispanic Women. J Card Fail 2021; 27:217-223. [PMID: 33232822 PMCID: PMC7880886 DOI: 10.1016/j.cardfail.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/29/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND African American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women. METHODS AND RESULTS Using the Women's Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91-0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02-1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06-3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. CONCLUSIONS Among postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona.
| | - Lindsay N Kohler
- Department of Health Promotion Sciences and Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Charles B Eaton
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nora Franceschini
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lorena Garcia
- Department of Public Health Sciences, University of California, Davis, California
| | - Liviu Klein
- Division of Cardiovascular Medicine, University of California, San Francisco, California
| | - Lisa W Martin
- Division of Cardiovascular Medicine, George Washington University, Washington, DC
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Aladdin H Shadyab
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Crystal W Cené
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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14
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Gronewold J, Engels M, van de Velde S, Cudjoe TKM, Duman EE, Jokisch M, Kleinschnitz C, Lauterbach K, Erbel R, Jöckel KH, Hermann DM. Effects of Life Events and Social Isolation on Stroke and Coronary Heart Disease. Stroke 2021; 52:735-747. [PMID: 33445957 DOI: 10.1161/strokeaha.120.032070] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic represents a severe, life-changing event for people across the world. Life changes may involve job loss, income reduction due to furlough, death of a beloved one, or social stress due to life habit changes. Many people suffer from social isolation due to lockdown or physical distancing, especially those living alone and without family. This article reviews the association of life events and social isolation with cardiovascular disease, assembling the current state of knowledge for stroke and coronary heart disease. Possible mechanisms underlying the links between life events, social isolation, and cardiovascular disease are outlined. Furthermore, groups with increased vulnerability for cardiovascular disease following life events and social isolation are identified, and clinical implications of results are presented.
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Affiliation(s)
- Janine Gronewold
- Department of Neurology, University Hospital Essen (J.G., E.-E.D., M.J., C.K., D.M.H.), University of Duisburg-Essen, Germany
| | - Miriam Engels
- Institute of Medical Sociology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany (M.E.)
| | - Sarah van de Velde
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Belgium (S.v.d.V.)
| | - Thomas Kofi Mensah Cudjoe
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (T.K.M.C.)
| | - Ela-Emsal Duman
- Department of Neurology, University Hospital Essen (J.G., E.-E.D., M.J., C.K., D.M.H.), University of Duisburg-Essen, Germany
| | - Martha Jokisch
- Department of Neurology, University Hospital Essen (J.G., E.-E.D., M.J., C.K., D.M.H.), University of Duisburg-Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Essen (J.G., E.-E.D., M.J., C.K., D.M.H.), University of Duisburg-Essen, Germany
| | - Karl Lauterbach
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Germany (K.L.)
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology (R.E., K.-H.J.), University of Duisburg-Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology (R.E., K.-H.J.), University of Duisburg-Essen, Germany
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen (J.G., E.-E.D., M.J., C.K., D.M.H.), University of Duisburg-Essen, Germany
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15
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Zannas AS, Gordon JL, Hinderliter AL, Girdler SS, Rubinow DR. IL-6 Response to Psychosocial Stress Predicts 12-month Changes in Cardiometabolic Biomarkers in Perimenopausal Women. J Clin Endocrinol Metab 2020; 105:dgaa476. [PMID: 32706883 PMCID: PMC7465560 DOI: 10.1210/clinem/dgaa476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cardiometabolic diseases are the number one cause of mortality, accounting for over one third of all deaths in the United States. Cardiometabolic risk further increases with psychosocial stress exposure and during menopausal transition in women. Because disease risk and stress burden are associated with aberrant immune signaling, we hypothesized that responses of interleukin-6 (IL-6) to psychosocial stress may predict longitudinal cardiometabolic outcomes in perimenopausal women. METHODS We conducted post hoc analyses in 151 perimenopausal or early postmenopausal women participants in a previously completed study. At study onset, participants underwent the Trier Social Stress Test (TSST), and plasma IL-6 was measured repeatedly before and during the 1 hour post-TSST. Subsequently, participants were randomly assigned to either hormonal treatment (HT) or placebo and followed for 12 months to determine longitudinal changes in cardiometabolic biomarkers. RESULTS Greater IL-6 reactivity to stress, measured with baseline-adjusted area under the curve, predicted 12-month decrease in flow-mediated dilatation of the brachial artery (P = 0.0005), a measure of endothelial-dependent vascular function, but not in endothelial-independent function measured with nitroglycerin-mediated dilatation (P = 0.17). Greater baseline IL-6 levels predicted 12-month increase in insulin resistance based on the homeostatic model assessment of insulin resistance score (P = 0.0045) and in the number of criteria met for metabolic syndrome (P = 0.0008). These predictions were not moderated by HT. CONCLUSIONS Greater baseline IL-6 levels as well as its reactivity to stress may predict worsening in distinct cardiometabolic biomarkers as women transition to menopause. Interleukin-6 reactivity predicts decline in endothelial-dependent vascular function, whereas baseline IL-6 presages accumulation of metabolic risk.
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Affiliation(s)
- Anthony S Zannas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan S Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Miao Jonasson J, Hendryx M, Shadyab AH, Kelley E, Johnson KC, Kroenke CH, Garcia L, Lawesson S, Santosa A, Sealy-Jefferson S, Lin X, Cene CW, Liu S, Valdiviezo C, Luo J. Social Support, Social Network Size, Social Strain, Stressful Life Events, and Coronary Heart Disease in Women With Type 2 Diabetes: A Cohort Study Based on the Women's Health Initiative. Diabetes Care 2020; 43:1759-1766. [PMID: 32499383 PMCID: PMC7372045 DOI: 10.2337/dc19-2065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We studied associations between social support, social network size, social strain, or stressful life events and risk of coronary heart disease (CHD) in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS From the Women's Health Initiative, 5,262 postmenopausal women with type 2 diabetes at baseline were included. Cox proportional hazards regression models adjusted for demographics, depressive symptoms, anthropometric variables, and lifestyle factors were used to examine associations between social factors and CHD. RESULTS A total of 672 case subjects with CHD were observed during an average 12.79 (SD 6.29) years of follow-up. There was a significant linear trend toward higher risk of CHD as the number of stressful life events increased (P for trend = 0.01; hazard ratio [HR] [95% CI] for the third and fourth quartiles compared with first quartile: 1.27 [1.03-1.56] and 1.30 [1.04-1.64]). Being married or in an intimate relationship was related to decreased risk of CHD (HR 0.82 [95% CI 0.69-0.97]). CONCLUSIONS Among postmenopausal women with type 2 diabetes, higher levels of stressful life events were associated with higher risk of CHD. Experience of stressful life events might be considered as a risk factor for CHD among women with type 2 diabetes.
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Affiliation(s)
- Junmei Miao Jonasson
- School of Public Health and Community Medicine at the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, IN
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA
| | - Erika Kelley
- Department of Reproductive Biology, School of Medicine, Case Western Reserve University, Cleveland, OH.,Department of Obstetrics and Gynecology, University Hospitals MacDonald Women's Hospital, Cleveland, OH
| | - Karen C Johnson
- Department of Preventive Medicine, School of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA
| | - Sofia Lawesson
- Department of Health, Medicine and Caring Sciences, School of Medicine, Linköping University, Linköping, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine at the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shawnita Sealy-Jefferson
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA
| | - Xiaochen Lin
- School of Public Health, Brown University, Providence, RI
| | - Crystal W Cene
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Simin Liu
- School of Public Health, Brown University, Providence, RI
| | - Carolina Valdiviezo
- MedStar Heart & Vascular Institute, MedStar Georgetown University Hospital, Washington, DC
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN
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17
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Gomez MA, Merz NB, Eastwood JA, Pepine CJ, Handberg EM, Bittner V, Mehta PK, Krantz DS, Vaccarino V, Eteiba W, Rutledge T. Psychological stress, cardiac symptoms, and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease. Stress Health 2020; 36:264-273. [PMID: 31957961 PMCID: PMC7369220 DOI: 10.1002/smi.2928] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/31/2022]
Abstract
This paper evaluated cross-sectional relationships between psychological stress and coronary artery disease (CAD) risk among women with suspected ischaemia and no obstructive coronary artery disease (INOCA). Between 1996 and 2000, 551 women with INOCA were enrolled in the Women's Ischemia Syndrome Evaluation (WISE) cohort from four U.S. institutions. Between 2009 and 2012, 376 women with INOCA were recruited from two U.S. institutions for an independent cohort study titled WISE-Coronary Vascular Dysfunction (WISE-CVD). Participants underwent coronary angiography and testing for CAD symptoms and risk factors at baseline. Psychological stress was assessed in the form of home/work stress in WISE and home/work stress and financial stress in WISE-CVD. Results showed that home/work stress predicted greater depression, functional impairment, CAD symptoms, and lower self-rated health in WISE but was inconsistent as a predictor in WISE-CVD. In contrast, >60% of WISE-CVD women reported moderate or severe financial stress. Financial stress levels predicted more CAD risk factors and cardiac symptoms, poorer self-rated health, and greater depression and functional impairment. Among women with INOCA, psychological stress was associated with CAD symptoms and CAD risk factors. The prevalence and predictive value of psychological stress in this population supports the inclusion of stress measures in future CAD research.
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Affiliation(s)
- Mayra A. Gomez
- Department of Psychology, Palo Alto University, Palo Alto, California
| | - Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | | | - Carl J. Pepine
- Department of Psychology, University of Florida, Gainesville, Florida
| | | | - Vera Bittner
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Puja K. Mehta
- Division of Cardiology, Emory University, Atlanta, Georgia
| | - David S. Krantz
- Department of Medical & Clinical, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Wafia Eteiba
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas Rutledge
- Psychology Service, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
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18
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Felix AS, Lehman A, Nolan TS, Sealy-Jefferson S, Breathett K, Hood DB, Addison D, Anderson CM, Cené CW, Warren BJ, Jackson RD, Williams KP. Stress, Resilience, and Cardiovascular Disease Risk Among Black Women. Circ Cardiovasc Qual Outcomes 2020; 12:e005284. [PMID: 30909729 DOI: 10.1161/circoutcomes.118.005284] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Empirical data on the link between stress and cardiovascular disease (CVD) risk among black women is limited. We examined associations of stressful life events and social strain with incident CVD among black women and tested for effect modification by resilience. METHODS AND RESULTS Our analysis included 10 785 black women enrolled in the Women's Health Initiative Observational Study and Clinical Trials cohort. Participants were followed for CVD for up to 23 years (mean, 12.5). Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for associations between stress-related exposures and incident CVD. We included interactions between follow-up time (age) and stressful life events because of evidence of nonproportional hazards. Effect modification by resilience was examined in the sub-cohort of 2765 women with resilience and stressful life events measures. Higher stressful life events were associated with incident CVD at ages 55 (hazard ratio for highest versus lowest quartile=1.80; 95% CI, 1.27-2.54) and 65 (hazard ratio for highest versus lowest quartile=1.40; 95% CI, 1.16-1.68), but not at older ages. Adjustment for CVD risk factors attenuated these associations. Similar associations were observed for social strain. In the sub-cohort of women with updated stressful life events and resilience measures, higher stressful life events were associated with incident CVD in multivariable-adjusted models (hazard ratio=1.61; 95% CI, 1.04-2.51). Resilience did not modify this association nor was resilience independently associated with incident CVD. CONCLUSIONS In this cohort of older black women, recent reports of stressful life events were related to incident CVD. Resilience was unrelated to incident CVD. CLINICAL TRIALS REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00000611.
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Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, College of Medicine, The Ohio State University, Columbus (A.S.F., S.S.-J.)
| | - Amy Lehman
- College of Public Health, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus (A.L.)
| | - Timiya S Nolan
- College of Public Health, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus (A.L.)
| | - Shawnita Sealy-Jefferson
- Division of Epidemiology, College of Medicine, The Ohio State University, Columbus (A.S.F., S.S.-J.)
| | - Khadijah Breathett
- Division of Cardiology, College of Medicine, University of Arizona, Tucson (K.B.)
| | - Darryl B Hood
- Division of Environmental Health Sciences, College of Medicine, The Ohio State University, Columbus (D.B.H.)
| | - Daniel Addison
- Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, College of Medicine, The Ohio State University, Columbus (T.S.N., C.M.A., B.J.W., K.P.W.)
| | - Cindy M Anderson
- College of Public Health, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus (A.L.)
| | - Crystal W Cené
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill (C.W.C.)
| | - Barbara J Warren
- College of Public Health, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus (A.L.)
| | - Rebecca D Jackson
- Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, The Ohio State University, Columbus (R.J.)
| | - Karen Patricia Williams
- College of Public Health, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus (A.L.)
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The latency period between type 2 diabetes and development of Coronary Artery Disease based on psychological factors. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Indirect impact of violent events on emergency department utilization and disease patterns. BMC Emerg Med 2020; 20:10. [PMID: 32054436 PMCID: PMC7020587 DOI: 10.1186/s12873-020-0307-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/04/2020] [Indexed: 12/02/2022] Open
Abstract
Background The health effects of war and armed conflict on casualties and mental health of those directly exposed has been well described, but few studies have explored the indirect health effects of violent events. This paper assesses the indirect health impact of several violent events that took place in Beirut in 2013–2014 on ED visit utilization and disease patterns. Methods As tracked by media reports, there were 9 violent events in Beirut during 2013–2014. We compared visits to the Emergency Department of a major medical center during weeks when violent events happened and weeks without such events (the preceding week and the same week in preceding years). After re-coding de-identified data from the medical records of 23,067 patients, we assessed differences in the volume of visits, severity index, and discharge diagnoses. Individual control charts were used to analyze ED visit trends post-event. Results Comparisons of weeks with violent events and weeks without such events indicate that the socio-demographic characteristics of patients who visited the Emergency Department were similar. Patients seen during violent weeks were significantly more likely to be admitted to the hospital, and less likely to present with low acuity complaints, indicating greater complexity of their conditions. The discharge diagnoses that were significantly higher during violent event weeks included anxiety disorders, sprains, and gastritis. Daily ED visits dropped post events by 14.111%, p < 0.0001. Conclusions The results indicate that violent events such as bombs, explosions, and terrorist attacks reverberate through the population, impact patterns of ED utilization immediately post-event and are associated with adverse health outcomes, even among those who are not directly affected by the events.
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Natt Och Dag Y, Mehlig K, Rosengren A, Lissner L, Rosvall M. Negative emotional states and negative life events: Consequences for cardiovascular health in a general population. J Psychosom Res 2020; 129:109888. [PMID: 31835155 DOI: 10.1016/j.jpsychores.2019.109888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The contemporary increase in psychological distress observed in many countries is, by itself, a public health issue of great concern. The present study aims to investigate associations between self-reported negative emotional states and negative life events, and cardiovascular disease (CVD). METHODS Prospective cohort study based on the Swedish INTERGENE cohort comprising 3614 men and women, aged 25 to 75. Baseline examinations during 2001-2004 included self-rating depression and anxiety scales, life stress, as well as a wide range of physiological and behavioral parameters, which allowed for relevant adjustments. Cox proportion hazard was used to predict incident CVD, CVD mortality as well as all-cause mortality. RESULTS The results showed a dose-response relationship between depressiveness, anxiety and negative life events on the one hand, and increased risk of CVD. Most of these associations persisted in the fully adjusted models. Furthermore, the youngest age group (25-44 years) generally showed the highest prevalence of psychosocial distress, and also had the highest risks of incident CVD with regard to depression and anxiety. CONCLUSION The associations between psychological distress and later life cardiovascular disease calls for enhanced public health efforts aiming at ameliorating psychological health, not least in younger age groups.
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Affiliation(s)
- Y Natt Och Dag
- School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
| | - K Mehlig
- School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - A Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - L Lissner
- School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - M Rosvall
- School of Public health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden; Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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23
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Stress, Psychological Resources, and HPA and Inflammatory Reactivity During Late Adolescence. Dev Psychopathol 2018; 31:699-712. [PMID: 30079845 DOI: 10.1017/s0954579418000287] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Psychosocial stress during childhood and adolescence is associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis and with heightened inflammation, both of which are implicated in poor health; however, factors that may protect against these effects relatively early in life are not well understood. Thus, we examined whether psychosocial resources protect against stress-related alterations in the HPA axis and heightened inflammation in a sample of 91 late adolescents. Participants completed measures of various stressors (major life events, daily interpersonal stress, early adversity), and psychosocial resources (mastery, optimism, self-esteem, and positive reappraisal). They also completed the Trier Social Stress Test and provided saliva and blood samples for the assessment of cortisol and interleukin-6 reactivity. Each of the stressors was associated with lower cortisol reactivity. Additionally, associations with major life events and daily stress were moderated by psychological resources, such that more life events and daily stress were associated with decreased HPA reactivity among adolescents with lower levels of psychological resources, but not among those with higher levels of psychological resources. This pattern of findings was observed only for cortisol reactivity and not for interleukin-6 reactivity. Findings suggest that psychological resources may counteract the effects of certain adversity-related decreases in cortisol reactivity.
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24
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Stewart AL, Kathawalla UK, Wolfe AG, Everson-Rose SA. Women's heart health at mid-life: what is the role of psychosocial stress? Womens Midlife Health 2018; 4:11. [PMID: 30766721 PMCID: PMC6297972 DOI: 10.1186/s40695-018-0041-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women in mid-life experience unique stressors, including transitions within their family roles, informal caregiving, job stress, and perceived discrimination. The impact of these stressors on cardiovascular health in women during mid-life is of growing interest in both the popular and scientific literature. The objective of this review is to summarize the recent literature on stress and cardiovascular health in mid-life women. We focus on stressors that are relevant to mid-life women, including social stress and discrimination, and long-term risk of CVD events and subclinical CVD measures. METHODS We systematically reviewed the literature published between January 2012 and April 2018 for studies examining stress in mid-life and either CVD endpoints or subclinical CVD outcomes. Eligible studies included at least one psychosocial stress exposure, a CVD or subclinical CVD outcome, and either included only female participants, reported sex-stratified analyses or tested for a sex*stress interaction. RESULTS We identified 37 studies published since 2012 that met our criteria and included women between the ages of 40 and 65, including 3 case-control studies, 15 cross-sectional studies, and 19 prospective cohort studies. Because clinical CVD events typically occur after age 65 in women, only 22 studies were available that evaluated stress and hard CVD events in samples with mid-life women. Results from these studies suggested an increased and significant risk of CVD due to stress. Of the 15 studies that included subclinical CVD outcomes, the majority showed that mid-life women experiencing greater levels of stress had more subclinical CVD, as indicated by carotid intima-media thickness, flow-mediated dilation and arterial stiffness; however, several studies reported null associations. CONCLUSIONS General life stress, including perceived stress and life events, in mid-life was significantly related to later-life CVD risk and mid-life subclinical CVD in the majority of studies published in the past six years. Job stress was inconsistently related to CVD risk in women, and fewer studies examined characteristics of other social roles, such as marriage, motherhood or caregiving. Perceived discrimination also was associated with CVD events and subclinical CVD in some samples of mid-life women. Further investigation into specific stressors relevant to women in mid-life, including caregiving and marital stress, are needed to understand the full extent to which life stress impacts CVD risk in mid-life women.
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Affiliation(s)
- Andrea L. Stewart
- Department of Epidemiology, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260 USA
| | - Ummul-Kiram Kathawalla
- Department of Psychology, University of Minnesota, 75 E River Parkway, Minneapolis, MN 55414 USA
| | - Alexandra G. Wolfe
- Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414 USA
| | - Susan A. Everson-Rose
- Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414 USA
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25
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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Berntson J, Patel JS, Stewart JC. Number of recent stressful life events and incident cardiovascular disease: Moderation by lifetime depressive disorder. J Psychosom Res 2017; 99:149-154. [PMID: 28712421 PMCID: PMC5558851 DOI: 10.1016/j.jpsychores.2017.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We investigated whether number of recent stressful life events is associated with incident cardiovascular disease (CVD) and whether this relationship is stronger in adults with a history of clinical depression. METHODS Prospective data from 28,583 U.S. adults (mean age=45years) initially free of CVD who participated in Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Number of past-year stressful life events (Wave 1), lifetime depressive disorder (Wave 1), and incident CVD (Wave 2) were determined by structured interviews. RESULTS There were 1069 cases of incident CVD. Each additional stressful life event was associated with a 15% increased odds of incident CVD [Odds Ratio (OR)=1.15, 95% Confidence Interval (CI): 1.11, 1.19]. As hypothesized, a stressful life events by lifetime depressive disorder interaction was detected (P=0.003). Stratified analyses indicated that stressful life events had a stronger association with incident CVD among adults with (OR=1.18, 95% CI: 1.10, 1.27, n=4908) versus without (OR=1.10, 95% CI: 1.07, 1.14, n=23,675) a lifetime depressive disorder. CONCLUSION Our findings suggest that a greater number of recent stressful life events elevate the risk of new-onset CVD and that this risk is potentiated in adults with a history of clinical depression.
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Affiliation(s)
- Jessica Berntson
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, United States
| | - Jay S Patel
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, United States
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, United States.
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27
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How life stressors influence modifiable lifestyle factors, depressive symptoms, and physical and mental health among Vietnamese older women? BMC Psychiatry 2017; 17:232. [PMID: 28662638 PMCID: PMC5492294 DOI: 10.1186/s12888-017-1395-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Research has demonstrated that exposure to life stressors can influence health through a number of pathways. However, knowledge about the patterns of life stressors and their contributions to health in different populations is limited. Vietnamese older women have attracted little research to date in this area. METHODS This cross-sectional study used an interview-administered-questionnaire to collect data from 440 Vietnamese older women. Descriptive analysis was used to describe life stressors among Vietnamese older women. Binary analysis and Structural Equation Modelling statistical analysis were used to examine the influences of life stressors on modifiable lifestyle factors, depressive symptoms, physical and mental health among Vietnamese older women. RESULTS Vietnamese older women in this study commonly reported the experience of losing a close person, including a baby/child, serious health or money problems, violence and disaster. Among the study participants, (1) exposure to more life stressors increased their depressive symptoms, and decreased their physical and mental health; (2) exposure to more life stressors also increased their physical health by increasing their physical activity levels. CONCLUSION Life stressors influenced health among Vietnamese older women through different pathways. Interventions to manage stress and depressive symptoms are required for Vietnamese older women in the future.
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28
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Lopizzo N, Tosato S, Begni V, Tomassi S, Cattane N, Barcella M, Turco G, Ruggeri M, Riva MA, Pariante CM, Cattaneo A. Transcriptomic analyses and leukocyte telomere length measurement in subjects exposed to severe recent stressful life events. Transl Psychiatry 2017; 7:e1042. [PMID: 28221367 PMCID: PMC5438034 DOI: 10.1038/tp.2017.5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/23/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023] Open
Abstract
Stressful life events occurring in adulthood have been found able to affect mood and behavior, thus increasing the vulnerability for several stress-related psychiatric disorders. However, although there is plenty of clinical data supporting an association between stressful life events in adulthood and an enhanced vulnerability for psychopathology, the underlying molecular mechanisms are still poorly investigated. Thus, in this study we performed peripheral/whole-genome transcriptomic analyses in blood samples obtained from 53 adult subjects characterized for recent stressful life events occurred within the previous 6 months. Transcriptomic data were analyzed using Partek Genomics Suite; pathway and network analyses were performed using Ingenuity Pathway Analysis and GeneMANIA Software. We found 207 genes significantly differentially expressed in adult subjects who reported recent stressful life experiences (n=21) compared with those without such experiences (n=32). Moreover, the same subjects exposed to such stressful experiences showed a reduction in leukocyte telomere length. A correlation analyses between telomere length and transcriptomic data indicated an association between the exposures to recent stressful life events and the modulation of several pathways, mainly involved in immune-inflammatory-related processes and oxidative stress, such as natural killer cell signaling, interleukin-1 (IL-1) signaling, MIF regulation of innate immunity and IL-6 signaling. Our data suggest an association between exposures to recent stressful life events in adulthood and alterations in the immune, inflammatory and oxidative stress pathways, which could be also involved in the negative effect of stressful life events on leukocyte telomere length. The modulation of these mechanisms may underlie the clinical association between the exposure to recent Stressful life events in adulthood and an enhanced vulnerability to develop psychiatric diseases in adulthood.
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Affiliation(s)
- N Lopizzo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
| | - S Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - V Begni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - S Tomassi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - N Cattane
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy
| | - M Barcella
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - G Turco
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - M Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - M A Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - C M Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College, London, London, UK
| | - A Cattaneo
- Biological Psychiatry Unit, IRCCS Fatebenefratelli S. Giovanni di Dio, Brescia, Italy,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College, London, London, UK,Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK. E-mail:
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Abstract
OBJECTIVE The aim of the study was to examine how psychological stress changes over time in young and middle-aged patients after experiencing an acute myocardial infarction (AMI) and whether these changes differ between men and women. METHODS We analyzed data obtained from 2358 women and 1151 men aged 18 to 55 years hospitalized for AMI. Psychological stress was measured using the 14-item Perceived Stress Scale (PSS-14) at initial hospitalization and at 1 month and 12 months after AMI. We used linear mixed-effects models to examine changes in PSS-14 scores over time and sex differences in these changes, while adjusting for patient characteristics and accounting for correlation among repeated observations within patients. RESULTS Overall, patients' perceived stress decreased over time, especially during the first month after AMI. Women had higher levels of perceived stress than men throughout the 12-month period (difference in PSS-14 score = 3.63, 95% confidence interval = 3.08 to 4.18, p < .001), but they did not differ in how stress changed over time. Adjustment for patient characteristics did not alter the overall pattern of sex difference in changes of perceived stress over time other than attenuating the magnitude of sex difference in PSS-14 score (difference between women and men = 1.74, 95% confidence interval = 1.32 to 2.16, p < .001). The magnitude of sex differences in perceived stress was similar in patients with versus without post-AMI angina, even though patients with angina experienced less improvement in PSS-14 score than those without angina. CONCLUSIONS In young and middle-aged patients with AMI, women reported higher levels of perceived stress than men throughout the first 12 months of recovery. However, women and men had a similar pattern in how perceived stress changed over time.
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Kelley KD, Peavy G, Edland S, Rogers W, Riley DE, Bordelon Y, Standaert D, Reich SG, Litvan I. The Role of Stress as a Risk Factor for Progressive Supranuclear Palsy. JOURNAL OF PARKINSON'S DISEASE 2017; 7:377-383. [PMID: 28409749 PMCID: PMC5952610 DOI: 10.3233/jpd-160945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND PSP, like Alzheimer's disease (AD), is a tauopathy. The etiopathogenesis of PSP is not well known and the role of stress has not yet been examined. Recent studies have shown that stress increases the risk for developing AD. This study investigates the role of stress as a risk factor for PSP. OBJECTIVE B To examine the association between the development of progressive supranuclear palsy (PSP) and self-reported life stressors. METHODS 76 patients diagnosed with PSP according to the NINDS-SPSP criteria and 68 age-matched unrelated controls were administered a life stressor questionnaire. Stress was quantified as total number of events, number of life changing events, and number of events characterized by self-rated severity. Conditional odds ratio (OR) was calculated for each measure, with participants in the highest quartile of each measure being defined as high-exposure in relation to all other participants. RESULTS There were no significant differences between the reported number of total events or life-changing events in cases and controls. However, we found 24.4% of cases (N = 11) and 9.1% of controls (N = 5) had a higher exposure to high severity events, yielding an OR of 3.2 (p = 0.04). CONCLUSIONS We found that cases have over a three times greater odds of high exposure to high-severity events than controls prior to the clinical development of PSP, while there were no differences in overall number of reported events. Our findings suggest that high exposure to highly stressful events may be associated with the development of PSP.
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Affiliation(s)
| | - Guerry Peavy
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
| | - Steven Edland
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
| | - Whitney Rogers
- Department of Neuroscience Training, University of Louisville, Louisville, KY, USA
| | - David E. Riley
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - David Standaert
- Department of Neurology, University of Alabama in Birmingham, Birmingham, AL, USA
| | - Stephen G. Reich
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - Irene Litvan
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
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Udo T, Purcell K, Grilo CM. Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. Int J Clin Pract 2016; 70:1003-1011. [PMID: 28032427 PMCID: PMC5215793 DOI: 10.1111/ijcp.12902] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022] Open
Abstract
AIM This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables. METHODS The study included 21 357 overweight/obese adults (52.9% women) from the 2001 to 2002 and 2004 to 2005 National Survey of Alcohol and Related Conditions. RESULTS Perceived weight discrimination was significantly associated with risk for arteriosclerosis, diabetes, high cholesterol, myocardial infarction, minor heart conditions and stomach ulcers. Perceived weight discrimination was associated with reporting more stressful life events. After adjusting additionally for stressful life events in the final multiple logistic regression, associations with arteriosclerosis, diabetes and minor cardiac conditions remained significant. Gender-stratified analyses revealed that perceived weight discrimination was associated with different medical conditions in women than men, and many associations became non-significant when adjusting for stressful life events, particularly for women. CONCLUSIONS Among overweight/obese adults, perceived weight discrimination is associated with significantly increased risk for obesity-related chronic medical conditions even after adjusting for BMI, physical activity and sociodemographic variables. Accounting for other acute stressful life events may also be important in understanding the health effects of perceived weight discrimination. Such added health risk of overweight/obesity posed by perceived weight discrimination warrants public health and policy interventions against weight discrimination to reduce the socioeconomic burden of obesity.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Katherine Purcell
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
- National Center on Addiction and Substance Abuse (at Yale), New Haven, CT. 06510
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Hougaard CØ, Nygaard E, Holm AL, Thielen K, Diderichsen F. Job mobility and health in the Danish workforce. Scand J Public Health 2016; 45:57-63. [PMID: 27887031 DOI: 10.1177/1403494816680785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The globalized economy has stimulated mobility in the labour market in many countries and Denmark has one of the highest rates of mobility between workplaces among the OECD countries. This raises the question of the potential health effects of mobility and the effect of disease on mobility. METHODS This study was register-based with a longitudinal design using data on the entire Danish population in 1992-2006. The data included mobility between employers and workplaces and seven different diseases based on admissions to hospital and drug prescriptions. RESULTS After adjusting for relevant confounders, an exposure-response relationship was seen between mobility and the incidence of ischaemic heart disease, stroke, duodenal ulcer, anxiety/depression and, most strongly, with alcohol-related disorders. The effects were not very strong, however, with odds ratios varying from 1.2 to 1.6. As expected, no effect was seen for colorectal cancer. We also found an effect of both somatic and mental disorders on mobility, but not for the two cancer types. Mobility did not seem to prevent being out of the labour force after diagnosis. CONCLUSIONS Frequent mobility in the labour market increases the risk of cardiovascular disease, common mental disorders and alcohol-related disorders and these diagnoses also seem to increase the risk of subsequent mobility.
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Affiliation(s)
| | - Else Nygaard
- 1 Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
| | - Astrid Ledgaard Holm
- 1 Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
| | - Karsten Thielen
- 1 Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark
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Drobizhev MY, Kikta SV, Machilskaya OV. CARDIOPSYCHIATRY. PROBLEMS OF TRANSLATION. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2016. [DOI: 10.15829/1728-8800-2016-4-88-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- M. Yu. Drobizhev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow
| | - S. V. Kikta
- Polyclinics № 3 of President’s Protocol Service, Moscow
| | - O. V. Machilskaya
- SRI of Urgent Care n.a. N. V. Sklifosofskiy of the Health Department, Moscow
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Comorbidity Factors and Brain Mechanisms Linking Chronic Stress and Systemic Illness. Neural Plast 2016; 2016:5460732. [PMID: 26977323 PMCID: PMC4761674 DOI: 10.1155/2016/5460732] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/11/2015] [Accepted: 10/25/2015] [Indexed: 12/16/2022] Open
Abstract
Neuropsychiatric symptoms and mental illness are commonly present in patients with chronic systemic diseases. Mood disorders, such as depression, are present in up to 50% of these patients, resulting in impaired physical recovery and more intricate treatment regimen. Stress associated with both physical and emotional aspects of systemic illness is thought to elicit detrimental effects to initiate comorbid mental disorders. However, clinical reports also indicate that the relationship between systemic and psychiatric illnesses is bidirectional, further increasing the complexity of the underlying pathophysiological processes. In this review, we discuss the recent evidence linking chronic stress and systemic illness, such as activation of the immune response system and release of common proinflammatory mediators. Altogether, discovery of new targets is needed for development of better treatments for stress-related psychiatric illnesses as well as improvement of mental health aspects of different systemic diseases.
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Vanasse A, Cohen A, Courteau J, Bergeron P, Dault R, Gosselin P, Blais C, Bélanger D, Rochette L, Chebana F. Association between Floods and Acute Cardiovascular Diseases: A Population-Based Cohort Study Using a Geographic Information System Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:168. [PMID: 26828511 PMCID: PMC4772188 DOI: 10.3390/ijerph13020168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 12/18/2022]
Abstract
Background: Floods represent a serious threat to human health beyond the immediate risk of drowning. There is few data on the potential link between floods and direct consequences on health such as on cardiovascular health. This study aimed to explore the impact of one of the worst floods in the history of Quebec, Canada on acute cardiovascular diseases (CVD). Methods: A cohort study with a time series design with multiple control groups was built with the adult population identified in the Quebec Integrated Chronic Disease Surveillance System. A geographic information system approach was used to define the study areas. Logistic regressions were performed to compare the occurrence of CVD between groups. Results: The results showed a 25%–27% increase in the odds in the flooded population in spring 2011 when compared with the population in the same area in springs 2010 and 2012. Besides, an increase up to 69% was observed in individuals with a medical history of CVD. Conclusion: Despite interesting results, the association was not statistically significant. A possible explanation to this result can be that the population affected by the flood was probably too small to provide the statistical power to answer the question, and leaves open a substantial possibility for a real and large effect.
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Affiliation(s)
- Alain Vanasse
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke (Québec), QC J1H 5N4, Canada.
- Research center of the Centre Hospitalier Universitaire de Sherbrooke (CHUS), 12th Avenue North, Sherbrooke (Québec), QC J1H 5N4, Canada.
| | - Alan Cohen
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke (Québec), QC J1H 5N4, Canada.
- Research center of the Centre Hospitalier Universitaire de Sherbrooke (CHUS), 12th Avenue North, Sherbrooke (Québec), QC J1H 5N4, Canada.
| | - Josiane Courteau
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke (Québec), QC J1H 5N4, Canada.
| | - Patrick Bergeron
- Department of Biological Sciences, Bishop's University, 2600 College Street, Sherbrooke (Québec), QC J1M, Canada.
| | - Roxanne Dault
- Department of Family Medicine and Urgent Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke (Québec), QC J1H 5N4, Canada.
| | - Pierre Gosselin
- Institute National de Santé Publique du Québec (INSPQ), 945 Wolf Avenue, Québec (Québec), QC G1V 5B3, Canada.
- Research center of the Centre Hospitalier Universitaire de Québec (CHUQ), Delta II building, 6th floor, 2875 Laurier Boulevard, Québec (Québec), QC G1V 2M2, Canada.
| | - Claudia Blais
- Institute National de Santé Publique du Québec (INSPQ), 945 Wolf Avenue, Québec (Québec), QC G1V 5B3, Canada.
- Faculty of Pharmacy, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec (Québec), QC G1V 0A6, Canada.
| | - Diane Bélanger
- Institute National de Santé Publique du Québec (INSPQ), 945 Wolf Avenue, Québec (Québec), QC G1V 5B3, Canada.
- Research center of the Centre Hospitalier Universitaire de Québec (CHUQ), Delta II building, 6th floor, 2875 Laurier Boulevard, Québec (Québec), QC G1V 2M2, Canada.
- The Eau Terre Environment Research center, Institute National de la Recherche Scientifique (INRS), 490 Couronne Street, Québec (Québec), QC G1K 9A9, Canada.
| | - Louis Rochette
- Institute National de Santé Publique du Québec (INSPQ), 945 Wolf Avenue, Québec (Québec), QC G1V 5B3, Canada.
| | - Fateh Chebana
- The Eau Terre Environment Research center, Institute National de la Recherche Scientifique (INRS), 490 Couronne Street, Québec (Québec), QC G1K 9A9, Canada.
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Abstract
OBJECTIVES To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults. METHODS The study sample came from 1992-2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51-61 years old in 1992 with no CVD history. A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity. RESULTS Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27% (hazard ratio [HR] = 1.27, 95% confidence interval = 1.17-1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose-response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant. CONCLUSION Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.
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Affiliation(s)
- Xiaoling Xiang
- a School of Social Work , University of Illinois at Urbana-Champaign , Urbana , IL , USA
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Denton EGD, Shaffer JA, Alcantara C, Cadermil E. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients. J Behav Med 2015; 39:28-40. [PMID: 26407692 DOI: 10.1007/s10865-015-9679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
Abstract
The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate density, there was an increase in depressive symptoms, but depressive symptoms slightly declined in census tracts with the highest density of Hispanics. Furthermore, gender significantly moderated the relation between Hispanic ethnic density and 1-year depressive symptom severity, such that Hispanic ethnic density was significantly associated with increased depressive symptom severity for female Hispanic patients with ACS, but not for male Hispanic patients. Previous research suggests that ethnic density may be protective against depression in Hispanic enclaves; however, our findings suggest a non-linear ethnic density effect and an overall more complex association between ethnic density and depression. These data add to a growing body of literature on the effects of sociodemographic and contextual factors on health.
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Affiliation(s)
- Ellen-Ge D Denton
- Department of Psychology, City University of New York College of Staten Island, 2800 Victory Blvd., Building 4S, Room 229, Staten Island, NY, 10314, USA.
| | - Jonathan A Shaffer
- University of Colorado Denver - Denver Campus, CLAS-Psychology, 3NC North Classroom, 1255 10th Street Mall, Denver, CO, 80217, USA
| | - Carmela Alcantara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 810, MC 4600, New York, NY, 10027, USA
| | - Esteban Cadermil
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA, 01610-1477, USA
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Xu X, Bao H, Strait K, Spertus JA, Lichtman JH, D'Onofrio G, Spatz E, Bucholz EM, Geda M, Lorenze NP, Bueno H, Beltrame JF, Krumholz HM. Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction. Circulation 2015; 131:614-23. [PMID: 25679303 DOI: 10.1161/circulationaha.114.012826] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Younger age and female sex are both associated with greater mental stress in the general population, but limited data exist on the status of perceived stress in young and middle-aged patients presenting with acute myocardial infarction. METHODS AND RESULTS We examined sex difference in stress, contributing factors to this difference, and whether this difference helps explain sex-based disparities in 1-month recovery using data from 3572 patients with acute myocardial infarction (2397 women and 1175 men) 18 to 55 years of age. The average score of the 14-item Perceived Stress Scale at baseline was 23.4 for men and 27.0 for women (P<0.001). Higher stress in women was explained largely by sex differences in comorbidities, physical and mental health status, intrafamily conflict, caregiving demands, and financial hardship. After adjustment for demographic and clinical characteristics, women had worse recovery than men at 1 month after acute myocardial infarction, with mean differences in improvement score between women and men ranging from -0.04 for EuroQol utility index to -3.96 for angina-related quality of life (P<0.05 for all). Further adjustment for baseline stress reduced these sex-based differences in recovery to -0.03 to -3.63, which, however, remained statistically significant (P<0.05 for all). High stress at baseline was associated with significantly worse recovery in angina-specific and overall quality of life, as well as mental health status. The effect of baseline stress on recovery did not vary between men and women. CONCLUSIONS Among young and middle-aged patients, higher stress at baseline is associated with worse recovery in multiple health outcomes after acute myocardial infarction. Women perceive greater psychological stress than men at baseline, which partially explains women's worse recovery.
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Affiliation(s)
- Xiao Xu
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Haikun Bao
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Kelly Strait
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - John A Spertus
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Judith H Lichtman
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Gail D'Onofrio
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Erica Spatz
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Emily M Bucholz
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Mary Geda
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Nancy P Lorenze
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Héctor Bueno
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - John F Beltrame
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.)
| | - Harlan M Krumholz
- From the Department of Obstetrics, Gynecology and Reproductive Sciences (X.X.), Department of Emergency Medicine (G.D.), Section of Cardiovascular Medicine, Department of Internal Medicine (E.S., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (X.X., H. Bao, K.S., E.S., E.M.B., M.G., N.P.L., H.M.K.); Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Chronic Disease Epidemiology (J.H.L.) and Department of Health Policy and Management (H.M.K.), Yale University School of Public Health, New Haven, CT; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H. Bueno); and Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, South Australia (J.F.B.).
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Goodman D, Park HL, Stefanick M, Hingle M, Lamonte M, LeBlanc E, Johnson K, Desai M, Anton-Culver H. Self-recalled Youth Physical Activity and Postmenopausal Cardiovascular Disease. HEALTH BEHAVIOR AND POLICY REVIEW 2014; 1:472-483. [PMID: 26523282 PMCID: PMC4627784 DOI: 10.14485/hbpr.1.6.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the association between childhood physical activity and incident cardiovascular disease (CVD) during postmenopausal years. METHODS Proportional hazards and logistic regression were used describe the association between self-reported childhood physical activity and CVD incidence and mortality in 36,741 postmenopausal women. RESULTS Older women, African-Americans, or nondrinkers or past drinkers self-reported the highest levels of youth physical activity and women with a history of diabetes, hypertension, overweight or obesity, or current smoking reported the highest youth physical activity dose. Youth physical activity was not associated with CVD incidence (HR=1.11; 0.93, 1.34) or mortality (HR=1.2; 0.9, 1.73). CONCLUSIONS Self-reported youth activity was not associated with postmenopausal CVD incidence or mortality.
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Affiliation(s)
- Deborah Goodman
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Hannah Lui Park
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Marcia Stefanick
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Melanie Hingle
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Michael Lamonte
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Erine LeBlanc
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Karen Johnson
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Manisha Desai
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, Irvine, CA
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Krajnak KM. Potential Contribution of Work-Related Psychosocial Stress to the Development of Cardiovascular Disease and Type II Diabetes: A Brief Review. ENVIRONMENTAL HEALTH INSIGHTS 2014; 8:41-5. [PMID: 25525370 PMCID: PMC4251185 DOI: 10.4137/ehi.s15263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 05/20/2023]
Abstract
Two of the major causes of death worldwide are cardiovascular disease and Type II diabetes. Although death due to these diseases is assessed separately, the physiological process that is attributed to the development of cardiovascular disease can be linked to the development of Type II diabetes and the impact that this disease has on the cardiovascular system. Physiological, genetic, and personal factors contribute to the development of both these disorders. It has also been hypothesized that work-related stress may contribute to the development of Type II diabetes and cardiovascular disease. This review summarizes some of the studies examining the role of work-related stress on the development of these chronic disorders. Because women may be more susceptible to the physiological effects of work-related stress, the papers cited in this review focus on studies that examined the difference in responses of men or women to work-related stress or on studies that focused on the effects of stress on women alone. Based on the papers summarized, it is concluded that (1) work-related stress may directly contribute to the development of cardiovascular disease by inducing increases in blood pressure and changes in heart rate that have negative consequences on functioning of the cardiovascular system; (2) workers reporting increased levels of stress may display an increased risk of Type II diabetes because they adopt poor health habits (ie, increased level of smoking, inactivity etc), which in turn contribute to the development of cardiovascular problems; and (3) women in high demand and low-control occupations report an increased level of stress at work, and thus may be at a greater risk of negative health consequences.
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