Sex differences in the combined effect of chronic stress with impaired vascular endothelium functioning and the development of early atherosclerosis: the Cardiovascular Risk in Young Finns study

Stress-Related Exhaustion, Polygenic Cognitive Potential, and Cognitive Test Performance - A General Population Study

Background

We investigated whether stress-related exhaustion (chronic or short-term, and co-occurring with depression or not) is related to cognitive performance and whether polygenic cognitive potential modifies these associations.

Methods

The participants were from the Young Finns Study (N = 541-1273). Stress-related exhaustion was assessed using the Maastricht Questionnaire, depressive symptoms with the Beck Depression Inventory, and cognitive performance with subtests of the Cambridge Neuropsychological Test Automated Battery, measuring visuospatial learning, reaction time, sustained attention, and executive function. Cognitive performance and depression were assessed in 2011, and exhaustion in 2001, 2007, and 2011. A polygenic score for cognitive potential was calculated based on a GWAS on intelligence.

Results

High stress-related exhaustion, especially chronic, was associated with slower reaction time. Only clinical levels of depression were related to slower reaction time. Polygenic cognitive potential did not modify these associations. There were no differences in cognitive performance between individuals with co-occurring exhaustion and depression vs. those with only either condition.

Conclusion

Stress-related exhaustion, especially if chronic, seems to relate to slower reactions. Co-occurring exhaustion and depression may not have additive effects on cognitive performance. High polygenic cognitive potential may not protect from or predispose to harmful effects of exhaustion or depression on reaction time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10354-z.

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

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

Bidirectional pathways between psychosocial risk factors and paranoid ideation in a general nonclinical population

We investigated (a) whether psychosocial factors (experienced stress, anticipatory worry, social detachment, sleeping disturbances, alcohol use) predict the course of paranoid ideation between the ages of 24 to 50 years and (b) whether the predictive relationships are more likely to proceed from the psychosocial factors to paranoid ideation, or vice versa. The participants (N = 1534-1553) came from the population-based Young Finns study. Paranoid ideation and psychosocial factors were assessed by reliable self-report questionnaires in 2001, 2007, and 2011/2012. The data were analyzed using growth curve and structural equation models. High experienced stress, anticipatory worry, social detachment, frequent sleeping disturbances, and frequent alcohol use predicted more paranoid ideation. More risk factors predicted increasing paranoid ideation. There were bidirectional predictive relationships of paranoid ideation with experienced stress, anticipatory worry, social detachment, and sleeping disturbances. The link between alcohol use and paranoid ideation was only correlative. In conclusion, paranoid ideation increases by reciprocal interactions with stress, worry, social detachment, and sleeping disturbances. The findings support the threat-anticipation model of paranoid ideation, providing important implications for treatment of paranoia.

DDAH1 promoter -396 4N insertion variant is associated with increased risk of type 2 diabetes in a gender-dependent manner

Background

Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthases, making it a contributing factor for diabetes. Endogenous ADMA is hydrolyzed by dimethylarginine dimethylaminohydrolase 1 (DDAH1), and a DDAH1 promoter ‐396 4N deletion/insertion polymorphism (DDAH1: ‐396_‐395insGCGT) regulates its transcriptional activity. This study aimed to explore the association between this polymorphism and type 2 diabetes (T2DM).

Methods

In a case–control study, all participants were genotyped for this polymorphism within two sets of populations (discovery: 1,227 T2DM patients and 1,339 controls; replication: 1,190 patients and 1,651 controls). The disease association was assessed by a unconditional logistic regression model. Homeostasis model assessment calculations were conducted among different genotypes.

Results

We identified that DDAH1: ‐396_‐395insGCGT insertion allele was significantly associated with increased risk of T2DM (discovery: adjusted odds ratio [OR] = 1.380, 95% CI = 1.128–1.687, p = .002; replication: OR = 1.231, 95% CI = 1.007–1.504, p = .043). The homeostasis model assessment of insulin resistance was increased in participants carrying Ins/Ins alleles (p = .0452). Interestingly, the insertion allele increased the risk of T2DM in males but not in females (male discovery: OR = 1.528, 95% CI = 1.141–2.047, p = .004; replication: OR = 1.439, 95% CI = 1.083–1.911, p = .012; female discovery: OR = 1.218, 95% CI = 0.913–1.626, p = .18; replication: OR = 1.161, 95% CI = 0.871–1.548, p = .308).

Conclusion

The DDAH1: ‐396_‐395insGCGT insertion allele is associated with increased risk of T2DM in a gender‐dependent manner, affects males but not females.

Chronic stress: a critical risk factor for atherosclerosis

Chronic stress refers to the non-specific systemic reaction that occurs when the body is stimulated by various internal and external negative factors over a long time. The physiological response to chronic stress exposure has long been recognized as a potent modulator in the occurrence of atherosclerosis. Furthermore, research has confirmed the correlation between atherosclerosis and cardiovascular events. Chronic stress is pervasive during negative life events and may lead to the formation of plaque. Several epidemiological studies have shown that chronic stress is an independent risk factor for the development of vascular disease and for increased morbidity and mortality in patients with pre-existing coronary artery disease. One possible mechanism for this process is that chronic stress causes endothelial injury, directly activating macrophages, promoting foam cell formation and generating the formation of atherosclerotic plaque. This mechanism involves numerous variables, including inflammation, signal pathways, lipid metabolism and endothelial function. The mechanism of chronic stress in atherosclerosis should be further investigated to provide a theoretical basis for efforts to eliminate the effect of chronic stress on the cardiocerebral vascular system.

Interleukin-6 gene polymorphism, chronic stress and atherosclerosis: interleukin-6-174G>C polymorphism, chronic stress and risk of early atherosclerosis in the Cardiovascular Risk in Young Finns Study

OBJECTIVE

Interleukin-6 protein has been suggested as a mediator connecting chronic stress and cardiovascular diseases. We investigated whether the functional G174C polymorphism (rs1800795) of interleukin-6 gene is associated with vital exhaustion, a measure of chronic stress, or with preclinical atherosclerosis.

METHODS

Associations between the interleukin-6-174G>C polymorphism, preclinical atherosclerosis, and vital exhaustion were examined in 1673 women and men aged 24-39years participating in the Cardiovascular Risk in Young Finns study. Vital exhaustion was measured using Maastricht Questionnaire. Preclinical atherosclerosis was assessed by carotid intima-media thickness using ultrasound techniques. DNA was genotyped for the interleukin-6-174G>C polymorphism (rs1800795).

RESULTS

The GG genotype of the interleukin-6-174G>C polymorphism was associated with higher vital exhaustion. Moreover, higher vital exhaustion was associated with greater intima-media thickness in men carrying G alleles, adjusted for cardiovascular risk factors.

CONCLUSION

Our findings support a role for the interleukin-6-174G>C polymorphism in increased risk of atherosclerosis in individuals with chronic stress. In addition, individuals carrying the G allele of the interleukin-6-174G>C polymorphism may be more prone to adverse effects of psychosocial stress.

Association of inflammatory and oxidative stress biomarkers in subjects with cardiovascular risk

Cardiovascular disease is originated in the vascular endothelium, which controls the homeostasis and the filtration and diffusion of molecules from blood to the tissues. The classical cardiovascular risk factors (CRFs) act directly on the endothelium through an increase in the production of reactive oxygen species, promoting an endothelial activation mediated by the expression of adhesion and proinflammatory molecules, which lead to endothelial dysfunction, the progression of the atherosclerotic plaque, and the onset of cardiovascular disease. The objective of this study was to analyze the association of superoxide dismutase, catalase, gluthatione peroxidase, and lipoperoxidation with fibrinogen, interleukin (IL)-6, tumor necrosis factor-α, and vascular cell adhesion molecule (VCAM)-1 in subjects with cardiovascular risk (CVR) and CRF. This was a cross-sectional study of 114 individuals; oxidative stress (superoxide dismutase, catalase, gluthatione peroxidase, and lipoperoxidation) and inflammatory (fibrinogen, IL-6, tumor necrosis factor-α, and VCAM-1) biomarkers were measured; a CVR score (Framingham) and its CRF were taken into consideration to classify the participants. Twenty-nine subjects out of a total of 114 had high CVR. Smokers and subjects with diabetes (43 subjects) were excluded from the low CVR group. Significant decreases in lipoperoxidation, IL-6, and VCAM-1 and an increase in SOD were found in the high CVR group (P ≤ 0.05). Individual analysis of each CRF in the 114 subjects revealed a different pattern in the biomarkers' statistical differences. Concluding that the biomarkers show statistical differences in each CRF, especially IL-6, VCAM-1, and SOD; therefore, these are highly recommended to be used as biomarkers of the oxidative stress and inflammatory status in CVR.

How mental stress affects endothelial function

Mental stress is an important factor contributing to recognized mechanisms underlying cardiovascular events. Among these, stress-related endothelial dysfunction is an early risk factor that predicts future development of severe cardiovascular disorders. Acute mental stress by a variety of tests impairs endothelial function in humans, although the opposite results have been reported by some investigators. Chronic stress always deteriorates endothelial function in humans and experimental animals. Stress hormones, such as glucocorticoids and pro-inflammatory cytokines, and endothelin-1 liberated in response to mental stress participate in endothelial dysfunction possibly via downregulation of endothelial nitric oxide synthase (eNOS) expression, eNOS inactivation, decreased nitric oxide (NO) actions, and increased NO degradation, together with vasoconstriction counteracting against NO-induced vasodilatation. Catecholamines do not directly affect endothelial function but impair its function when blood pressure elevation by the amines is sustained. Endogenous opioids favorably affect endothelial function, which counteract deteriorating effects of other stress hormones and mediators. Inhibition of cortisol and endothelin-1 production, prevention of pro-inflammatory mediator accumulation, hypnotics, mirthful laughter, humor orientation, and lifestyle modification would contribute to the prevention and treatment for stress-related endothelial dysfunction and future serious cardiovascular disease.