Association of psychosocial stress factors and vascular function before and after acute mental stress Public
Bruno, Melissa (Spring 2018)
Published
Abstract
Objective: Psychological stress, depression, and trauma are commonly hypothesized as important risk factors for adverse cardiovascular outcomes. In this study, we aimed to determine if a higher burden of psychosocial stress, assessed by means of a summary psychosocial stress score, is associated with worse vascular function before and after acute mental stress in cases with a previous myocardial infarction (MI) and age- and sex-matched community controls.
Methods: 303 cases who were hospitalized for MI and 110 community controls frequency matched on sex and age were included in this analysis. Flow-mediated vasodilation (FMD) and reactive hyperemia index (RHI) were measured before and 30 minutes after mental stress procedures and their association with a psychosocial summary score, including depression, post-traumatic stress disorder (PTSD), perceived stress, childhood trauma, and lifetime trauma, was examined.
Results: Overall, cases had more adverse sociodemographic and clinical profiles compared to controls. Cases exhibited a significant but weak negative correlation between the psychosocial distress summary score and post-mental stress RHI measurements, indicating worse vascular function per increased levels of distress (b -0.14, p=0.02). Controls had more significant correlations with vascular function compared to the cases. Among controls, the psychosocial distress summary score had significant correlations with pre- and post-mental health FMD, -0.334 (p<0.01) and -0.286 (p<0.01), respectively. Among cases there were no significant regressions coefficients for resting FMD or resting RHI. Controls had significant negative coefficients for all resting FMD models. For controls, significant positive interactions between time and stress score were found for RHI percent change in the crude (b= 2.9) and demographic-adjusted models (b= 2.9), but not after medical history adjustment.
Conclusions: Psychosocial stress is related more adverse resting vascular function in those without existing CAD, especially at rest. In those who have previously experienced a MI, stress is more related to post-mental stress vascular function. Due to the healthier state of vessels in those without CAD, a more definitive relationship between increasing psychosocial stress burden and impaired vascular function may be more evident in this group as opposed to the post-MI group. This study also demonstrates the importance to consider cumulative effects of psychosocial stress variables on vascular function.
Table of Contents
INTRODUCTION.......................................1
METHODS..................................................4
RESULTS....................................................9
DISCUSSION.............................................13
STRENGTHS AND WEAKNESSES........15
REFERENCES...........................................17
TABLES & FIGURES................................22
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