Negative feelings (discontent) predict progress of intima-media thickness of the common carotid artery in treated hypertensive men at high cardiovascular risk

Associations of Psychological Well-Being With Carotid Intima Media Thickness in African American and White Middle-Aged Women

OBJECTIVES

The present cross-sectional study aimed to a) examine associations between measures of psychological well-being, specifically life satisfaction and life engagement, and intima media thickness, a subclinical marker of atherosclerosis; b) investigate if the interaction of psychological well-being and life events correlated with intima media thickness; and c) explore these relationships across race.

METHODS

A sample of 485 women (38% African American and 62% white; mean [standard deviation] age = 50.2 [2.9] years) underwent ultrasonography to assess carotid artery intima media thickness (IMT). The women completed self-report measures of life satisfaction, life engagement, and life events.

RESULTS

Average (standard deviation) IMT was 0.666 (0.10) mm. Life satisfaction showed a significant, independent, inverse relationship with IMT, after controlling for demographic, behavioral, psychological, and cardiovascular covariates (β = -0.105, p = .039), such that each 1-point higher life satisfaction score was correlated with a significant 0.008-mm lower level of mean IMT. No significant association was seen between life events and IMT (r = 0.05, p = .32), and life satisfaction did not interact with life events on IMT (β = -0.036, p = .46). No significant interaction between life satisfaction and race on IMT was observed (β = 0.068, p = .37). In contrast to life satisfaction, life engagement was not a significant correlate of IMT (r = -0.07, p = .12).

CONCLUSIONS

Life satisfaction, a measure of psychological well-being, is an important independent correlate of subclinical atherosclerosis in middle-aged women.

Association of depression with common carotid artery intima media thickness and augmentation index in a large Urban South Indian population- The Chennai Urban Rural Epidemiology Study (CURES - 138)

AIM

The aim of the study was to assess the relationship of depression with carotid intima media thickness and augmentation index in Asian Indians.

RESEARCH DESIGN AND METHODS

For this study, 1505 subjects were randomly selected from a population based study conducted in Chennai, South India. Right common carotid artery intima medial thickness [IMT] was determined using high-resolution B-mode ultrasonography. Augmentation index [AI] was measured using the Sphygmocor apparatus. Depressive symptoms were assessed using a previously validated instrument, the Patient Health Questionnaire -12 (PHQ -12).

RESULTS

Of the 1505 subjects included in this study, depressive symptoms were present in 16.6% (n = 250) of the subjects. The mean IMT and AI values among subjects with depression were significantly higher than those without depression [0.83 ± 0.43 mm vs 0.73 ± 0.12 mm, P < 0.001] and IMT was higher in females with depression while AI was higher in males with depression. However, both IMT and AI were higher among those with depression in both genders. In multiple logistic regression model, depressive symptoms were associated with IMT even after adjusting for age, gender, body mass index, fasting plasma glucose, serum cholesterol and hypertension (Odds ratio [OR] =2.17, 95% Confidence intervals [CI]:1.01- 4.63, P = 0.047) but in the case of AI, the significance was lost in the adjusted model (OR = 1.01, 95% CI: 0.991-1.02, P = 0.445).

CONCLUSION

Among Asian Indians, presence of depressive symptoms was associated with carotid intima media thickness and Augmentation index, even after adjusting for potential confounders.

Associations between dimensional personality measures and preclinical atherosclerosis: the cardiovascular risk in Young Finns study

OBJECTIVE

To assess how multidimensional personality-trait theories, such as the Psychobiological Model of Temperament and Character, and the Five-factor Model of Personality, are associated with subclinical atherosclerosis as indicated by carotid intima-media thickness (IMT). The analysis was designed to tolerate non-linear development in which the same personality profiles can have multiple final outcomes and different antecedent profiles can have the same final outcome.

METHODS

605 men and 844 women (average age 31.6year, s.d.=5.0, range=24-39) provided data on IMT and traits of the psychobiological model, 725 men and 1011 women were assessed for IMT and the five-factor model (age 37.7year, s.d.=5.0, range=30-45). Robust multidimensional Hotelling's T(2) statistic was used to detect personality differences between participants with high IMT and others. Model-based clustering method further explored the effect.

RESULTS

Those with a high level of subclinical atherosclerosis within the sample (highest IMT-decile) had a combined higher persistence (i.e., were perseverative or perfectionistic), more disorganized (schizotypal) character, and more antisocial temperamental configuration than others (P=0.019). No effect was found for the five-factor model (P=0.978). Traditional methods that did not account for multidimensionality and nonlinearity did not detect an association.

CONCLUSION

Psychological well-being may have positive effects on health that reduce atherosclerosis in the population as a whole. Increased subclinical atherosclerosis was associated with a profile that combines known risk factors, such as cynical distrust and hostile tendencies. More frequent use of statistical procedures that can cope with non-linear interactions in complex psychobiological systems may facilitate scientific advances in health promotion.

Cardiac signatures of personality

BACKGROUND

There are well-established relations between personality and the heart, as evidenced by associations between negative emotions on the one hand, and coronary heart disease or chronic heart failure on the other. However, there are substantial gaps in our knowledge about relations between the heart and personality in healthy individuals. Here, we investigated whether amplitude patterns of the electrocardiogram (ECG) correlate with neurotisicm, extraversion, agreeableness, warmth, positive emotion, and tender-mindedness as measured with the Neuroticism-Extraversion-Openness (NEO) personality inventory. Specifically, we investigated (a) whether a cardiac amplitude measure that was previously reported to be related to flattened affectivity (referred to as Eκ values) would explain variance of NEO scores, and (b) whether correlations can be found between NEO scores and amplitudes of the ECG.

METHODOLOGY/PRINCIPAL FINDINGS

NEO scores and rest ECGs were obtained from 425 healthy individuals. Neuroticism and positive emotion significantly differed between individuals with high and low Eκ values. In addition, stepwise cross-validated regressions indicated correlations between ECG amplitudes and (a) agreeableness, as well as (b) positive emotion.

CONCLUSIONS/SIGNIFICANCE

These results are the first to demonstrate that ECG amplitude patterns provide information about the personality of an individual as measured with NEO personality scales and facets. These findings open new perspectives for a more efficient personality assessment using cardiac measures, as well as for more efficient risk-stratification and pre-clinical diagnosis of individuals at risk for cardiac, affective and psychosomatic disorders.

Health-related quality of life in hypertension, chronic kidney disease, and coexistent chronic health conditions

With the increasing prevalence of hypertension, there has been a growing interest in understanding the health-related quality of life (HRQOL) of patients with hypertension. Although hypertension is often perceived as asymptomatic, it is associated with impaired HRQOL because of complications or comorbidities, awareness of the diagnosis, and adverse effects from antihypertensive medications. This article focuses on the literature published since 2000, on HRQOL in elderly hypertensive individuals as well as hypertensives with co-existent diseases, including chronic kidney disease, cardiovascular disease, and diabetes mellitus. Most of the studies found that hypertensive individuals with co-existent co-morbidities tend to have lower HRQOL than those with hypertension alone, and identified the number of co-morbid illnesses as an independent determinant of HRQOL. The most pronounced effect was noted in the physical function domains of HRQOL. Studies have also examined the effects on HRQOL of specific classes of antihypertensive drugs without specific demonstration of superiority of one drug class over another in terms of HRQOL measures. Although there is evidence in favor of angiotensin-converting enzyme-inhibition for improving renal and cardiovascular outcomes in hypertensive patients, its role in ameliorating HRQOL outcomes remains to be established.

Chronic stress and the development of early atherosclerosis: moderating effect of endothelial dysfunction and impaired arterial elasticity

This study aims to explore the interactive effect of vital exhaustion (VE) and endothelial dysfunction on preclinical atherosclerosis, assessed by carotid intima-media thickness (IMT). Furthermore, interaction between VE and carotid elasticity is examined. Participants were 1,596 young healthy adults from the Cardiovascular Risk in Young Finns study. Endothelial dysfunction was measured by brachial flow-mediated dilatation (FMD), and carotid elasticity by carotid artery compliance (CAC). Significant interactions between FMD and VE, and between CAC and VE, for IMT were found in participants with the very lowest FMD and CAC. Thus, VE may be harmful if the endothelium is not working properly.

Quality of life and insulin resistance in patients with coronary heart disease

BACKGROUND AND OBJECTIVE

Diabetes mellitus and impaired glucose tolerance have not only been associated with increased morbidity and mortality, but also with poor quality of life. The purpose of this study was to determine whether there is a relationship between poor quality of life and insulin resistance in patients with myocardial infarction without known diabetes mellitus.

METHODS AND RESULTS

One hundred and nineteen patients, men and women aged between 31 and 80 years with a hospital-diagnosed myocardial infarction occurring 3 months before inclusion, were studied. Minor symptoms evaluation profile was used to estimate the quality of life at entry. Low quality of life (contentment and vitality) was significantly negatively (P<0.05) associated with insulin resistance.

CONCLUSION

In patients with coronary heart disease and without known diabetes mellitus an estimated measure of quality of life was significantly and independently associated with poor insulin resistance.

Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes

AIMS

Recent studies have suggested an association between depression and subclinical atherosclerosis as measured by presence of carotid atherosclerotic plaque and increased intima-media thickening in non-clinical populations. Given the high prevalence of depression in patients with Type 1 diabetes and the diabetes-related risk factors for atherosclerosis, we hypothesized that this relation might also be of special relevance in Type 1 diabetic patients.

METHODS

Intima-media thickness (IMT) and the presence of plaques in the carotid arteries were quantitatively assessed by high-resolution ultrasound in 175 adults (89 men, 86 women) with an established diagnosis of Type 1 diabetes. Having been treated for depression or current Beck Depression Inventory scores > 10 were considered to indicate depression.

RESULTS

In men, the risk of plaque was higher in depressed subjects relative to non-depressed participants after adjustment for age, smoking status, systolic blood pressure, dyslipidaemia and body mass index [odds ratio (OR) 5.19; 95% confidence interval (CI) 1.29, 20.81]. Depressed women did not have an increased risk of plaque compared with non-depressed women (OR 0.97; 95% 95% CI 0.22, 4.34). We did not observe an association between depression and IMT, in men or in women.

CONCLUSIONS

In line with previous research, our findings suggest a link between depression and subclinical atherosclerosis in Type 1 diabetic men, but not in women.

Auto-eficácia, doenças crônicas e incapacidade funcional na velhice

A doença crônica, maior causa de incapacidade entre os idosos, é de grande interesse porque é influenciada por fatores médicos, psicológicos e sociais. O objetivo desta revisão é mostrar a relevância da crença de auto-eficácia como mecanismo protetor ou mediador no ajustamento de idosos incapacitados. Pesquisas indicam que quanto maior as crenças de auto-eficácia, menor a incapacidade, o distress psicológico, os sintomas depressivos, o declínio em atividades básicas e instrumentais da vida diária; e maior a saúde percebida, o ajustamento à dor, o esforço despendido em atividades requeridas, o ajustamento pessoal e a capacidade de mobilização de recursos de enfrentamento.

Psychosocial factors at home and at work and four-year progression in intima media thickness

This study analyzed the relationship between psychosocial factors and progression in intima media thickness (IMT). In 1998 and 2002, 95 healthy participants underwent a clinical examination, including ultrasound of the arteria carotis communis (ACC). IMT progression in women was 0.033 mm/year (SD=0.033) and in men 0.048 mm/year (SD=0.033). For cohabiting women as opposed to single women, the means for total IMT progression over the 4 years were, respectively, 0.137 (SE=0.019) and 0.016 (SE=0.048) mm. For women with above average as opposed to below average mean scores of effort, IMT progression were 0.149 (SE=0.026) and 0.098 (SE=0.024) mm, respectively. For men without children as opposed to men with children, mean scores for IMT progression were 0.231 (SE=0.029) and 0.137 (SE=0.028) mm, respectively. For men above average as opposed to those below average, scores of effort-reward imbalance IMT progression were 0.216 (SE=0.030) and 0.155 (SE=0.027) mm, respectively. Adjustment for confounders did not change the results significantly. We found that psychosocial factors were independent significant predictors of IMT progression. The associations were different between the genders.

Depressive symptoms and carotid artery intima-media thickness in young adults: the Cardiovascular Risk in Young Finns Study

OBJECTIVE

Depression and coronary heart disease are often comorbid conditions, but the mechanism behind this link is largely unknown. We tested the hypothesis that a high level of depressive symptoms in healthy young adults would be related to more prevalent preclinical atherosclerosis.

METHODS

We studied the association between depressive symptoms and carotid atherosclerosis in 1126 young adults (410 men and 716 women) as part of the ongoing population-based Cardiovascular Risk in Young Finns Study. The participants responded to a revised version of Beck's Depression Inventory in 1992, 1997, and 2001. Carotid atherosclerosis was assessed by measuring the thickness of the common carotid artery intima-media complex with ultrasound in 2001. Cardiovascular risk factors were measured in childhood/adolescence (1980) and in adulthood (2001).

RESULTS

In men, high scorers of depressive symptoms in 2001 had higher carotid artery intima-media thickness (0.63 mm) compared with those with low or moderate scores on depressive symptoms (0.57 mm). This relationship (B = 0.08, F[1, 405] = 9.24, p = .003) persisted after adjustment for age and cardiovascular risk factors in adolescence and adulthood. Depression scores in 1992 and 1997 were not predictive of intima-media thickness. In women, no association was found between depressive symptoms and intima-media thickness.

CONCLUSIONS

Depressive symptoms during early adulthood seem to be associated with higher levels of carotid intima-media thickness in men, but not in women.

Reduced quality of life after myocardial infarction in women compared with men

BACKGROUND

Psychosocial factors have been suggested as risk factors for atherosclerotic disease.

HYPOTHESIS

The purpose of the present study was to examine whether there is a gender difference in quality of life after a myocardial infarction with modem treatment of acute ischemic heart disease.

METHODS

In all, 123 men and women aged between 31 and 80 years, and with a hospital-diagnosed myocardial infarction occurring 1-12 months prior to inclusion, were studied. Minor symptoms evaluation profile (MSEP) was used to estimate quality of life at entry.

RESULTS

Age, hemodynamic data, smoking habits, as well as laboratory data, concomitant cardiovascular disease, and revascularization rate did not differ between men and women. Women had significantly more negative feelings regarding all the estimated dimensions of quality of life (Contentment, Vitality, and Sleep) than did men.

CONCLUSION

Self-assessed quality of life after a myocardial infarction was significantly lower among women than among men despite similar age, treatment, and hemodynamic and laboratory data. The causal relationship is however, not known. Further studies are needed to evaluate the underlying mechanism of this observation. This may lead to the development of novel treatment strategies in female patients after a myocardial infarction.

Geriatric depression and vascular diseases: what are the links?

BACKGROUND

The term "vascular depression" has been proposed to describe a subset of depressive disorders that occurs in old age as a consequence of cerebrovascular disease. However, depression has been shown to result from other cardiovascular diseases such as coronary heart diseases, as well as to precipitate, worsen or precede vascular diseases. Depression also increases the likelihood of the incidence of vascular risk factors such as diabetes.

AIMS

To review clinical and epidemiological evidence linking geriatric depression and vascular diseases, and to discuss the potential mechanisms that could underlie this association.

METHOD

Systematic review of the literature of the last 5 years through Medline database search.

RESULTS

Papers report the following potential ways of association: (1) there is a direct influence of vascular disease, in particular, arteriosclerosis, on the incidence of depression; (2) depressive disorders have a direct impact on the cardiovascular system; (3) depression and vascular disease share either a common pathophysiological process or genetic determinants.

DISCUSSION

Depression can be understood as the direct consequence of brain damage in neurodegenerative disorders such as Parkinson's or Huntington's diseases. Similarly, vascular depression is mostly considered to be the consequence of microvascular lesions on prefrontal and subcortical regions. However, this functional neuroanatomical model offers no explanation for cases where depression has been shown to precede vascular diseases. Since cardiovascular diseases develop in a context of acquired environmental factors together with genetically determined disease, it may be postulated that geriatric depression could both result from brain lesions of vascular origin and also share some pathogenic or genetic determinants.

Low Well-Being Is an Independent Predictor for Stroke in Elderly Patients with Diabetes Mellitus

OBJECTIVES

To examine whether psychological factors are risk factors for the development of stroke in elderly diabetic patients.

DESIGN

Prospective cohort study.

SETTING

Outpatient clinic.

PARTICIPANTS

Three hundred seventy-six diabetic outpatients free of stroke; mean age 75.

METHODS

Well-being and diabetes-specific burden were assessed at baseline using the Philadelphia Geriatric Center morale scale and the Elderly Diabetes Burden Scale (EDBS), respectively. Symptomatic stroke was defined as a focal neurological deficit with rapid onset that persists for more than 24 hours, supported by brain computed tomography or magnetic resonance imaging.

RESULTS

During the 3-year follow-up period, 25 symptomatic strokes (24 ischemic strokes and 1 cerebral hemorrhage) occurred. Low scores on the morale scale (</=7) were significant predictors for stroke after adjustment for age; sex; body mass index; hemoglobin A1c level; systolic blood pressure; serum levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol; smoking; and previous ischemic heart disease (IHD) (hazard ratio (HR)=3.0, 95% confidence interval (CI)=1.2-7.3, P=.017). The relationship between low morale scores and future stroke remained significant after adjusting for socioeconomic factors and microalbuminuria. Increased symptom burden and social burden, but not dietary restrictions, worry about diabetes mellitus (DM), treatment satisfaction, and burden by tablets or insulin of EDBS, were also significant predictors for stroke after adjustment for age, sex, duration of DM, previous IHD, and microalbuminuria (HR=2.6, 95% CI=1.1-6.5, P=.039).

CONCLUSION

Low well-being and symptom burden were predictors of stroke in elderly patients with diabetes mellitus (DM), although the causal relationship remains unknown.

Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures

BACKGROUND

Studies have linked depression to sudden death and serious cardiovascular events in patients with preexisting cardiac illness. Recent studies have shown decreased vagal function in cardiac patients with depression and depressed patients without cardiac illness.

METHODS

We compared 20-hour, sleeping, and awake heart period variability measures using spectral analysis, fractal dimension, and symbolic dynamics in two patient groups with major depression and ischemic heart disease (mean age 59-60 years) before and after 6 weeks of paroxetine or nortriptyline treatment.

RESULTS

Spectral measures showed decreases in awake and sleeping total power (TP: 0.0-0.5 Hz), ultra low frequency power (ULF: 0-0.0033 Hz), very low frequency power (VLF: 0.0033-0.04 Hz), and low-frequency power (LF: 0.04-0.15 Hz) for nortriptyline condition and a decrease in high-frequency power (HF: 0.15-0.5 Hz) for the awake condition in patients who received nortriptyline. A measure of nonlinear complexity, WC-100, significantly increased after paroxetine during the awake condition.

CONCLUSIONS

These findings suggest that nortriptyline has stronger vagolytic effects on cardiac autonomic function compared with paroxetine, which is in agreement with previous clinical and preclinical reports. Paroxetine may have some cardio-protective effects, especially in cardiac patients.

Diminished chaos of heart rate time series in patients with major depression

BACKGROUND

Depression and anxiety have been linked to serious cardiovascular events in patients with preexisting cardiac illness. A decrease in cardiac vagal function as suggested by a decrease in heart rate (HR) variability has been linked to sudden death.

METHODS

We compared LLE and nonlinearity scores of the unfiltered (UF) and filtered time series (very low, low, and high frequency; VLF, LF and HF) of HR between patients with depression (n = 14) and healthy control subjects (n = 18).

RESULTS

We found significantly lower LLE of the unfiltered series in either posture, and HF series in patients with major depression in supine posture (p <.002). LLE (LF/UF), which may indicate relative sympathetic activity was also significantly higher in supine and standing postures in patients (p <.05); LF/HF (LLE) was also higher in patients (p <.05) in either posture.

CONCLUSIONS

These findings suggest that major depression is associated with decreased cardiac vagal function and a relative increase in sympathetic function, which may be related to the higher risk of cardiovascular mortality in this group and illustrates the usefulness of nonlinear measures of chaos such as LLE in addition to the commonly used spectral measures.

Going to the heart of the matter: do negative emotions cause coronary heart disease?

OBJECTIVE

Negative emotions, such as anger, anxiety, and depression, have emerged as potentially important risk factors for coronary heart disease. The purpose of this article is to consider the nature and function of emotions, to review epidemiological evidence for an association between the three negative emotions and coronary heart disease (CHD), to discuss briefly the mechanisms by which emotions may be linked to CHD, and to consider this evidence in light of theoretical insights provided by mainstream psychological research on emotions.

METHODS

We collected articles published between 1980 and 1998 on the relationship between each negative emotion and CHD. We also collected review articles or chapters published during the same time period that considered mechanisms by which emotions may increase CHD risk. We used a qualitative approach to review the published literature.

RESULTS

Evidence that anxiety is involved in the onset of CHD is strongest, whereas evidence for an association between anger and CHD is limited but suggestive. Although depression has consistently been linked to mortality following a myocardial infarction, evidence for its role in the onset of coronary disease is quite mixed. Numerous unresolved issues leave our current understanding of the emotion-health relationship incomplete. Psychological theories of emotion are considered to help address gaps in our knowledge.

CONCLUSION

Growing evidence indicates that negative emotions may influence the development of CHD. The focused and specific consideration of negative emotions and their possible role in the etiology of CHD gives insight into current knowledge and suggests important directions for future research.

Depression and bipolar disorder: relationships to impaired fatty acid and phospholipid metabolism and to diabetes, cardiovascular disease, immunological abnormalities, cancer, ageing and osteoporosis. Possible candidate genes

Depression and bipolar disorder are two of the commonest illnesses in the developed world. While some patients can be treated effectively with available drugs, many do not respond, especially in the depression related to bipolar disorder. Depression is associated with diabetes, cardiovascular disease, immunological abnormalities, multiple sclerosis, cancer, osteoporosis and ageing: in each case depressed individuals have a worse outcome than non-depressed individuals. In all of these conditions there is now evidence of impaired phospholipid metabolism and impaired fatty acid-related signal transduction processes. Impaired fatty acid and phospholipid metabolism may be a primary cause of depression in many patients and may explain the interactions with other diseases. Several novel gene candidates for involvement in depression and bipolar disorder are proposed.

Cardiac autonomic control buffers blood pressure variability responses to challenge: a psychophysiologic model of coronary artery disease

This article presents a model that identifies effects of blood pressure variability (BPV) as a possible mechanism by which psychological/psychiatric factors and health behaviors confer increased risk of coronary artery disease (CAD) and acute coronary syndromes. Recent research in vascular biology and dynamics of coronary artery blood flow suggests that BPV may have pathogenic effects on the coronary endothelium, plaque formation, and plaque stability. Thus, BPV may be a risk factor for cardiovascular disease independent of mean arterial pressure. The model proposes that autonomic control of the heart exerts a buffering or inhibitory influence on oscillations in blood pressure. Established psychological/behavioral risk factors for CAD, such as depression, hostility, and anxiety, as well as physical deconditioning and aging, are associated with diminished autonomic control of the heart, which may disinhibit pathogenic BPV. Together, these data suggest a coherent, testable psychophysiological model of CAD. In this article, we review these data and make recommendations for research to examine the model.

Stroke was predicted by dimensions of quality of life in treated hypertensive men

BACKGROUND AND PURPOSE

Psychosocial factors have been suggested as risk factors for atherosclerotic disease. The purpose of the present study was to examine whether quality of life predicted strokes and acute coronary events in a prospective study.

METHODS

The study included 412 treated hypertensive men, aged 50 to 72 years, with >/=1 of the following: serum cholesterol >/=6.5 mmol/L, smoking, or diabetes mellitus. The Minor Symptoms Evaluation Profile (MSEP) was used to estimate quality of life at entry. Incidences of stroke and acute coronary events were recorded during follow-up. The median follow-up time was 6.6 years.

RESULTS

Sixty-four patients had an acute coronary event, and 37 had a stroke during the follow-up period. The Cox regression analyses revealed that the 3 dimensions of MSEP at entry were significant predictors of stroke. The relationship between low contentment at entry and the incidence of stroke during follow-up remained significant (relative risk=1.04; 95% CI, 1.01 to 1.06; P=0.003) even after adjustment for other potential cardiovascular risk factors. Vitality also remained an independent predictor for stroke after adjustment for these potential cardiovascular risk factors (relative risk=1.04; 95% CI, 1. 02 to 1.06; P<0.0001). There was no relationship between MSEP score at entry and myocardial infarction during follow-up.

CONCLUSIONS

An independent and significant association between reduced well-being at entry and future stroke was observed in hypertensive men at high cardiovascular risk. The causal relationship is not known, however.

Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women?

OBJECTIVE

In this article, we evaluated the prospective association between measures of trait anger, hostility, and anxiety and indices of carotid atherosclerosis in 200 healthy middle-aged postmenopausal women.

METHODS

Starting in 1983, 541 premenopausal women were evaluated for their levels of standard cardiovascular risk factors and psychosocial attributes, including their scores on Spielberger Trait Anger, Anxiety, and Anger-in, and Public Self-Consciousness. Starting in 1991, the Cook-Medley Hostile Attitudes Scale was also administered. Starting in 1993, 200 women who had been menopausal for at least 5 years were scanned for carotid atherosclerosis using B-mode ultrasound. The scans were scored for average intima-media thickness (IMT) and plaque index.

RESULTS

Women who had high Trait Anger, Anger-In, and Public Self-Consciousness scores had high IMT scores on average 10 years later. Women who had high Cook-Medley scores also had high IMT scores on average 1.5 years later. Multivariate analyses adjusting for the standard cardiovascular risk factors that most highly predicted IMT scores indicated that holding anger in, being self aware, and having hostile attitudes were significant predictors of IMT. Women with higher plaque scores also tended to report holding in their anger.

CONCLUSIONS

Anger suppression and hostile attitudes do predict women's carotid IMT in midlife. Ultrasound measures of carotid atherosclerosis can be used to advance our understanding of the early development of atherosclerosis in women.

Improvement in various estimates of quality of life after coronary artery bypass grafting in patients with and without a history of hypertension

OBJECTIVE

To describe various estimates of the quality of life (QOL) prior to and for 2 years after coronary artery bypass grafting (CABG) for patients with a history of hypertension compared with nonhypertensives.

METHODS

Patients in western Sweden in whom CABG had been performed between 1988 and 1991 participated. Their QOL was estimated from the Physical Activity Score, the Nottingham Health Profile, and the Psychological General Well-being Index.

RESULTS

All three questionnaires detected a significant improvement in QOL already at 3 months, which persisted at 1 and 2 years both for hypertensive and for nonhypertensive patients. With the Physical Activity Score and the Psychological General Well-being Index the improvement in QOL of hypertension patients was less marked 3 months after the operation compared with that of nonhypertensives (P < 0.05). Two years after the CABG improvement was less marked for hypertensive patients than it was for nonhypertensive patients in terms of the Physical Activity Score (P < 0.01). With the Nottingham Health Profile the improvement was similar for hypertensive and nonhypertensive patients at each evaluation after the operation. With all three measures the results indicated that hypertensive patients had a worse QOL that did nonhypertensive patients. However, in a multivariate analysis considering other risk indicators simultaneously, a history of hypertension did not appear as an independent risk indicator for an adverse QOL 2 years after CABG.

CONCLUSION

There was a significant improvement in various QOL estimates after CABG both for hypertensive and for nonhypertensive patients. The degree of improvement tended to be less marked for hypertensive patients than it was for nonhypertensive patients, especially 3 months after the operation and concerning physical activities. Hypertensives had a worse QOL than did nonhypertensives. However, the differences were small and could mainly be explained in terms of factors other than hypertension.