Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study

Socioeconomic deprivation, unhealthy lifestyle, and premature mortality in patients with type 2 diabetes: A population-based longitudinal study

BACKGROUND

Adverse health behaviors have been found to play a role in linking socioeconomic deprivation and mortality, but relevant evidence in patients with type 2 diabetes is lacking. We aimed to quantify the mediation effect of overall lifestyles on the association between socioeconomic deprivation and premature mortality as well as the interaction of deprivation and lifestyle in diabetes.

METHODS

This cohort study included 20,463 UK Biobank participants with type 2 diabetes at recruitment between 2006 and 2010. Socioeconomic deprivation level was determined using the Townsend deprivation index. An overall lifestyle score was constructed based on six health behaviors including smoking, alcohol consumption, physical activity, diet, sleep duration, and television viewing time. Cox proportional hazards models were employed to investigate the associations of socioeconomic deprivation and lifestyle with premature mortality.

RESULTS

Over a mean follow-up of 7.4-12.7 years, 3381, 2382, 1281, and 577 patients with diabetes died before ages 80, 75, 70, and 65 years, respectively. High socioeconomic deprivation showed an association with a higher risk of premature mortality that was partially mediated by overall lifestyles. A significant interaction was found between lifestyle and deprivation on premature mortality, which became more apparent as age at death decreased. The adjusted hazard ratio (HR) for death before age 80 years when comparing the unfavorable versus favorable lifestyle was 1.49 (95% CI 1.21-1.82) in the least deprived group and 1.92 (1.56-2.36) in the most deprived group. Equivalent HRs for death before age 65 years were 1.33 (0.76-2.33) and 3.78 (2.04-7.02), respectively.

CONCLUSIONS

In patients with type 2 diabetes, unhealthy lifestyles mediated the association between socioeconomic deprivation and premature mortality and conferred disproportionate risk of premature mortality in more deprived groups.

The efficacy of a stress mindset intervention on psychosocial health and daily stress processes in college students

INTRODUCTION

Although stress is commonly characterized as harmful, interventions promoting adaptive stress mindsets have led to improved physiological, psychological, and behavioral outcomes. Interventions including rehearsal of stress mindset strategies may improve health and functioning.

METHODS

We tested the efficacy of an intervention including an in-person stress mindset seminar and daily rehearsal on psychosocial outcomes and daily stress-related processes over 21 days. Eighty-eight first-year college students were randomized to a stress-is-enhancing condition (SEC) or non-intervention-control (NIC). The SEC attended an interactive seminar providing education about stress physiology and strategies to adopt a more positive stress mindset. Daily dairies recorded stress processes (perceived stress, stress mindset, affect, and daily stressor appraisals) with writing prompts encouraging daily rehearsal of seminar strategies for the SEC.

RESULTS

The intervention produced more adaptive stress mindsets, improved depression and anxiety symptoms, as well as improved daily challenge appraisals and greater perceived ability to cope with stressors, relative to control. No effect was found on daily affect, perceived daily stress, or perceptions of daily stressors as threatening or controllable.

DISCUSSION

These findings further support the efficacy of stress mindset interventions on psychosocial health and adaptive cognitive responses to daily stress and suggest that rehearsal may help maintain effects.

Associations between psychosocial burden and prognostic biomarkers in patients with chronic coronary syndrome: a STABILITY substudy

AIMS

To investigate associations between psychosocial (PS) burden and biomarkers reflecting pathophysiological pathways in patients with chronic coronary syndrome.

METHODS AND RESULTS

Psychosocial factors were collected from self-assessed questionnaires and biomarkers representing inflammation [high-sensitivity (hs)-C-reactive protein (CRP), interleukin-6 (IL-6), lipoprotein-associated phospholipase A2 (Lp-PLA2)] and cardiac injury/stress [hs-troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP)] were measured in 12 492 patients with chronic coronary syndrome in the STABILITY trial. Associations between level of each PS factor [never-rarely (reference), sometimes, often-always] and biomarkers were evaluated using linear models with adjusted geometric mean ratios (GMR). A score comprising four factors ('feeling down', 'loss of interest', financial stress', and 'living alone') that previously demonstrated association with cardiovascular (CV) outcome was created, and categorized into three levels: low, moderate, and high PS burden. Associations between PS score and biomarkers were evaluated similarly. Greater PS burden was significantly associated with a gradual increase in inflammatory biomarkers [GMR (95% confidence interval) for moderate vs. low PS burden; and high vs. low PS burden]: hs-CRP [1.09 (1.04-1.14); 1.12 (1.06-1.17)], IL-6 [1.05 (1.02-1.07); 1.08 (1.05-1.11)], LpPLA2 [1.01 (1.00-1.02); 1.02 (1.01-1.04)], and cardiac biomarkers hs-TnT [1.03 (1.01-1.06); 1.06 (1.03-1.09)] and NT-proBNP [1.09 (1.04-1.13); 1.21 (1.15-1.27)].

CONCLUSION

In patients with chronic coronary syndrome, greater PS burden was associated with increased levels of inflammatory and cardiac biomarkers. While this observational study does not establish causal nature of these associations, the findings suggest inflammation and cardiac injury/stress as plausible pathways linking PS burden to an elevated CV risk that needs to be further explored.

The relation between stress-related neural activity assessed by brain 18F-FDG-PET/CT and cardiovascular outcomes: a systematic review and meta-analysis

PURPOSE

Our study aims to investigate the associations between stress-related neural activity (SNA), a quantified imaging biomarker in processing stress responses assessed by 18F-FDG-PET/CT, and cardiovascular (CV) outcomes based on available evidence.

METHODS

We searched databases from inception to December 1, 2024. Studies assessing the associations between SNA, as quantified by measuring FDG uptake values in the amygdala using 18F-FDG-PET/CT, and CV outcomes were included. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Random-effects model was implemented for pooled effect sizes (ESs) and heterogeneity evaluation.

RESULTS

Ten studies with 3523 patients with 18F-FDG-PET/CT were included in our analysis (mean age: 58.5 years; 48.9% female). The ESs included in the analysis comprised hazard ratios (HR) and standardized mean differences (SMD). Among the studies reporting HR, 192 (11.5%) patients experienced composite adverse CV events during a mean follow-up period of 3.8 years. SNA significantly correlated with an increased risk of composite adverse CV events (pooled adjusted HR: 1.61, 95% confidence interval [CI]: 1.12, 2.32). Among the studies reported SMD, individuals experienced composite adverse CV events had significantly higher SNA values than those who did not (Hedges's g = 0.55, 95% CI: 0.14, 0.96).

CONCLUSIONS

SNA, as a noninvasive quantified indicator of processing stress responses assessed by brain 18F-FDG-PET/CT, is associated with an increased risk of CV outcomes. Further research is warranted to validate these findings and to investigate the clinical utility of SNA across various demographic groups.

Associations of a Composite Stress Measurement Tool With Cardiovascular Risk Factors and Outcomes: Findings From the Dallas Heart Study

BACKGROUND

Most data linking chronic stress with cardiovascular disease (CVD) risk factors and outcomes have focused on single-domain stress measurements. We evaluated the association between a novel composite measure of chronic perceived stress and CVD risk factors and outcomes in a diverse population.

METHODS AND RESULTS

Individual chronic stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated to create a novel composite stress score (CSS). Participants from the DHS (Dallas Heart Study) phase 2 (2007-2009) visit without prevalent CVD who completed chronic stress questionnaires were included (n=2685). Associations between CSS and demographics, cardiac risk factors, and health behaviors were assessed in multivariable analyses. Cox proportional hazards models adjusting for traditional risk factors were used to determine associations of the CSS with adjudicated atherosclerotic CVD and global CVD (atherosclerotic CVD, heart failure, and atrial fibrillation) outcomes. CSS was higher among participants who were younger, women, and Black or Hispanic individuals, with lower income and educational attainment (P<0.0001 for each). In multivariable regression models adjusting for age, sex, race and ethnicity, income and education, higher CSS associated with hypertension, smoking, higher body mass index, hemoglobin A1C, high-sensitivity C-reactive protein, and sedentary time (P<0.01 for each). Over a median follow-up of 12.4 years, higher CSS associated with atherosclerotic CVD (adjusted hazard ratio [HR]. 1.22 per SD [95% CI, 1.01-1.47]) and global CVD (adjusted HR, 1.20 [95% CI, 1.03-1.40]). No interactions were seen between CSS, demographic factors, and outcomes.

CONCLUSIONS

Composite measures of chronic stress are higher in vulnerable populations and may help identify individuals at risk for CVD who may benefit from enhanced prevention strategies.

The impact of war on ACS admissions and triage - a single center experience

Introduction

Contemporary data regarding the impact of war on cardiovascular disease is scarce. The Israel-Gaza war that erupted on October 7th, 2023, provided a tragic opportunity to explore the effect of war on the epidemiology, characteristics, and management of patients with acute coronary syndrome (ACS) living in areas of active armed conflict.

Methods

All patients admitted with ACS to our medical center, between October 7th, 2023, and January 6th, 2024, were retrospectively included. Crucial time intervals in the management of individuals with ACS were collected in a predetermined spreadsheet. In-hospital and 30-day outcomes were obtained from the medical records and contrasted with ACS cases admitted in the period preceding the war.

Results

A total of 449 individuals (102 females [22.7 %]) with a diagnosis of ACS were recruited, 358 patients (144 STEMI and 214 NSTEMI) were admitted during the 9 months before October 7th and 91 patients (42 STEMI and 49 NSTEMI) in the 3 months after October 7th. Compared to the control period, a significant reduction in ACS admissions per month was noted (38.91 vs. 28.79, p < 0.001) driven by fewer cases of both STEMI and NSTEMI (15.65 vs. 13.29, p = 0.011 and 23.26 vs. 15.5, p < 0.001, respectively). In patients with STEMI, the total ischemic time was similar before and after the war (179 min vs. 187 min, p = 0.849).

Conclusions

War has a dramatic impact on cardiovascular incidence and outcomes which, however, are not necessarily linked to higher admission rates. Nevertheless, with the adoption of systematic approach and increased awareness, patients with ACS can be managed effectively even at times of extremely limited resources such as war.

Neurocardiac Axis Physiology and Clinical Applications

The neurocardiac axis constitutes the neuronal circuits between the arteries, heart, brain, and immune organs (including thymus, spleen, lymph nodes, and mucosal associated lymphoid tissue) that together form the cardiovascular brain circuit. This network allows the individual to maintain homeostasis in a variety of environmental situations. However, in dysfunctional states, such as exposure to environments with chronic stressors and sympathetic activation, this axis can also contribute to the development of atherosclerotic vascular disease as well as other cardiovascular pathologies and it is increasingly being recognized as an integral part of the pathogenesis of cardiovascular disease. This review article focuses on 1) the normal functioning of the neurocardiac axis; 2) pathophysiology of the neurocardiac axis; 3) clinical implications of this axis in hypertension, atherosclerotic disease, and heart failure with an update on treatments under investigation; and 4) quantification methods in research and clinical practice to measure components of the axis and future research areas.

The empathy and stress mindset of healthcare workers: the chain mediating roles of self-disclosure and social support

The hospital is a workplace full of stressful events for healthcare workers (HCWs) due to unpredictable changes in their daily routines. Perceptions of stressful events (stress mindset) have a significant impact on an individual's health and well-being. However, few studies have reported the factors and potential counter mechanisms influencing these perceptions. This study aimed to evaluate the relationship between empathy, self-disclosure, social support, and stress mindset of HCWs, and to explore the mechanism of empathy on stress mindset. Five hundred and eight HCWs (35.2% men and 64.8% women) completed the Interpersonal Reactivity Index (IRI), the Distress Disclosure Index (DDI), the Social Support Rating Scale (SSRS), the Stress Mindset Measure (SMM), and demographic questionnaires online in China. The results showed that empathy was positively linked with stress mindset and positively correlated with self-disclosure and social support. In the multiple mediating model, self-disclosure and social support mediated the association between empathy and stress mindset sequentially. The results imply that empathy, self-disclosure, and social support play a significant role in the formation of HCWs' stress mindset. These findings have substantial ramifications for reducing stress and creating successful government interventions to fortify stress mindset in healthcare.

Individual and area-level socioeconomic status, Life's Simple 7, and comorbid cardiovascular disease and cancer: a prospective analysis of the UK Biobank cohort

OBJECTIVES

We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations.

STUDY DESIGN

This was a population-based prospective cohort study.

METHODS

We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors.

RESULTS

Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES.

CONCLUSIONS

Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear.

Systemic and local regulation of hematopoietic homeostasis in health and disease

Hematopoietic stem cells (HSCs) generate all blood cell lineages responsible for tissue oxygenation, life-long hematopoietic homeostasis and immune protection. In adulthood, HSCs primarily reside in the bone marrow (BM) microenvironment, consisting of diverse cell types that constitute the stem cell 'niche'. The adaptability of the hematopoietic system is required to respond to the needs of the host, whether to maintain normal physiology or during periods of physical, psychosocial or environmental stress. Hematopoietic homeostasis is achieved by intricate coordination of systemic and local factors that orchestrate the function of HSCs throughout life. However, homeostasis is not a static process; it modulates HSC and progenitor activity in response to circadian rhythms coordinated by the central and peripheral nervous systems, inflammatory cues, metabolites and pathologic conditions. Here, we review local and systemic factors that impact hematopoiesis, focusing on the implications of aging, stress and cardiovascular disease.

Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure

BACKGROUND AND AIMS

Chronic stress associates with cardiovascular disease, but mechanisms remain incompletely defined. Advanced imaging was used to identify stress-related neural imaging phenotypes associated with atherosclerosis.

METHODS

Twenty-seven individuals with post-traumatic stress disorder (PTSD), 45 trauma-exposed controls without PTSD, and 22 healthy controls underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). Atherosclerotic inflammation and burden were assessed using 18F-FDG PET (as maximal target-to-background ratio, TBR max) and MRI, respectively. Inflammation was assessed using high-sensitivity C-reactive protein (hsCRP) and leucopoietic imaging (18F-FDG PET uptake in spleen and bone marrow). Stress-associated neural network activity (SNA) was assessed on 18F-FDG PET as amygdala relative to ventromedial prefrontal cortex (vmPFC) activity. MRI diffusion tensor imaging assessed the axonal integrity (AI) of the uncinate fasciculus (major white matter tract connecting vmPFC and amygdala).

RESULTS

Median age was 37 years old and 54% of participants were female. There were no significant differences in atherosclerotic inflammation between participants with PTSD and controls; adjusted mean difference in TBR max (95% confidence interval) of the aorta 0.020 (-0.098, 0.138), and of the carotids 0.014 (-0.091, 0.119). Participants with PTSD had higher hsCRP, spleen activity, and aorta atherosclerotic burden (normalized wall index). Participants with PTSD also had higher SNA and lower AI. Across the cohort, carotid atherosclerotic burden (standard deviation of wall thickness) associated positively with SNA and negatively with AI independent of Framingham risk score.

CONCLUSIONS

In this study of limited size, participants with PTSD did not have higher atherosclerotic inflammation than controls. Notably, impaired cortico-limbic interactions (higher amygdala relative to vmPFC activity or disruption of their intercommunication) associated with carotid atherosclerotic burden. Larger studies are needed to refine these findings.

Psychometric Testing of the Brief Coping Orientation to Problems Experienced Inventory Among Diverse Women From a Rural Community in Hawai'i

The Brief COPE (Coping Orientation to Problems Experienced) Inventory is a standardized and widely used scale that enables researchers to measure coping responses of persons in relation to stressors. The psychometric properties of this scale, however, have not been assessed for communities in Hawai'i. This study investigated the psychometric properties of the Brief COPE for diverse women from a rural community on the island of O'ahu in Hawai'i. This study was conducted in a federally qualified health center (FQHC) with 161 women who were of a childbearing age between the ages of 18 to 38 years. Contrary to previous research, the factor structure of the final model suggested six factors: Behavioral Disengagement, Denial, Venting, and Self-Blame; Action Coping, Positive Reframing, Acceptance, and Planning; Humor; Substance Use; Social Support; and Religion. The final model demonstrated good model fit with an RMSEA of .07 and CFI of .95. The reduced factor structure may be a more robust measure of coping strategies, which may allow for better resources and interventions that adequately address the way women of childbearing ages from rural communities respond to stressful situations. Exploring coping mechanisms of diverse women will better our understanding of the way people respond to stress and develop strengths and mechanisms that mediate stressors including those that are linked to social and cultural determinants of health. Findings from this study may also inform future research and policy that aim to foster coping, and thus, resiliency of diverse women, particularly in rural settings.

Novel Perspectives in Chronic Kidney Disease-Specific Cardiovascular Disease

Chronic kidney disease (CKD) affects > 10% of the global adult population and significantly increases the risk of cardiovascular disease (CVD), which remains the leading cause of death in this population. The development and progression of CVD-compared to the general population-is premature and accelerated, manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. CKD and CV disease combine to cause multimorbid cardiorenal syndrome (CRS) due to contributions from shared risk factors, including systolic hypertension, diabetes mellitus, obesity, and dyslipidemia. Additional neurohormonal activation, innate immunity, and inflammation contribute to progressive cardiac and renal deterioration, reflecting the strong bidirectional interaction between these organ systems. A shared molecular pathophysiology-including inflammation, oxidative stress, senescence, and hemodynamic fluctuations characterise all types of CRS. This review highlights the evolving paradigm and recent advances in our understanding of the molecular biology of CRS, outlining the potential for disease-specific therapies and biomarker disease detection.

Exposome in ischaemic heart disease: beyond traditional risk factors

Ischaemic heart disease represents the leading cause of morbidity and mortality, typically induced by the detrimental effects of risk factors on the cardiovascular system. Although preventive interventions tackling conventional risk factors have helped to reduce the incidence of ischaemic heart disease, it remains a major cause of death worldwide. Thus, attention is now shifting to non-traditional risk factors in the built, natural, and social environments that collectively contribute substantially to the disease burden and perpetuate residual risk. Of importance, these complex factors interact non-linearly and in unpredictable ways to often enhance the detrimental effects attributable to a single or collection of these factors. For this reason, a new paradigm called the 'exposome' has recently been introduced by epidemiologists in order to define the totality of exposure to these new risk factors. The purpose of this review is to outline how these emerging risk factors may interact and contribute to the occurrence of ischaemic heart disease, with a particular attention on the impact of long-term exposure to different environmental pollutants, socioeconomic and psychological factors, along with infectious diseases such as influenza and COVID-19. Moreover, potential mitigation strategies for both individuals and communities will be discussed.

Beliefs about stress moderate the association between COVID-19-related work demands and burnout symptoms in physicians

The present study set out to investigate the role of different stress beliefs (positive and negative beliefs about stress, as well as perceived control) on the association between central COVID-19-related work demands and burnout symptoms in physicians during the second lockdown of the SARS-CoV-2 pandemic. N = 154 practicing physicians (mean [SD] age = 37.21 [9.43] years]; 57.14% female) participated in our cross-sectional German-wide online survey and answered questions about sociodemographic factors, their current work situation, their stress beliefs, and their current burnout symptoms. Moderation analyses revealed significant interaction effects between stress beliefs and specific COVID-19-related work demands on the prediction of burnout symptoms, most consistent with respect to perceived control. Positive believes about stress and its controllability were cross-sectional associated with reduced, negative believes about stress however with enhanced associations between COVID-19-related work demands and burnout symptoms. This finding indicates, if confirmed by longitudinal research, the potential of the usage of stress beliefs in prevention programs for physicians in order to mitigating negative effects of chronic stress.

Lifestyle effects on aging and CVD: A spotlight on the nutrient-sensing network

Aging is widespread worldwide and a significant risk factor for cardiovascular disease (CVD). Mechanisms underlying aging have attracted considerable attention in recent years. Remarkably, aging and CVD overlap in numerous ways, with deregulated nutrient sensing as a common mechanism and lifestyle as a communal modifier. Interestingly, lifestyle triggers or suppresses multiple nutrient-related signaling pathways. In this review, we first present the composition of the nutrient-sensing network (NSN) and its metabolic impact on aging and CVD. Secondly, we review how risk factors closely associated with CVD, including adverse life states such as sedentary behavior, sleep disorders, high-fat diet, and psychosocial stress, contribute to aging and CVD, with a focus on the bridging role of the NSN. Finally, we focus on the positive effects of beneficial dietary interventions, specifically dietary restriction and the Mediterranean diet, on the regulation of nutrient metabolism and the delayed effects of aging and CVD that depend on the balance of the NSN. In summary, we expound on the interaction between lifestyle, NSN, aging, and CVD.

Adrenal SGLT1 or SGLT2 as predictors of atherosclerosis under chronic stress based on a computer algorithm

Background

Chronic stress promotes the development of atherosclerosis, causing disruptions in the body's hormone levels and changes in the structural function of organs.

Objective

The purpose of this study was to investigate the pathological changes in the adrenal gland in a model of atherosclerosis under chronic stress and to verify the expression levels of Sodium-glucose cotransporter (SGLT) 1 and SGLT2 in the adrenal gland and their significance in the changes of adrenal gland.

Methods

The model mice were constructed by chronic unpredictable stress, high-fat diet, and Apoe-/- knockout, and they were tested behaviorally at 0, 4, 8 and 12 weeks. The state of the abdominal artery was examined by ultrasound, and the pathological changes of the aorta and adrenal glands were observed by histological methods, and the expression levels and distribution of SGLT1 and SGLT2 in the adrenal gland were observed and analyzed by immunofluorescence and immunohistochemistry. The predictive value of SGLT1 and SGLT2 expression levels on intima-media thickness, internal diameter and adrenal abnormalities were verified by receiver operating characteristic (ROC) curves, support vector machine (SVM) and back-propagation (BP) neural network.

Results

The results showed that chronic stress mice had elevated expression levels of SGLT1 and SGLT2. The model mice developed thickening intima-media and smaller internal diameter in the aorta, and edema, reticular fiber rupture, increased adrenal glycogen content in the adrenal glands. More importantly, analysis of ROC, SVM and BP showed that SGLT1 and SGLT2 expression levels in the adrenal glands could predict the above changes in the aorta and were also sensitive and specific predictors of adrenal abnormalities.

Conclusion

SGLT1 and SGLT2 could be potential biomarkers of adrenal injury in atherosclerosis under chronic stress.

Prevalence of dyslipidemia and its associated factors among university academic staff and students in Bangladesh

BACKGROUND

Dyslipidemia is one of the important contributors to cardiovascular disease and type 2 diabetes. There is little or no information on dyslipidemia among academic staff and students in Bangladesh. Therefore, this study aimed to investigate the prevalence and factors related to dyslipidemia among university academic staff and students in Bangladesh.

METHODS

A total of 533 participants (302 academic staff and 231 students) were enrolled in this cross-sectional study. A simple random sampling technique was used to enrol the participants. Fasting blood samples were obtained from the participants, and serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured using the standard methods. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III) model guideline. Multivariable logistic regression was conducted to identify the factors related to lipid marker abnormalities.

RESULTS

Overall, the prevalence of dyslipidemia was 81.5%, of which 85% was in staff and 76.5% in students. A significant difference was found in the prevalence of dyslipidemia between males and females only in the student group (p < 0.01). Among staff, hypertriglyceridemia prevalence was 49.7%, hypercholesterolemia 23%, high LDL-C 24.7% and low HDL-C 77.3%. On the other hand, hypertriglyceridemia prevalence was 39%, hypercholesterolemia 25.6%, high LDL-C 26.5% and low HDL-C 69.3% among students. The most common lipid abnormality was low HDL-C in both groups. The prevalence of mixed dyslipidemia was 14.2% and 14.1% in staff and students, respectively. According to the regression analysis, increased age, obesity, diabetes, and inadequate physical activity were significantly associated with dyslipidemia.

CONCLUSIONS

Dyslipidemia was prevalent among the majority of the study participants. Increased age, obesity, diabetes, and inadequate physical activity were significantly associated with dyslipidemia. The study's results highlight the importance of implementing interventions to address the associated risk factors of dyslipidemia among academic staff and students in Bangladesh.

Associations of Cumulative Perceived Stress with Cardiovascular Risk Factors and Outcomes: Findings from The Dallas Heart Study

Background

Data remain sparse regarding the impact of chronic stress on cardiovascular disease (CVD) risk factors and outcomes. Prior work has been limited by incomplete assessments of perceived stress and focus on single stress domains. We evaluated the association between a composite measure of perceived stress and CVD risk factors and outcomes.

Methods

Participants from the Dallas Heart Study phase 2 (2007-2009) without prevalent CVD who completed questionnaire assessments of perceived stress were included (n=2685). Individual perceived stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated into a single cumulative stress score (CSS) with equal weighting for each component. Associations between CSS and demographics, psychosocial variables and cardiac risk factors were assessed in univariable and multivariable analyses. Cox proportional hazards models were used to determine associations of the CSS with atherosclerotic CVD (ASCVD) and Global CVD (ASCVD, heart failure, and atrial fibrillation) after adjustment for demographics and traditional risk factors.

Results

Median age of the study population was 48 years, 55% were female, 49% Black and 15% Hispanic/Latinx. CSS was higher among participants who were younger, female, Black or Hispanic, and those with lower income and educational attainment (p<.0001 for each). Higher CSS was associated with self-report of racial/ethnic discrimination, lack of health insurance and last medical contact > one year previously (p<.0001 for each). In multivariable regression models adjusting for age, gender, race/ethnicity, income and education, higher CSS associated with hypertension, smoking, and higher body mass index, waist circumference Hemoglobin A1C, hs-CRP and sedentary time (p< 0.01 for each). Over a median follow-up of 12.4 years, higher CSS associated with ASCVD (adjusted HR 1.22 per SD, 95% CI 1.01-1.47) and Global CVD (HR 1.20, 95% CI 1.03-1.40). No interactions were seen between CSS, demographic factors, and outcomes.

Conclusion

Composite multidimensional assessments of perceived stress may help to identify individuals at risk for CVD who may be targeted for stress mitigation or enhanced prevention strategies. These approaches may be best focused on vulnerable populations, given the higher burden of stress in women, Black and Hispanic individuals, and those with lower income and education.

WHAT IS NEW?

A novel measure of cumulative stress was created that integrates generalized, psychosocial, financial, and neighborhood perceived stress.Cumulative stress was higher among women, Black and Hispanic participants, younger individuals and persons with lower income and educational attainment and was associated with adverse health behaviors and increased burden of cardiovascular disease (CVD) risk factors.In a diverse cohort, higher cumulative stress associated with incident CVD after adjustment for demographics and traditional risk factors. No interactions were seen based on demographic factors.

CLINICAL IMPLICATIONS

Although associations of chronic stress with CVD were similar across demographic subgroups, the higher burden of stress among younger individuals, women, Black and Hispanic participants, and those with lower SES suggests that CVD risk associated with higher stress affects marginalized groups disproportionately.Cumulative Stress is associated with modifiable risk factors and health behaviors. Future studies should explore targeting behavioral modification and risk factor reduction programs, as well as stress reduction strategies, to individuals with high cumulative stress.Additional research is needed to uncover mechanisms that underly the association between chronic stress and cardiovascular disease.

The prevalence and factors associated with obesity and hypertension in university academic staff: a cross-sectional study in Bangladesh

Obesity is a major risk factor for hypertension, type 2 diabetes and other morbidities. On the other hand, hypertension is a leading cause of cardiovascular disease. The presence of obesity in hypertensive persons increases cardiovascular risk and related mortality. Data on the prevalence of obesity and hypertension in academic staff in Bangladesh are scarce. This study aimed to determine the prevalence and factors associated with obesity and hypertension among university academic staff in Bangladesh. In total, 352 academic staff were enrolled in this study from two universities in Bangladesh. A pre-structured questionnaire was used to obtain data on anthropometric, demographic and lifestyle-related factors. Bivariate and multivariate logistic regression analyses were performed to assess the factors associated with obesity and hypertension. Overall, the prevalence of general and abdominal obesity and hypertension was 26.7%, 46.9% and 33.7%, respectively. Female staff had a significantly higher prevalence of both general and abdominal obesity (41% and 64.1%, respectively) than male staff (21.5% and 34.9%, respectively) (p < 0.001). In contrast, male staff had a higher prevalence of hypertension (36.9%) than female staff (25.6%)(p < 0.001). An increased prevalence of hypertension was found in the higher BMI and WC groups of the participants. The prevalence of general obesity, abdominal obesity and hypertension was higher in the 30-40 years, > 50 years and 41-50 years age groups, respectively. According to the regression analysis, female gender and inadequate physical activity were independently associated with general and abdominal obesity. On the other hand, increased age, BMI, WC, presence of diabetes and smoking showed a significant association with hypertension. In conclusion, the prevalence of obesity and hypertension was higher among university academic staff members in Bangladesh. Our findings suggest that comprehensive screening programs are needed to facilitate the diagnosis, control, and prevention of obesity and hypertension in high-risk population groups.

Innate Immunity System in Patients With Cardiovascular and Kidney Disease

With a global burden of 844 million, chronic kidney disease (CKD) is now considered a public health priority. Cardiovascular risk is pervasive in this population, and low-grade systemic inflammation is an established driver of adverse cardiovascular outcomes in these patients. Accelerated cellular senescence, gut microbiota-dependent immune activation, posttranslational lipoprotein modifications, neuroimmune interactions, osmotic and nonosmotic sodium accumulation, acute kidney injury, and precipitation of crystals in the kidney and the vascular system all concur in determining the unique severity of inflammation in CKD. Cohort studies documented a strong link between various biomarkers of inflammation and the risk of progression to kidney failure and cardiovascular events in patients with CKD. Interventions targeting diverse steps of the innate immune response may reduce the risk of cardiovascular and kidney disease. Among these, inhibition of IL-1β (interleukin-1 beta) signaling by canakinumab reduced the risk for cardiovascular events in patients with coronary heart disease, and this protection was equally strong in patients with and without CKD. Several old (colchicine) and new drugs targeting the innate immune system, like the IL-6 (interleukin 6) antagonist ziltivekimab, are being tested in large randomized clinical trials to thoroughly test the hypothesis that mitigating inflammation may translate into better cardiovascular and kidney outcomes in patients with CKD.

Effects of stress beliefs on the emotional and biological response to acute psychosocial stress in healthy men

BACKGROUND

Negative beliefs about stress (e.g., "stress is bad") constitute an independent risk factor for increased morbidity and mortality. One potential underlying mechanism are altered responses to acute psychosocial stress. The aim of this study was to investigate whether beliefs about stress are associated with physiological and endocrine stress response patterns.

METHODS

A total of N = 77 healthy adults were randomised to an experimental and a placebo control group and were subsequently exposed to the Trier Social Stress Test (TSST). Stress beliefs were measured before and after a psychological manipulation aiming at fostering more balanced stress beliefs or a placebo manipulation. Self-reported stress was measured four times before/after the TSST, heart rate was assessed continuously, and cortisol was assessed eight times before/after the TSST.

RESULTS

There was a significant decrease in negative stress beliefs (p < .001) and increase in positive stress beliefs (p < .001) in participants in the experimental condition, which was absent in participants in the placebo condition. The participants in the experimental group had more pronounced self-reported stress reactions (p = .028) while at the same time also showing more pronounced stress recoveries (p = .036). The findings regarding cortisol were mixed.

CONCLUSIONS

More balanced stress beliefs appeared to be associated with more efficient subjective responses to acute psychosocial stress. These findings attest to a potential mechanism translating negative stress beliefs into ill health while at the same time outlining targets for psychological interventions.

PET/MR imaging of inflammation in atherosclerosis

Myocardial infarction, stroke, mental disorders, neurodegenerative processes, autoimmune diseases, cancer and the human immunodeficiency virus impact the haematopoietic system, which through immunity and inflammation may aggravate pre-existing atherosclerosis. The interplay between the haematopoietic system and its modulation of atherosclerosis has been studied by imaging the cardiovascular system and the activation of haematopoietic organs via scanners integrating positron emission tomography and resonance imaging (PET/MRI). In this Perspective, we review the applicability of integrated whole-body PET/MRI for the study of immune-mediated phenomena associated with haematopoietic activity and cardiovascular disease, and discuss the translational opportunities and challenges of the technology.

Work-related stress and atopic dermatitis: Results from the study on occupational allergy risks

Chronic stress at work is ubiquitous in modern societies. However, its influence on atopic dermatitis (AD) has hardly been investigated. This study aimed to elucidate the association between work-related stress and AD via a longitudinal study. The analysis comprised data from three phases (2002-2003, 2007-2009, 2017-2018) of the prospective Study on Occupational Allergy Risks (SOLAR), including 1,240 young adults aged 16 to 18 years at baseline (61% female) who were originally recruited for the International Study of Asthma and Allergies in Childhood Phase II in 1995-1996. AD was assessed at all three phases based on self-reports of a physician's diagnosis and symptoms. Work-related stress was measured at all three periods using the work discontent and work overload scales from the Trier Inventory for the Assessment of Chronic Stress with adaptions to school and university. Generalized estimating equations were used to analyze the association between stress and AD, treating work discontent and work overload first as continuous and then as categorical exposure variables. We observed 50 AD cases (4%) at SOLAR I, 48 (4%) at SOLAR II, and 42 (3%) at SOLAR III. A one-point increase in the work discontent score was associated with an odds ratio (OR) for AD of 1.05 (95% confidence interval [CI], 1.00-1.10). The respective increase in the work overload score led to an OR of 1.03 (95% CI, 0.99-1.06). In the categorical analysis, there was no clear indication of elevated odds of AD in the highest vs. lowest exposure group (4th vs. 1st quartile: OR, 1.53; 95% CI, 0.92-2.53 for work discontent; OR, 1.38, 95% CI, 0.83-2.27 for work overload). Altogether, we observed limited to no evidence for an association between work-related stress and AD. Our study's ability to detect stronger evidence may have been compromised by shortcomings such as nondifferential misclassification of the outcome or insufficient statistical precision due to small numbers of AD cases. Another explanation could be that AD predominantly becomes evident in childhood, not in adulthood.

Stress, Resilience, and the Brain-Gut Axis: Why is Psychogastroenterology Important for all Digestive Disorders?

In this review article, we show that stress and resilience play an integral role in the brain-gut axis and are critical to symptom expression across all digestive disorders. The relationship between stress, coping, and resilience provides a mechanistic basis for brain-gut behavior therapies. Psychogastroenterology is the field best equipped to translate and mitigate these constructs as part of patient care across all digestive disorders.

Physiological reactions to and recovery from acute stressors: the roles of chronic anxiety and stable resources

Background

Research has shown that employees subjected to acute stressors at work can suffer devastating repercussions. However, little is known about how employees who are experiencing ongoing chronic anxiety or have stable resources respond to acute stressors, particularly regarding their physiological responses to these situations. This study examines the physiological effects of an acute stressor when workers are already under chronic anxiety (i.e., cognitive anxiety and somatic anxiety) or when they have a stable resource (i.e., job control).

Participants and procedure

Data were collected from 230 full-time employees working at three major oil companies in Brazil. First, demographic, anxie-ty, and job control measures were collected via questionnaire. Later, muscle tension, skin temperature, and heart rate were collected during a simulated task to assess the physiological response to stress. Hypotheses were tested by repeated measures general linear modeling.

Results

The findings indicated that when employees were exposed to an acute stressor, those with chronic cognitive and somatic anxiety exhibited more heightened physiological responses than those lower on chronic anxiety. Further, compared to those with low control, employees with stable, high control over their work experienced a lower physiological reaction to the acute stressor.

Conclusions

Chronic anxiety generates high levels of physiological arousal and hyper-responsiveness to acute environmental stressors. Also, employees possessing stable resources, such as job control, experience reduced physiological responsivity to an acute stressor.

Psychometric properties and factorial invariance of the Farsi version of the Stress Mindset Measure

The Stress Mindset Measure consists of eight items to assess whether individuals hold a stress-is-enhancing or a stress-is-debilitating mindset. The current research is a cross-sectional study and aimed to investigate the factor structure, internal consistency reliability, and construct and convergent validity of the Farsi version of the Stress Mindset Measure (SMM). Prior to conducting the study, forward and backward translations of the SMM were performed. Using the convenience sampling method, we recruited 400 none-clinical sample (161 men and 239 women; aged 18 to 69). We utilized SPSS version 24, Amos, and Mplus 7.1 software to analyze the data. Results revealed satisfactory reliability and validity indexes for the Farsi version of the Stress Mindset Measure. The internal consistency of the Farsi version of the Stress Mindset Measure was in the excellent range (α = 0.87). The results of the confirmatory factorial analysis revealed two factors of the Stress Mindset Measure instead of the single factor suggested by the previous studies (fitness indices for the two-factor model were RMSEA = 0.78, CFI = 0.96, and TLI = 0.94). Moreover, we found that the stress-is-debilitating mindset is positively associated with stress (r = 0.233), depression (r = 0.163), and anxiety (r = 0.197). However, this mindset has been found to have no significant relationship with cognitive strategies of emotion regulation and life satisfaction. Also, findings showed no significant correlation between the stress-is-enhancing mindsets and the other variables. The results of this study suggest that the Farsi SMM has proper psychometric properties to assess stress mindsets.

COVID-19 pandemic: study on simple, easy, and practical relaxation techniques while wearing medical protective equipment

BACKGROUND

No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment.

METHODS

This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance.

RESULTS

Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6).

CONCLUSION

Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.

Essential Oils, Phytoncides, Aromachology, and Aromatherapy—A Review

Chemical compounds from plants have been used as a medicinal source for various diseases. Aromachology is a unique field that studies the olfactory effects after inhaling aromatic compounds. Aromatherapy is a complementary treatment methodology involving the use of essential oils containing phytoncides and other volatile organic compounds for various physical and mental illnesses. Phytoncides possess an inherent medicinal property. Their health benefits range from treating stress, immunosuppression, blood pressure, respiratory diseases, anxiety, and pain to anti-microbial, anti-larvicidal, anti-septic, anti-cancer effects, etc. Recent advancements in aromatherapy include forest bathing or forest therapy. The inhalation of phytoncide-rich forest air has been proven to reduce stress-induced immunosuppression, normalize immune function and neuroendocrine hormone levels, and, thus, restore physiological and psychological health. The intricate mechanisms related to how aroma converts into olfactory signals and how the olfactory signals relieve physical and mental illness still pose enormous questions and are the subject of ongoing research. Aromatherapy using the aroma of essential oils/phytoncides could be more innovative and attractive to patients. Moreover, with fewer side effects, this field might be recognized as a new field of complementary medicine in alleviating some forms of physical and mental distress. Essential oils are important assets in aromatherapy, cosmetics, and food preservatives. The use of essential oils as an aromatherapeutic agent is widespread. Detailed reports on the effects of EOs in aromatherapy and their pharmacological effects are required to uncover its complete biological mechanism. This review is about the evolution of research related to phytoncides containing EOs in treating various ailments and provides comprehensive details from complementary medicine.

Psychological stress, body shape and cardiovascular events: Results from the Whitehall II study

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.

The Omnipresence of Autonomic Modulation in Health and Disease

The Autonomic Nervous System (ANS) is a critical part of the homeostatic machinery with both central and peripheral components. However, little is known about the integration of these components and their joint role in the maintenance of health and in allostatic derailments leading to somatic and/or neuropsychiatric (co)morbidity. Based on a comprehensive literature search on the ANS neuroanatomy we dissect the complex integration of the ANS: (1) First we summarize Stress and Homeostatic Equilibrium - elucidating the responsivity of the ANS to stressors; (2) Second we describe the overall process of how the ANS is involved in Adaptation and Maladaptation to Stress; (3) In the third section the ANS is hierarchically partitioned into the peripheral/spinal, brainstem, subcortical and cortical components of the nervous system. We utilize this anatomical basis to define a model of autonomic integration. (4) Finally, we deploy the model to describe human ANS involvement in (a) Hypofunctional and (b) Hyperfunctional states providing examples in the healthy state and in clinical conditions.

Association between Health-Related Physical Fitness and Risk of Dyslipidemia in University Staff: A Cross-Sectional Study and a ROC Curve Analysis

Background: This study aimed to assess the relationship between dyslipidemia (DL) risk and health-related physical fitness (HPF) and evaluated the prognostic value of HPF for risk of DL. Methods: A total of 776 university staff members were recruited, of which 407 were females, and 369 males. Blood samples and HPF tests were collected from all participants after 12 h fasting. Results: The prevalence of DL was 41.77% and 51.49% in female and male university staff members, respectively, and there was no significant difference between genders (χ2 = 2.687, p = 0.101). According to the logistic regression analysis, age, male sex, GLU, hypertension, BMI, BF, WHtR, and LAP were significant risk factors for DL (p < 0.05), VCI and, SAR were significant protective factors for DL (p < 0.05), and SMI, GS, and VG were not significantly associated with the risk of DL. The area under the receiver-operating characteristic (ROC) curve (AUC) analysis indicated that, LAP (AUC: 0.730, 95CI%: 0.697–0.762), WHtR (AUC: 0.626, 95CI%: 0.590–0.660), and BMI (AUC: 0.599, 95CI%: 0.563–0.634) are valid predictors of DL, and LAP and WHtR perform better than BMI (Z = 8.074, p < 0.001) in predicting DL in male and female university staff members. Conclusion: The risk of DL is significantly related to body composition, cardiorespiratory fitness, and flexibility. LAP and WHtR perform better than BMI in predicting risk of DL in male and female university staff members.

Impact of Acute and Chronic Psychosocial Stress on Vascular Inflammation

Significance: Atherosclerosis and its complications, such as acute coronary syndromes, are the leading causes of death worldwide. A wide range of inflammatory processes substantially contribute to the initiation and progression of cardiovascular disease (CVD). In addition, epidemiological studies strongly associate both chronic stress and acute psychosocial stress with the occurrence of CVDs. Recent Advances: Extensive research during recent decades has not only identified major pathways in cardiovascular inflammation but also revealed a link between psychosocial factors and the immune system in the context of atherosclerosis. Both chronic and acute psychosocial stress drive systemic inflammation via neuroimmune interactions and promote atherosclerosis progression. Critical Issues: The associations human epidemiological studies found between psychosocial stress and cardiovascular inflammation have been substantiated by additional experimental studies in mice and humans. However, we do not yet fully understand the mechanisms through which psychosocial stress drives cardiovascular inflammation; consequently, specific treatment, although urgently needed, is lacking. Future Directions: Psychosocial factors are increasingly acknowledged as risk factors for CVD and are currently treated via behavioral interventions. Additional mechanistic insights might provide novel pharmacological treatment options to reduce stress-related morbidity and mortality. Antioxid. Redox Signal. 35, 1531-1550.

High Perceived Stress May Shorten Activated Partial Thromboplastin Time and Lead to Worse Clinical Outcomes in Patients With Coronary Heart Disease

Objective: To determine the association of perceived stress with coagulation function and their predictive values for clinical outcomes. Methods: This prospective cohort study derived from a cross-sectional study for investigating the psychological status of inpatients with suspicious coronary heart disease (CHD). In this study, the 10-item Perceived Stress Scale (PSS-10) as an optional questionnaire was used to assess the severity of perceived stress. Coagulation function tests, such as activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen were measured within 1 h after admission. Furthermore, 241 patients with CHD out of 705 consecutive inpatients were included in the analyses and followed with a median of 26 months for the clinical outcomes. Results: The patients in high perceived stress status (PSS-10 score > 16) were with shorter APTT (36.71 vs. 38.45 s, p = 0.009). Shortened APTT ( ≤ 35.0 s) correlated with higher PSS-10 score (14.67 vs. 11.22, p = 0.003). The association of APTT with depression or anxiety was not found. Multiple linear models adjusting for PT estimated that every single point increase in PSS-10 was relevant to approximately 0.13 s decrease in APTT (p = 0.001) regardless of the type of CHD. APTT (every 5 s increase: hazard ratio (HR) 0.68 [0.47-0.99], p = 0.041) and perceived stress (every 5 points increase: HR 1.31 [1.09-1.58], p = 0.005) could predict the cardiovascular outcomes. However, both predictive values would decrease when they were simultaneously adjusted. After adjusting for the physical clinical features, the associated of perceived stress on cardiac (HR 1.25 [1.04-1.51], p = 0.020) and composite clinical outcomes (HR 1.24 [1.05-1.47], p = 0.011) persisted. Conclusions: For the patients with CHD, perceived stress strongly correlates with APTT. The activation of the intrinsic coagulation pathway is one of the mechanisms that high perceived stress causes cardiovascular events. This hints at an important role of the interaction of mental stress and coagulation function on cardiovascular prognosis. More attention needs to be paid to the patients with CHD with high perceived stress.

The association between chronic stress, hair cortisol, and angiographically documented coronary atherosclerosis, a case-control study

Cardiovascular diseases remain the principal contributor to global mortality and morbidity. Chronic stress has emerged as a strong prognostic factor for cardiovascular diseases. We aimed to measure hair cortisol concentration (HCC) in patients with angiographically confirmed coronary atherosclerosis and find the association between HCC and classic cardiovascular risk factors in a case-control study. The study included 500 angiographically confirmed coronary atherosclerosis patients and 500 age and sex-matched controls having no coronary stenosis. Hair cortisol concentration was assessed from a single sample of scalp hair by ELISA. Perceived stress scale 10 was used to evaluate the stress level of the participants. Spearman rank correlation was applied to find the association between hair cortisol level and classic cardiovascular risk factors. Multivariate regression was executed to assess the independent contribution of hair cortisol concentration as a coronary atherosclerosis risk factor. Median hair cortisol concentration was significantly high in patients with angiographically documented coronary atherosclerosis compared to controls (158(17.6-1331.3) pg/mg versus 73 (13.4-889) pg/mg. Hair cortisol concentration showed a significant positive correlation with BMI r = 525 and Hb1Ac r = 665 (both, p = ≤0.0001). In multivariate logistic regression analysis after adjusting for all the confounding variables, HCC, matched odds ratio (MOR), 10.73;95%CI (1.60,42.09) p-value = 0.001 remained the most significant predictor of coronary atherosclerosis.LAY SUMMARYHair cortisol concentrations (HCC) were significantly high in patients with angiographically confirmed coronary atherosclerosis compared to controls. HCC showed a significant positive correlation with diabetes and obesity and remained a major predictor of coronary atherosclerosis in the final analysis.

How Do We Measure Stress in Latinos in the United States? A Systematic Review

Background: Previous research has documented that Latinos report higher levels of stress than other ethnicities and are an increasing portion of the demographics of the United States. While there are many measures to assess stress and other stress-related conditions, there are no systematic reviews to date to assess whether the current measures of generalized stress are valid or reliable in Latinos in the United States. The purpose of this systematic review was to examine the current state of the literature assessing the psychometric properties in stress measures in this population.

Methods: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to review the literature from January 1990 to May 2020 for studies, which measured the psychometric properties of scales measuring generalized stress in Latinos in the United States.

Results: Twelve studies measured the psychometric properties of eight scales of generalized stress. The 10-item Perceived Stress Scale, the Hispanic Stress Inventory, the Hispanic Women's Social Stressor Scale, and the Family Obligation Stress Scale show the strongest reliability and validity for measuring stress in Latinos in the United States. Most studies were done in traditional immigration destinations in the United States.

Conclusion: While four scales which show acceptable reliability and validity for measuring stress in Latinos in the United States, continuing to develop and further validate these scales within Latino communities will be critical to understand and address Latino stress more comprehensively. Our findings can inform health research and clinical interventions for this at-risk community.

Association of Noise Annoyance with Measured Renal Hemodynamic Changes

BACKGROUND

Chronic mental stress is recognized as a modifiable risk factor for cardiovascular disease. The aim of this study was to demonstrate that noise annoyance-induced stress is associated with changes in renal hemodynamics.

METHODS

Renal hemodynamic parameters were measured using steady-state input clearance with infusion of para-aminohippuric acid and inulin in individuals with normal, high normal, and elevated blood pressure. All individuals ranked subjective annoyance due to noise in everyday life on a 7-grade Likert scale. The median of all rankings was used as a cutoff point to divide the group into noise-annoyed and non-noise-annoyed individuals. Different renal hemodynamic parameters were calculated based on the Gomez equation.

RESULTS

Noise-annoyed individuals (n = 58) showed lower renal plasma flow (599 ± 106 vs. 663 ± 124 mL/min, p = 0.009), lower renal blood flow (1,068 ± 203 vs. 1,172 ± 225 mL/min, p = 0.047), higher filtration fraction (22.7 ± 3.3 vs. 21.3 ± 3.0, p = 0.012), higher renal vascular resistance (88.9 ± 25.6 vs. 75.8 ± 22.9 mm Hg/[mL/min], p = 0.002), and higher resistance of afferent arteriole (2,439.5 ± 1,253.4 vs. 1,849.9 ± 1,242.0 dyn s-1 cm-5, p = 0.001) compared to non-noise-annoyed individuals (n = 55). There was no difference in measured glomerular filtration rate (133 ± 11.8 vs. 138 ± 15 mL/min, p = 0.181), resistance of efferent arteriole (2,419.4 ± 472.2 vs. 2,245.8 ± 370.3 dyn s-1 cm-5, p = 0.060), and intraglomerular pressure (64.0 ± 3.1 vs. 64.6 ± 3.5 mm Hg, p = 0.298) between the groups. After adjusting for age, renal plasma flow, renal blood flow, and renal vascular resistance remained significantly different between the groups, with a trend in increased afferent arteriolar resistance and filtration fraction.

CONCLUSION

In this study, noise annoyance was associated with reduced renal perfusion attributed to increased renal vascular resistance predominantly at the afferent site. Long-term consequences of this renal hemodynamic pattern due to noise annoyance need to be investigated.

Psychometric properties of the stress control mindset measure in university students from Australia and the UK

INTRODUCTION

Beliefs about the consequences of stress, stress mindsets, are associated with health and performance outcomes under stress. This article reports the development and examination of the psychometric properties of a measure of stress mindset: The Stress Control Mindset Measure (SCMM). The measure is consistent with theory on mindsets about self-attributes and conceptualizes stress mindset as the extent to which individuals endorse beliefs that stress can be enhancing.

METHODS

The study adopted a correlational cross-sectional survey design in two student samples. Undergraduate students from an Australian university (Sample 1, N = 218) and a UK university (Sample 2, N = 214) completed the SCMM and measures of health and well-being outcomes.

RESULTS

Confirmatory factor analyses supported a four-factor structure and strict measurement invariance across samples (ΔCFI < 0.01). Reliability, convergent validity, discriminant validity, and concurrent validity of the overall SCMM were supported in both samples. Incremental validity was supported for most outcomes, accounting for significantly more variance (between 2.2% and 5.9%) in health and well-being outcomes than an existing measure.

CONCLUSIONS

Current data provide preliminary support for the SCMM as a reliable and valid measure with good psychometric properties and theoretically consistent relations with health outcomes under stress. Findings provide initial evidence supporting the potential utility of the SCMM in future research examining relations between stress mindsets and health and performance outcomes.

Psychological Stress as a Risk Factor for Cardiovascular Disease: A Case-Control Study

Introduction

Stress is a phenomenon elicited in response to certain triggers that may be external or internal. Stress has been identified as a risk factor for various diseases, including cardiovascular disease. In this study, we aim to find an association between psychological stress and cardiovascular disease in the local setting

Methods

This case-control study was conducted in a tertiary care hospital in Pakistan from June 2019 to December 2019. One hundred and seventeen (117) patients with myocardial infarction and unstable angina were enrolled in the case group. One hundred and ten (110) patient’s attendants were enrolled in the study as controlled.

Results

The risk of a cardiovascular event was higher in patients with a history of social isolation (OR, 2.47), marital stress (OR, 2.28), work stress (OR, 3.2), childhood abuse (OR, 2.78), or trauma (OR, 2.67).

Conclusion

Psychological stress is an important risk for cardiovascular disease, which is often overlooked. Efforts should be made to include questions related to psychological stress in the history-taking of patients at risk of a cardiovascular event and the management plan should include psychological counseling.

A Proof-of-Concept System Dynamics Simulation Model of the Development of Burnout and Recovery Using Retrospective Case Data

The phenomenon of burnout is a complex issue, which despite major efforts from researchers and organizations remains hard to prevent. The current literature highlights an increasing global prevalence of employees that are dealing with burnout. What has been largely missing is a more systemic, dynamic, and personal perspective on the interactions of the key determinants of burnout. Burnout can be seen as the outcome of a complex system involving feedback loops between individual mental models, individual behavior, and external social influences. Understanding the feedback loops involved may enable employees and organizations to intervene in burnout trajectories early and effectively. System dynamics (SD) modeling is a methodology that can describe the structure and behavior of a complex system. The current paper describes the development of an SD model of burnout. First, an expert- and literature-informed causal loop diagram (CLD) of burnout is developed. Then, a novel approach is developed to collect personal retrospective scenario data. Finally, the CLD and data are translated into a quantitative SD model. The potential of the SD model is illustrated by simulating the behavior of three realistic personas during the onset of and recovery from burnout. The process of development of an SD model of burnout is presented and the strengths and limitations of the approach are discussed.

A Scoping Review of Stress Beliefs: Literature Integration, Measurement Issues, and Theoretical Concerns

BACKGROUND

Individual stress beliefs are associated with stress-related behavioral responses and health consequences. The Common-Sense Model of Self-Regulation may help in understanding the role of stress beliefs in these behavioral responses and consequences.

PURPOSE

To synthesize empirical studies exploring the relationship between stress beliefs and stress-related behavioral responses and health consequences using the Common-Sense Model as a guiding framework.

METHODS

Peer-reviewed journal articles on stress beliefs in PsycArticles, PsycINFO, PubMed, Scopus, and Sociological Abstracts were included if they were in English, reported on adult humans. Nineteen of the 1,972 unique articles reporting on 24 studies met inclusion criteria. Study quality was assessed with existing reporting criteria.

RESULTS

Four of the five Common-Sense Model representations were included across the review studies, namely Identity, Cause, Consequences, and Control. Consequences and Control-related stress beliefs are associated with stress-based health and behavioral outcomes. One study explored Identity-related stress beliefs with health outcomes, reporting no relationship. No study assessed the relationship between Cause-related stress beliefs and behaviors or health outcomes. No study has explored any aspect of Timeline-related stress beliefs. Study quality ranged from very low to very high.

CONCLUSIONS

There is limited evidence exploring stress-related beliefs and behaviors and health outcomes. According to the Common-Sense Model, the Timeline representations remains to be investigated in the stress context, and Identity and Cause are under-researched. This review highlights future directions for stress beliefs research.

How do you think about stress? A qualitative analysis of beliefs about stress

This qualitative study aimed to identify common stress beliefs. Undergraduate psychology students (N = 35) completed semi-structured interviews discussing the sensations, causes, purpose, valence, consequences, control, and timeline of stress. Interviews were analysed via double-coded thematic analysis employing a latent, inductive, and realist framework. Five themes (cognition, emotion, physical health, interpersonal relations, and behaviour) and 17 subthemes were identified. Themes and subthemes were validated in a Delphi study of experts in stress research (N = 14). Many of these identified beliefs have not been incorporated into current measures of stress beliefs, suggesting the need for new approaches to measuring this construct.

Stress-Associated Neurobiological Pathway Linking Socioeconomic Disparities to Cardiovascular Disease

BACKGROUND

Lower socioeconomic status (SES) associates with a higher risk of major adverse cardiac events (MACE) via mechanisms that are not well understood.

OBJECTIVES

Because psychosocial stress is more prevalent among those with low SES, this study tested the hypothesis that stress-associated neurobiological pathways involving up-regulated inflammation in part mediate the link between lower SES and MACE.

METHODS

A total of 509 individuals, median age 55 years (interquartile range: 45 to 66 years), underwent clinically indicated whole-body ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography imaging and met pre-defined inclusion criteria, including absence of known cardiovascular disease or active cancer. Baseline hematopoietic tissue activity, arterial inflammation, and in a subset of 289, resting amygdalar metabolism (a measure of stress-associated neural activity) were quantified using validated ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography methods. SES was captured by neighborhood SES factors (e.g., median household income and crime). MACE within 5 years of imaging was adjudicated.

RESULTS

Over a median 4.0 years, 40 individuals experienced MACE. Baseline income inversely associated with amygdalar activity (standardized β: -0.157 [95% confidence interval (CI): -0.266 to -0.041]; p = 0.007) and arterial inflammation (β: -0.10 [95% CI: -0.18 to -0.14]; p = 0.022). Further, income associated with subsequent MACE (standardized hazard ratio: 0.67 [95% CI: 0.47 to 0.96]; p = 0.029) after multivariable adjustments. Mediation analysis demonstrated that the path of: ↓ neighborhood income to ↑ amygdalar activity to ↑ bone marrow activity to ↑ arterial inflammation to ↑ MACE was significant (β: -0.01 [95% CI: -0.06 to -0.001]; p < 0.05).

CONCLUSIONS

Lower SES: 1) associates with higher amygdalar activity; and 2) independently predicts MACE via a serial pathway that includes higher amygdalar activity, bone marrow activity, and arterial inflammation. These findings illuminate a stress-associated neurobiological mechanism by which SES disparities may potentiate adverse health outcomes.

Modifiable Cardiovascular Risk, Hematopoiesis, and Innate Immunity

Unhealthy diet, lack of exercise, psychosocial stress, and insufficient sleep are increasingly prevalent modifiable risk factors for cardiovascular disease. Accumulating evidence indicates that these risk factors may fuel chronic inflammatory processes that are active in atherosclerosis and lead to myocardial infarction and stroke. In concert with hyperlipidemia, maladaptive immune system activities can contribute to disease progression and increase the probability of adverse events. In this review, we discuss recent insight into how the above modifiable risk factors influence innate immunity. Specifically, we focus on pathways that raise systemic myeloid cell numbers and modulate immune cell phenotypes, reviewing hematopoiesis, leukocyte trafficking, and innate immune cell accumulation in cardiovascular organs. Often, relevant mechanisms that begin with lifestyle choices and lead to cardiovascular events span multiple organ systems, including the central nervous, endocrine, metabolic, hematopoietic, immune and, finally, the cardiovascular system. We argue that deciphering such pathways provides not only support for preventive interventions but also opportunities to develop biomimetic immunomodulatory therapeutics that mitigate cardiovascular inflammation.

Social Stress Increases Vulnerability to High-Fat Diet-Induced Insulin Resistance by Enhancing Neutrophil Elastase Activity in Adipose Tissue

Social stress (SS) has been linked to the development of cardiovascular disease (CVD), which is closely associated with insulin resistance (IR); however, the causal effect of SS on IR remains unclear. The 8-week-old male C57BL/6 mice were exposed to SS by housing with a larger CD-1 mouse in a shared home cage without physical contact for 10 consecutive days followed by high-fat diet (HFD) feeding. Control mice were housed in the same cage without a CD-1 mouse. After 6 weeks of HFD, insulin sensitivity was significantly impaired in stressed mice. While the percentage of classically activated macrophages in epididymal white adipose tissue (eWAT) was equivalent between the two groups, the percentage of lymphocyte antigen 6 complex locus G6D (Ly-6G)/neutrophil elastase (NE)-double positive cells markedly increased in stressed mice, accompanied by augmented NE activity assessed by ex vivo eWAT fluorescent imaging. Treatment with an NE inhibitor completely abrogated the insulin sensitivity impairment of stressed mice. In vitro NE release upon stimulation with a formyl peptide receptor 1 agonist was significantly higher in bone marrow neutrophils of stressed mice. Our findings show that SS-exposed mice are susceptible to the development of HFD-induced IR accompanied by augmented NE activity. Modulation of neutrophil function may represent a potential therapeutic target for SS-associated IR.

Psychological stress, stressful life events, male factor infertility, and testicular function: a cross-sectional study

OBJECTIVE

To assess the association between psychological stress and male factor infertility as well as testicular function (semen quality, serum reproductive hormones) and erectile dysfunction.

DESIGN

Cross-sectional study.

SETTING

University Hospital-based research center.

PATIENTS

Men with impaired semen quality were included from infertile couples, and men with naturally conceived pregnant partners were used as a reference population.

INTERVENTIONS

Participants completed a questionnaire on health and lifestyle, including a 14-item questionnaire about self-rated psychological stress symptoms and stressful life event (SLEs), had a physical examination performed, delivered a semen sample and had a blood sample drawn.

MAIN OUTCOMES

Differences in stress scores (calculated from self-reported stress symptoms) and SLEs between infertile and fertile men were assessed in crude and fully adjusted linear regression models. Secondary outcomes were semen quality, serum reproductive hormones, and erectile dysfunction.

RESULTS

Of 423 men, 176 (41.6%) experienced at least one SLE in the 3 months prior to inclusion (50.4%/36.9%: infertile/fertile men, P = .03); β-coefficient and 95% confidence interval for the difference between the groups on the transformed scale in fully adjusted linear regression models was 0.18 (0.06, 0.30). However, there were no differences in psychological stress symptoms between the two groups (β-coefficient and 95% confidence interval) on the transformed scale (0.14; -0.02, 0.30). No association between stress (self-reported stress symptoms and SLEs) and testicular function or with erectile dysfunction was found in any of the men.

CONCLUSION

Infertile men reported a higher number of SLEs than fertile men but did not report more psychological stress symptoms. Distress and SLEs were not associated with reduced male reproductive function.