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Yilmaz Y, Uçar C, Yildiz S. Activities of the hypothalamo-pituitary-adrenal axis and autonomic nervous system following a strong earthquake. Stress Health 2024; 40:e3281. [PMID: 37291076 DOI: 10.1002/smi.3281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023]
Abstract
This study aimed to investigate the effects of post-traumatic stress, caused by a strong earthquake, on the hypothalamo-pituitary-adrenal axis (HPA) and autonomous nervous system activity (ANS). Activities of the HPA (as salivary cortisol) and ANS (as heart-rate variability [HRV]) were measured following the 2020 Elazig (Türkiye) earthquake (6.8 Richter Scale, classified as strong). A total of 227 participants (103 men (45%) and 124 women (%55)) provided saliva samples twice, namely, 1 week and 6 weeks after the earthquake. Of these participants, HRV was measured in 51 participants by 5 min continuous electrocardiogram (ECG) recording. Frequency- and time-domain parameters of the HRV were calculated to assess the activity of ANS and low/high frequency (LF/HF) ratio was used as surrogate for sympathovagal balance. Salivary cortisol levels decreased from week 1 towards week 6 (17.40 ± 1.48 and 15.32 ± 1.37 ng/mL, respectively, p < 0.05). There were no gender differences (17.99 ± 2.63 and 16.90 ± 1.60 ng/mL, respectively for females and males, p > 0.05) for salivary cortisol levels. There were no differences in time- and frequency domain parameters of the HRV including LF/HF ratio (2.95 ± 0.38 ms2 and 3.60 ± 0.70 ms2 , respectively for week 1 and 6, p > 0.05). The data show that HPA axis activity, but not that of the ANS, remains higher 1 week after the earthquake but decreases afterwards towards the sixth week, suggesting that the HPA axis might be responsible for the long-term effects of a traumatic event like a strong earthquake.
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Affiliation(s)
- Yücehan Yilmaz
- Faculty of Medicine, Department of Physiology, University of Inonu, Malatya, Türkiye
| | - Cihat Uçar
- Faculty of Medicine, Department of Physiology, Malatya Turgut Ozal University, Battalgazi, Türkiye
| | - Sedat Yildiz
- Faculty of Medicine, Department of Physiology, University of Inonu, Malatya, Türkiye
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2
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Narita K, Hoshide S, Kario K. Time course of disaster-related cardiovascular disease and blood pressure elevation. Hypertens Res 2021; 44:1534-1539. [PMID: 34381195 DOI: 10.1038/s41440-021-00698-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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3
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Pengo MF, Albini F, Guglielmi G, Mollica C, Soranna D, Zambra G, Zambon A, Bilo G, Parati G. Home blood pressure during COVID-19-related lockdown in patients with hypertension. Eur J Prev Cardiol 2021; 29:e94-e96. [PMID: 33899916 PMCID: PMC8135487 DOI: 10.1093/eurjpc/zwab010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/23/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy
| | | | - Giulia Guglielmi
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy
| | - Chiara Mollica
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Gaia Zambra
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Antonella Zambon
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy.,Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
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Fath AR, Aglan A, Platt J, Yaron JR, Varkoly KS, Beladi RN, Gorgas D, Jean JT, Dasni P, Eldaly AS, Juby M, Lucas AR. Chronological Impact of Earthquakes on Blood Pressure: A Literature Review and Retrospective Study of Hypertension in Haiti Before and After the 2010 Earthquake. Front Public Health 2021; 8:600157. [PMID: 33520917 PMCID: PMC7844318 DOI: 10.3389/fpubh.2020.600157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: We review prior studies on the incidence of hypertension (HTN) after earthquakes and present a retrospective analysis of HTN after the 2010 earthquake in Haiti. Methods: Prior reports on HTN incidence were reviewed and a retrospective chart review for diagnosis of HTN in 4,308 patient charts was performed over a 7 year period (five clinics). A retrospective cohort study (RCS) was then performed on 11 patients with linear follow-up. Results: The Literature review revealed a significant increase in acute and subacute HTN following earthquakes. However, the chronic effects of earthquakes varied. Our chart review uncovered no significant difference in diagnosed HTN in a Fort-Liberté clinic 128 kilometers (km) distant and 4 weeks post-event. A secondary linear RCS for 11 individuals, prior to and after the earthquake, also did not detect a significant change in HTN prevalence. Conclusion: Prior studies demonstrate acute and subacute, increases in HTN after earthquakes, but late changes have varied. Retrospective studies in the Fort-Liberté clinic, 128 km distant and 4 weeks post-event, revealed no significant change in HTN, confirming prior findings that changes in HTN after earthquakes are early and local events. Further work examining HTN after earthquakes is needed to improve early health care after natural disasters.
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Affiliation(s)
- Ayman R Fath
- Internal Medicine Department, Creighton University, Phoenix, AZ, United States
| | - Amro Aglan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jeri Platt
- Glen Echo Presbyterian Church, Columbus, OH, United States
| | - Jordan R Yaron
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Kyle S Varkoly
- Kansas City University, Joplin, Kansas City, MO, United States
| | - Roxana N Beladi
- Kansas City University, Joplin, Kansas City, MO, United States
| | - Diane Gorgas
- Department of Emergency Medicine and Office of Global Health, Ohio State University's Wexner Medical Center, Columbus, OH, United States
| | - Jean Tom Jean
- Jerusalem Baptist Church, Fort-Liberté, Haiti.,Santiago Medical School, Santiago, Dominican Republic
| | | | - Abdullah S Eldaly
- Plastic and Reconstructive Surgery Department, Tanta University Hospitals, Tanta, Egypt
| | - Michael Juby
- Midwestern University Medical School, Phoenix, AZ, United States
| | - Alexandra R Lucas
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States.,Internal Medicine Department, Creighton University Arizona Health Education Alliance, Phoenix, AZ, United States
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5
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Moitinho de Almeida M, van Loenhout JAF, Thapa SS, Kumar KC, Schlüter BS, Singh R, Banse X, Putineanu D, Mahara DP, Guha-Sapir D. Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal. PLoS One 2019; 14:e0220016. [PMID: 31318948 PMCID: PMC6638971 DOI: 10.1371/journal.pone.0220016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background In 2015, an earthquake killing 9,000 and injuring 22,000 people hit Nepal. The Tribhuvan University Teaching Hospital (TUTH), a reference tertiary hospital, was operational immediately after the earthquake. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay. Methods An earthquake victim dataset was created based on patient records, with information on sex, age, date of admission and discharge, diagnosis, and surgical intervention. We performed an initial descriptive overview of the earthquake victims followed by a time-to-event analysis to compare length of hospital stay in different groups, using log rank test and cox regression to calculate Hazard Ratios. Results There were in total 501 admitted victims, with the peak of admissions occurring on the fifth day after the earthquake. About 89% had injury as main diagnosis, mostly in lower limbs, and 66% of all injuries were fractures. Nearly 69% of all patients underwent surgery. The median length of hospital stay was 10 days. Lower limb and trunk injuries had longer hospital stays than injuries in the head and neck (HR = 0.68, p = 0.009, and HR = 0.62 p = 0.005, respectively). Plastic surgeries had longer hospital stays than orthopaedic surgeries (HR = 0.57 p = 0.006). Having a crush injury and undergoing an amputation also increased time to discharge (HR = 0.57, p = 0.013, and HR = 0.65 p = 0.045 respectively). Conclusions Hospital stay was particularly long in this sample in comparison to other studies on earthquake victims, indirectly indicating the high burden TUTH had to bear to treat these patients. To strengthen resilience, tertiary hospitals should have preparedness plans to cope with a large influx of injured patients after a large-scale disaster, in particular for the initial days when there is limited external aid.
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Affiliation(s)
- Maria Moitinho de Almeida
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Sunil Singh Thapa
- Department of Orthopedics, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - K. C. Kumar
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Benjamin-Samuel Schlüter
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | - Xavier Banse
- Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dan Putineanu
- Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Deepak Prakash Mahara
- Department of Orthopedics, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Gorchakova N, Heimuller E, Galkin A. Current Safety Data of the Complex Herbal Medicine with Sedative and Cardioprotective Actions. INNOVATIVE BIOSYSTEMS AND BIOENGINEERING 2018. [DOI: 10.20535/ibb.2018.2.3.143029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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7
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Exploring Perception of Vibrations from Rail: An Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111303. [PMID: 29072612 PMCID: PMC5707942 DOI: 10.3390/ijerph14111303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022]
Abstract
Rail transport is an environmentally responsible approach and traffic is expected to increase in the coming decades. Little is known about the implications for quality of life of populations living close to railways. This study explores the way in which vibrations from rail are perceived and described by these populations. The study took place in the Västra Götaland and Värmland regions of Sweden. A qualitative study approach was undertaken using semi-structured interviews within a framework of predetermined questions in participants’ homes. A 26.3% response rate was achieved and 17 participants were interviewed. The experience of vibrations was described in tangible terms through different senses. Important emerging themes included habituation to and acceptance of vibrations, worry about property damage, worry about family members and general safety. Participants did not reflect on health effects, however, chronic exposure to vibrations through multimodal senses in individual living environments may reduce the possibility for restoration in the home. Lack of empowerment to reduce exposure to vibrations was important. This may alter individual coping strategies, as taking actions to avoid the stressor is not possible. The adoption of other strategies, such as avoidance, may negatively affect an individual’s ability to cope with the stressor and their health.
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Konno S, Munakata M. Blood Pressure Elevation Lasting Longer Than 1 Year Among Public Employees After the Great East Japan Earthquake: The Watari Study. Am J Hypertens 2017; 30:120-123. [PMID: 27784682 DOI: 10.1093/ajh/hpw131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/03/2016] [Accepted: 10/04/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We have previously reported that the public employees of Watari town showed significantly greater elevations in both systolic and diastolic blood pressure than the general population 4-8 months after the Great East Japan Earthquake, which occurred on 11 March 2011. To examine whether these differences persisted thereafter, we conducted a follow-up study for both the public employees and the general population of Watari town over 1 year. METHODS Among 225 public employees and 1232 individuals from the general population of the town who received consecutive annual health checkups from 2010 to 2012, 89 pairs were matched for age and sex according to a propensity score. RESULTS The baseline characteristics (predisaster) did not statistically differ between the paired groups. The public employees showed significantly higher systolic and diastolic blood pressure in 2011 (postdisaster) compared with the general population (129.8 ± 14.0/78.0 ± 11.7 vs. 117.0 ± 14.4/71.6 ± 11.4 mm Hg, P < 0.001 for both). Furthermore, the systolic blood pressure of the public employees remained significantly higher than that of the general population in 2012 (125.3 ± 16.0 vs. 119.9 ± 15.5 mm Hg, P = 0.023). CONCLUSION Prolonged blood pressure elevation among the public employees was observed for more than 1 year after the disaster, suggesting a need for close blood pressure monitoring of public employees engaged in long-term disaster relief operations.
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Affiliation(s)
- Satoshi Konno
- Division of Hypertension and Research Center for Lifestyle-related Disease, Tohoku Rosai Hospital, Sendai, Japan
| | - Masanori Munakata
- Division of Hypertension and Research Center for Lifestyle-related Disease, Tohoku Rosai Hospital, Sendai, Japan.
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9
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Li C, Luo X, Zhang W, Zhou L, Wang H, Zeng C. YaAn earthquake increases blood pressure among hospitalized patients. Clin Exp Hypertens 2016; 38:495-9. [PMID: 27398731 DOI: 10.3109/10641963.2015.1116549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND YaAn, a city in Sichuan province, China, was struck by a major earthquake measuring 7.0 on the Richter scale on April 20, 2013. This study sought to investigate the impact of YaAn earthquake on the blood pressure (BP) among hospitalized patients in the department of cardiology. METHODS We enrolled 52 hospitalized patients who were admitted to our hospital at least three days before the day of earthquake in 2013 (disaster group) as compared with 52 patients during April 20, 2014 (nondisaster group). BP was measured three times per day and the prescription of antihypertensive medicine was recorded. RESULTS The earthquake induced a 3.3 mm Hg significant increase in the mean postdisaster systolic blood pressure (SBP) in the disaster group as compared with the nondisaster group. SBP at admission was positively associated with the elevated SBP in the logistic regression model (odds ratio (OR) = 1.09, 95% confidence interval (CI):1.016-1.168, p = 0.015), but not other potential influencing factors, including antihypertensive medicine, sex, age, and body weight, excluding β-blockers. Patients with β-blockers prescription at the time of earthquake showed a blunt response to earthquake-induced SBP elevation than those who were taking other antihypertensive drugs (OR = 0.128, 95% CI: 0.019-0.876, p = 0.036). CONCLUSION The YaAn earthquake induced significant increase in SBP even at a distance from the epicenter among hospitalized patients. The findings demonstrate that pure psychological components seem to be a cause of the pressor response and β-blockers might be better in controlling disaster-induced hypertension.
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Affiliation(s)
- Chuanwei Li
- a Department of Cardiology, Daping Hospital , The Third Military Medical University , Chongqing , PR China
| | - Xiaoli Luo
- a Department of Cardiology, Daping Hospital , The Third Military Medical University , Chongqing , PR China
| | - Wen Zhang
- b Respiratory Department, Xinqiao Hospital , The Third Military Medical University , Chongqing , PR China
| | - Liang Zhou
- c Department of Health Statistics , College of Preventive Medicine, Third Military Medical University , Chongqing , PR China
| | - Hongyong Wang
- a Department of Cardiology, Daping Hospital , The Third Military Medical University , Chongqing , PR China
| | - Chunyu Zeng
- a Department of Cardiology, Daping Hospital , The Third Military Medical University , Chongqing , PR China
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10
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Nishizawa M, Hoshide S, Okawara Y, Shimpo M, Matsuo T, Kario K. Aftershock Triggers Augmented Pressor Effects in Survivors: Follow-Up of the Great East Japan Earthquake. Am J Hypertens 2015; 28:1405-8. [PMID: 25890830 DOI: 10.1093/ajh/hpv044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous reports focused on the significant acute effects immediately after an earthquake on an increase in blood pressure (BP) assessed by ambulatory BP monitoring. However, there have been no data on the impact of environmental triggers on the long-term response to earthquake. METHODS We analyzed the ambulatory BP monitoring data of 8 patients who lived in the disaster area of the 11 March 2011 Great East Japan Earthquake on the day of the largest aftershock with a first tsunami warming (sirens) on 7 December 2012. RESULTS There was no significant difference in the BP in either the period 1 hour before (median (range): 126.5 (121.5-138.0) vs. 137.8 (129.5-177.0) mm Hg, P = 0.07) or that 1 hour after (139.3 (113.0-143.5) vs. 137.5 (125.0-192.0) mm Hg, P = 0.27) the aftershock between those living at home and those who had been living in temporary housing. After the time of aftershock, the systolic BP levels at that night (124.9 (113.2-137.9) vs. 107.0 (101.9-110.1) mm Hg, P = 0.021) and systolic BP levels at the following morning (149.3 (131.0-196.2) vs. 129.5 (128.8-131.0) mm Hg, P = 0.029) were also significantly higher in those living in temporary housing at the time compared to those living in their own homes. CONCLUSION Our data suggest that the stress of a change in living conditions following the disaster might have contributed an increased risk of cardiovascular events.
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Affiliation(s)
- Masafumi Nishizawa
- Department of Medicine, Minamisanriku Public Medical Clinic, Minamisanriku, Motoyoshi-gun, Miyagi, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Masahisa Shimpo
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Takefumi Matsuo
- Hyogo Prefectural Awaji Medical Center, Shioya, Sumoto-shi, Hyogo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan;
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11
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Blood pressure elevation in hemodialysis patients after the Great East Japan Earthquake. Hypertens Res 2013; 37:139-44. [DOI: 10.1038/hr.2013.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 05/21/2013] [Accepted: 07/06/2013] [Indexed: 11/08/2022]
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Hung KKC, Lam ECC, Chan EYY, Graham CA. Disease pattern and chronic illness in rural China: the Hong Kong Red Cross basic health clinic after 2008 Sichuan earthquake. Emerg Med Australas 2013; 25:252-9. [PMID: 23759047 DOI: 10.1111/1742-6723.12080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical teams might have difficulties preparing for deployment to rural towns due to a lack of prior information. The study objective was to identify the health needs and chronic disease prevalence of rural Chinese following a major earthquake. METHODS Hong Kong Red Cross organised a basic healthcare team to Yanmen town, Jiangyou 3 weeks after the 2008 Sichuan earthquake. A cross-sectional records-based study of all patients treated by the Hong Kong Red Cross basic healthcare team from 1 June to 19 June 2008 was conducted. RESULTS Two thousand and thirty-four individual patient encounters occurred during the 19-day period. Musculoskeletal, respiratory and gastrointestinal problems were the top three categories and accounted for 30.4%, 17.4% and 12.7%, respectively. The 43.4% of the 762 patients with blood pressure measurements were above the recognised criteria for hypertension. CONCLUSIONS We identified that the management of chronic diseases was an important issue, especially with the high prevalence of hypertension found in our study. Medical responders need to be aware of the potential pre-existing disease burden in the community, with the possible exacerbation in post-disaster situations. Careful planning on the use of treatment guidelines with particular focus on the local health resources available and issues with continuation of care will provide better care for the patients.
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Affiliation(s)
- Kevin K C Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
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Long-term blood pressure changes induced by the 2009 L'Aquila earthquake: assessment by 24 h ambulatory monitoring. Hypertens Res 2013; 36:795-8. [PMID: 23595046 DOI: 10.1038/hr.2013.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 01/21/2013] [Accepted: 01/23/2013] [Indexed: 02/08/2023]
Abstract
An increased rate of cardiovascular and cerebrovascular events has been described during and immediately after earthquakes. In this regard, few data are available on long-term blood pressure control in hypertensive outpatients after an earthquake. We evaluated the long-term effects of the April 2009 L'Aquila earthquake on blood pressure levels, as detected by 24 h ambulatory blood pressure monitoring. Before/after (mean±s.d. 6.9±4.5/14.2±5.1 months, respectively) the earthquake, the available 24 h ambulatory blood pressure monitoring data for the same patients were extracted from our database. Quake-related daily life discomforts were evaluated through interviews. We enrolled 47 patients (25 female, age 52±14 years), divided into three groups according to antihypertensive therapy changes after versus before the earthquake: unchanged therapy (n=24), increased therapy (n=17) and reduced therapy (n=6). Compared with before the quake, in the unchanged therapy group marked increases in 24 h (P=0.004), daytime (P=0.01) and nighttime (P=0.02) systolic blood pressure were observed after the quake. Corresponding changes in 24 h (P=0.005), daytime (P=0.01) and nighttime (P=0.009) diastolic blood pressure were observed. Daily life discomforts were reported more frequently in the unchanged therapy and increased therapy groups than the reduced therapy group (P=0.025 and P=0.018, respectively). In conclusion, this study shows that patients with unchanged therapy display marked blood pressure increments up to more than 1 year after an earthquake, as well as long-term quake-related discomfort. Our data suggest that particular attention to blood pressure levels and adequate therapy modifications should be considered after an earthquake, not only early after the event but also months later.
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Nozaki E, Nakamura A, Abe A, Kagaya Y, Kohzu K, Sato K, Nakajima S, Fukui S, Endo H, Takahashi T, Seki H, Tamaki K, Mochizuki I. Occurrence of Cardiovascular Events After the 2011 Great East Japan Earthquake and Tsunami Disaster. Int Heart J 2013; 54:247-53. [DOI: 10.1536/ihj.54.247] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eiji Nozaki
- Department of Cardiology, Iwate Prefectural Central Hospital
| | | | - Akiyo Abe
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Yuta Kagaya
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Katsuya Kohzu
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Kenjiro Sato
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Souta Nakajima
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Sigefumi Fukui
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Hideaki Endo
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Tohru Takahashi
- Department of Cardiology, Iwate Prefectural Central Hospital
| | - Hirofumi Seki
- Department of Neurosurgery, Iwate Prefectural Central Hospital
| | - Kenji Tamaki
- Department of Cardiology, Iwate Prefectural Miyako Hospital
| | - Izumi Mochizuki
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital
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Watanabe K, Tani Y, Tanaka K, Hayashi Y, Asahi K, Nakayama M, Watanabe T. Acute changes in home blood pressure after the Great East Japan Earthquake among patients with chronic kidney disease in Fukushima City. Clin Exp Nephrol 2012; 17:718-724. [PMID: 23224028 DOI: 10.1007/s10157-012-0750-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/21/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Blood pressure (BP) transiently increases after major earthquakes. Although home BP increased in hypertensive patients after the Great East Japan Earthquake (measuring 9.0 on the Richter scale) on March 11th, 2011, such profiles in patients with chronic kidney disease (CKD) have not been investigated. METHODS This retrospective single-center observational study included 38 patients with CKD at the predialysis stage [male, n=27 (71%); mean age 66.0 years; mean estimated glomerular filtration rate (eGFR) 46.0 mL/min/1.73 m²] who lived in Fukushima City. We compared their morning BP between two and four weeks after the quake with that of a control group of 39 non-CKD patients with hypertension. RESULTS Systolic BP (SBP) remained elevated for one week after the quake in the CKD and non-CKD groups [before vs. after the quake 133.7±15.6 vs. 136.9±16.9 (p=0.017) and 129.9±7.8 vs. 133.3±9.3 mmHg (p=0.009), respectively]. Increases in SBP in the morning after the quake were statistically significant in the group with but not in that without CKD (7.1 and 3.4 mmHg; p=0.038 and 0.221, respectively). Multivariate analysis revealed that a low eGFR was an independent risk factor for elevated SBP after the quake. CONCLUSIONS The quake caused acute changes in the home BP and the fact that BP elevation correlated with renal function suggests a possible mechanism of CKD, such as enhanced activity of the sympathetic nervous system in such patients.
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Affiliation(s)
- Kimio Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Yoshihiro Tani
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Kenichi Tanaka
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Yoshimitsu Hayashi
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Koichi Asahi
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Masaaki Nakayama
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Tsuyoshi Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
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Disaster Events and the Risk of Sudden Cardiac Death: A Washington State Investigation. Prehosp Disaster Med 2012; 22:313-7. [DOI: 10.1017/s1049023x00004921] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Psychological distress following disaster events may increase the risk of sudden cardiac death. In 2001, the Nisqually earthquake and the 11 September terrorist attacks profoundly affected Washington state residents.Hypothesis:This research investigated the theory that the incidence of sudden cardiac death would increase following these disaster events.Methods:Death certificates were abstracted using a uniform case definition to determine the number of sudden cardiac deaths for the 48-hour and one week periods following the two disaster events. Sudden cardiac deaths from the corresponding 48-hour and one-week periods in the three weeks before the events, and the analogous periods in 1999 and 2000 were designated as control times. Using t-tests, the number of sudden cardiac deaths for the periods following the disaster events was compared to those of the control periods.Results:In total, 32 sudden cardiac deaths occurred in the four counties affected by the Nisqually earthquake during the 48 hours after the event, compared to an average of 22 ±3.5 (standard deviation) in the same counties during the control periods (p = 0.02). No difference was observed for the one week period (94 compared to 79.2 ±12.4,p = 0.28). No difference was observed in the number of sudden cardiac deaths in the 48-hours or one-week following the terrorist attacks compared to control periods.Conclusions:A local disaster caused by a naturally occurring hazard, but not a geographically remote human disaster, was associated with an increased risk of sudden cardiac death. A better understanding of the underlying mechanisms may have implications for prevention of sudden cardiac death.
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Sokejima S, Nakatani Y, Kario K, Kayaba K, Minowa M, Kagamimori S. Seismic Intensity and Risk of Cerebrovascular Stroke: 1995 Hanshin-Awaji Earthquake. Prehosp Disaster Med 2012; 19:297-306. [PMID: 15645625 DOI: 10.1017/s1049023x00001928] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:No epidemiological data exist concerning the influence of an earthquake on the risk of stroke. Whether the incidence of cerebrovascular stroke increased after the 1995 Hanshin-Awaji earthquake (EQ) in Japan and whether seismic intensity affected stroke risk dose-dependently was examined.Methods:A retrospective cohort study was conducted among residents, who were living in two towns on the island of Awaji and were participants of the National Health Insurance (NHI) program. The two towns were divided into 11 districts and their respective damage and socioeconomic states were investigated. Reviewing the NHI documents issued before and after the EQ, people who had strokes (9th International Classification of Diseases, codes 430–431 or 433–434.9) were identified. Risk of stroke in relation to the seismic intensities, was assessed with the Cox proportional hazard model.Results:Among subjects aged 40 to 99 years, 45 of 8,758 (0.514%) had a stroke the year before the EQ, 72 of 8,893 (0.810%) had a stroke in the first year following the EQ, and 49 of 8,710 (0.566%) had a stroke in the second year following the EQ. In districts where the earthquake's intensity was ≤9.5 on the modified Mercalli intensity (MMI), compared with the year prior to the EQ, the relative risk (RR) of stroke was 2.4 (95% confidence interval (CI) 1.1, 5.0) in the first year following the EQ, after adjusting for age, gender, and income. In that year, compared with MMI of <8.5–9.0, RRs for 9.0–9.5 and ≥9.5 were 1.6 (CI 0.9, 2.1) and 2.0 (CI 1.1, 3.7), respectively (pfor trend 0.02). No trend for the RR was observed in the year before the EQ or in the second year following the EQ.Conclusion Stroke increased in the first year following the EQ. The increase was associated with seismic intensity in a dose-response manner. Results suggest a potential threshold for RR of >2.0 in areas near 9.5 on the MMI scale.
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Affiliation(s)
- Shigeru Sokejima
- Department of Public Health Administration and Policy, National Institute of Public Health, Wako, Saitama, Japan
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Cardiovascular and cerebrovascular events pre- and post-earthquake of 6 April 2009: the Abruzzo's experience. Am J Hypertens 2012; 25:556-60. [PMID: 22318513 DOI: 10.1038/ajh.2012.4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND On 6 April 2009, an earthquake occurred in Abruzzo, a small region in the middle-east of Italy. Its chief town, L'Aquila, was the epicenter. We carried out an observational analysis to evaluate the potential association between the earthquake and the rate of cardiovascular and cerebrovascular admissions of the residents in the province of L'Aquila. METHODS We used administrative discharge data, extracting all admissions made from 6 April to 31 July 2008 (pre-earthquake control period) or from 6 April to 31 July 2009 (post-earthquake period), assigned to diagnosis-related groups (DRGs) related to cardiovascular or cerebrovascular diseases. RESULTS The overall number of hospitalizations for cardio- or cerebrovascular diseases by residents in L'Aquila before and after the earthquake was 10,833. In the whole region, the hospitalization rate was slightly lower in 2009 (-0.9%), whereas only in the local health unit (LHU) of L'Aquila it showed an increase by +13.2% (P < 0.01), essentially due to cardiovascular diseases (+21.9%) in elderly people (+26.9%; P < 0.01). The proportion of the main comorbidities in the admissions for cardiovascular diseases of the residents in L'Aquila significantly increased (P = 0.03), but no significant differences could be observed for each comorbidity separately. CONCLUSIONS Our study supports previous findings of an association between earthquakes and an increase in cardiovascular diseases in the elderly.
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Abstract
The devastating Great East Japan Earthquake, which was 9.0 on the Richter scale, occurred on March 11, 2011. Japan experienced the Great Hanshin-Awaji Earthquake 16 years ago, and I was working at the epicenter, and reported the characteristics of the earthquake-associated cardiovascular risk and high blood pressure (BP) found during the continuous practice and clinical studies of Tsuna Medical Association before and after the quake. A major disaster increases thrombophilic tendency and BP, both of which trigger disaster-induced cardiovascular events such as stroke, cardiac events, etc. The high salt intake and the increased salt sensitivity caused by disrupted circadian rhythms are the 2 major leading causes of disaster hypertension (HT) through neurohumoral activation under stressful conditions. To better assess and reduce the risks for disaster-associated cardiovascular events, we introduced the web-based Disaster Cardiovascular Prevention (DCAP) network (which consists of DCAP risk and prevention score assessment, and self-measured BP monitoring at both the shelter and the home) to the survivors of the 2011 disaster, and frequently found newly developed HT. Here I review the recent evidence, possible mechanism and the management of "disaster HT" for effective prevention of disaster-induced cardiovascular events.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, and Department of Sleep and Circadian Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan.
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Depressive Symptoms and 24-Hour Ambulatory Blood Pressure in Africans: The SABPA Study. Int J Hypertens 2011; 2012:426803. [PMID: 22028954 PMCID: PMC3199098 DOI: 10.1155/2012/426803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/03/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022] Open
Abstract
Disturbances in circadian rhythm might play a central role in the neurobiology of depression. We examined the association between depressive symptoms and 24-hour ambulatory BP in a sample of 405 (197 black and 208 Caucasian) urbanized African teachers aged 25 to 60 yrs (mean 44.6 ± 9.6 yrs). Depressive symptoms were assessed using the self-administered 9-item Patient Health Questionnaire (PHQ-9). After adjusting for age, sex, and ethnicity, participants with severe depressive symptoms (PHQ-9 ≥ 15) had higher odds of hypertension defined from ambulatory BP and/or use of antihypertensive medication (odds ratio = 2.19, 95% CI, 1.00–4.90) in comparison to participants with no symptoms. Compared to Caucasians with no depressive symptoms, those with severe symptoms had blunted nocturnal systolic BP drop of 4.7 mmHg (95% CI, −0.5 to 10.0, P = 0.07). In summary, depressive symptoms were associated with the circadian BP profile in black and Caucasian Africans.
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Walczewska J, Rutkowski K, Wizner B, Cwynar M, Grodzicki T. Stiffness of large arteries and cardiovascular risk in patients with post-traumatic stress disorder. Eur Heart J 2010; 32:730-6. [DOI: 10.1093/eurheartj/ehq354] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Petrazzi L, Striuli R, Polidoro L, Properzi G, Casale R, Pasqualetti P, Desideri G, Ferri C, Parati G. Changes in 24-hour ambulatory blood pressure monitoring during the 2009 earthquake at L'Aquila. Am J Med 2010; 123:e1-3. [PMID: 20920671 DOI: 10.1016/j.amjmed.2010.01.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
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Measuring the effects of stress on the cardiovascular system during a disaster: the effective use of self-measured blood pressure monitoring. J Hypertens 2010; 28:657-9. [DOI: 10.1097/hjh.0b013e32833815a4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In both physiologic and pathological conditions, instantaneous heart rate value is the result of a rather complex interplay. It constantly varies under the influence of a number of factors: nonmodifiable and modifiable ones. Pharmacologic blockade with beta-adrenergic antagonists and/or with parasympathetic antagonists such as atropine have permitted the identification of the mechanisms of autonomic nervous regulation of heart rate in a variety of physiologic and pathological conditions. The analysis of heart rate and blood pressure variability has yielded additional information on the autonomic control of the circulation, which has proven to have diagnostic and prognostic implications in a number of clinically relevant conditions such as hypertension, acute myocardial infarction, heart failure, and predisposition to sudden cardiac death. This article will summarize, based on available epidemiologic and clinical studies, the key variables influencing heart rate and heart rate variability in view of the known association between heart rate and cardiovascular disease.
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Acute cardiovascular effects of the Wenchuan earthquake: ambulatory blood pressure monitoring of hypertensive patients. Hypertens Res 2009; 32:797-800. [DOI: 10.1038/hr.2009.98] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms. J Am Coll Cardiol 2009; 52:2156-62. [PMID: 19095133 DOI: 10.1016/j.jacc.2008.08.057] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 07/23/2008] [Accepted: 08/26/2008] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study sought to estimate the extent to which behavioral and pathophysiological risk factors account for the association between psychological distress and incident cardiovascular events. BACKGROUND The intermediate processes through which psychological distress increases the risk of cardiovascular disease (CVD) are incompletely understood. An understanding of these processes is important for treating psychological distress in an attempt to reduce CVD risk. METHODS In a prospective study of 6,576 healthy men and women (ages 50.9 +/- 13.1 years), we measured psychological distress (using the 12-item version of the General Health Questionnaire >or=4) and behavioral (smoking, alcohol, physical activity) and pathophysiological (C-reactive protein, fibrinogen, total and high-density lipoprotein cholesterol, obesity, hypertension) risk factors at baseline. The main outcome was CVD events (hospitalization for nonfatal myocardial infarction, coronary artery bypass, angioplasty, stroke, heart failure, and CVD-related mortality). RESULTS Cigarette smoking, physical activity, alcohol intake, C-reactive protein, and hypertension were independently associated with psychological distress. There were 223 incident CVD events (63 fatal) over an average follow-up of 7.2 years. The risk of CVD increased in relation to presence of psychological distress in age- and sex-adjusted models (hazard ratio: 1.54, 95% confidence interval: 1.09 to 2.18, p = 0.013). In models that were adjusted for potential mediators, behavioral factors explained the largest proportion of variance ( approximately 65%), whereas pathophysiological factors accounted for a modest amount (C-reactive protein approximately 5.5%, hypertension, approximately 13%). CONCLUSIONS The association between psychological distress and CVD risk is largely explained by behavioral processes. Therefore, treatment of psychological distress that aims to reduce CVD risk should primarily focus on health behavior change.
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Sparrenberger F, Fuchs SC, Moreira LB, Fuchs FD. Stressful life events and current psychological distress are associated with self-reported hypertension but not with true hypertension: results from a cross-sectional population-based study. BMC Public Health 2008; 8:357. [PMID: 18922180 PMCID: PMC2600643 DOI: 10.1186/1471-2458-8-357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 10/15/2008] [Indexed: 11/17/2022] Open
Abstract
Background The evidence linking stress to hypertension has been scarcely documented in population-based studies. Methods Participants were selected through a multi-stage probability sampling and interviewed at home, being submitted to measures of demographics, anthropometrics, blood pressure (BP), and risk factors for hypertension. Hypertension was defined as BP ≥ 140/90 mm Hg or use of BP-lowering drugs or as self-reported hypertension. Stressful life events were investigated through an inventory of nine major life events occurring in the year preceding the interview. Psychological distress was evaluated through a facial scale of expression of emotion in the last month. Results In the total, 1,484 adult individuals were investigated. Prevalence of hypertension was lower in individuals who reported any stressful life event in comparison with individuals who did not reported an event (34.3 versus 44.2%, P < 0.01), such as relative or friend death, loss of job, divorce, violence and migration. There was a trend for higher prevalence of hypertension in individuals with higher psychological distress in the last month, which was not longer significant after adjustment for confounding. In contrast, individuals who self-reported hypertension, but actually had normal blood pressure and were not using antihypertensive medication, reported higher numbers of stressful events. Conclusion Recent stressful life events and current psychological distress are not associated with hypertension. Associations between stress events and distress with self-reported hypertension are not intermediated by effects of stress on blood pressure, and may be ascribed to negative feeling about disease and not to the disease itself.
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Steptoe A, Brydon L. Emotional triggering of cardiac events. Neurosci Biobehav Rev 2008; 33:63-70. [PMID: 18534677 DOI: 10.1016/j.neubiorev.2008.04.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 04/25/2008] [Accepted: 04/28/2008] [Indexed: 12/19/2022]
Abstract
Psychological factors may contribute not only to the evolution of coronary atherosclerosis and long-term risk of coronary heart disease, but also to the triggering of acute cardiac events in patients with advanced atherosclerosis. Evidence for emotional triggering of cardiac events derives both from population-based studies of hospital admissions and sudden deaths following major traumas such as earthquakes and terrorist incidents, and from individually based interview studies with survivors of acute coronary syndromes (ACS). The latter indicate that acute anger, stress and depression or sadness may trigger ACS within a few hours in vulnerable individuals. The psychobiological processes underlying emotional triggering may include stress-induced haemodynamic responses, autonomic dysfunction and parasympathetic withdrawal, neuroendocrine activation, inflammatory responses involving cytokines and chemokines, and prothrombotic responses, notably platelet activation. These factors in turn promote coronary plaque disruption, myocardial ischaemia, cardiac dysrhythmia and thrombus formation. The implications of these findings for patient care and ACS prevention are outlined.
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Affiliation(s)
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Bhattacharyya MR, Steptoe A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications. Prog Cardiovasc Dis 2007; 49:353-65. [PMID: 17329181 DOI: 10.1016/j.pcad.2006.11.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emotional triggers of acute coronary syndromes include population-level events such as earthquakes and terrorist attacks, and individual experiences of acute anger, stress and depression. The methodology of studying emotional triggers has developed markedly over recent years, though limitations remain. The biological processes underlying triggering include acute autonomic dysregulation, neuroendocrine activation, hemostatic and inflammatory responses which, when associated with plaque disruption, promote myocardial ischemia, cardiac dysrhythmia and thrombosis formation. Prevention and management strategies for ameliorating emotional triggering remain to be effectively developed.
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Affiliation(s)
- Mimi R Bhattacharyya
- Department of Epidemiology and Public Health, University College London, London, UK
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Abstract
BACKGROUND Prolonged physiological activation before or after stressors has gained recognition as a decisive element in theories that explain the link between stress and disease, specifically cardiovascular (CV) disease. This view is opposed to the conventional reactivity hypothesis that emphasizes responses during stressors. PURPOSE Prolonged activity has not often been an explicit research goal of real-life stress studies. Nevertheless, a growing number of these studies have provided evidence for prolonged activity, often as a secondary research goal. METHODS An overview of this evidence is lacking and is provided in this article. RESULTS The combined data from the reviewed studies suggest that discrete and chronic stress sources, as well as negative emotional episodes and dispositions, are related to prolonged CV activity of various durations, including sleep periods. On the other hand, evidence supporting the assumption that prolonged stress-related activation predicts disease is still very modest. CONCLUSIONS In this article we suggest that future research of prolonged activation should give priority to (a) the establishment of clear beginnings and endings of stressful events, (b) the prediction of disease by prolonged activation, and (c) potential psychological mediators of stress-related prolonged activation. These mediators may include, for example, worry and rumination, or other processes characterized by perseverative cognition, including unconscious processes.
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Affiliation(s)
- Suzanne Pieper
- Division of Clinical and Health Psychology, Leiden University, The Netherlands.
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Gerin W, Chaplin W, Schwartz JE, Holland J, Alter R, Wheeler R, Duong D, Pickering TG. Sustained blood pressure increase after an acute stressor: the effects of the 11 September 2001 attack on the New York City World Trade Center. J Hypertens 2005; 23:279-84. [PMID: 15662215 DOI: 10.1097/00004872-200502000-00009] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effects of catastrophic stress on blood pressure are well documented, but usually few measurements were taken before the event occurred, and the people studied were directly involved or geographically close to the disaster. The impact of the 11 September 2001 (9/11) attacks in New York City had far greater reach, and has been sustained by subsequent events. OBJECTIVE To test the hypothesis that, after the 9/11 attacks, blood pressures in the population affected would be increased compared with that in both the preceding months and the same period during the previous year. METHODS We used data available from a current study of blood pressure in four sites in the USA that enabled us to examine them from two perspectives: a mixed (within and between groups) analysis that tested the overall differences in blood pressure before and after 9/11, and a within-subjects model to examine the more focused issue of individual change in blood pressure after 9/11. The blood pressures of 427 hypertensive individuals were telemonitored at four sites. An additional 101 patients had been monitored at two sites during the same period in the previous year. RESULTS Mean systolic blood pressure was significantly greater during the 2 months after 9/11, across the four sites, compared with that assessed during the previous 2 months (range of observed differences 1.7-3.8 mmHg). At the two sites for which data were available for the same period in the year 2000, there was also a significant effect for the same period during the preceding year for systolic blood pressure. However, at both these sites the effect at 2000 was significantly smaller than the effect at 2001. Blood pressure also generally increased among those individuals in whom monitoring overlapped the 9/11 event. CONCLUSION The World Trade Center attacks produced a substantial and sustained increase in blood pressure that appears to be independent of seasonal effects, and which has important implications for morbidity and financial burden. The ubiquitous continuing reference to the events in the news reports may contribute to the sustained effects.
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Affiliation(s)
- William Gerin
- Kravis Cardiovascular Health Center, Mount Sinai Medical Center, New York, USA.
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Survey for the Medical Needs and Life Conditions following the 2004 Sri Lanka Tsunami. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00014758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
OBJECTIVE The objective of this study was to review the evidence that behavioral and emotional factors are triggers of acute coronary syndromes. METHOD Systematic review of the published literature from 1970 to 2004 of trigger events, defined as stimuli or activities occurring within 24 hours of the onset of acute coronary syndromes. RESULTS There is consistent evidence that physical exertion (particularly by people who are not normally active), emotional stress, anger, and extreme excitement can trigger acute myocardial infarction and sudden cardiac death in susceptible individuals. Many triggers operate within 1 to 2 hours of symptom onset. There are methodologic limitations to the current literature, including sampling, retrospective reporting, and presentation biases, the role of memory decay and salience, and reverse causation because of silent prodromal events. CONCLUSIONS Behavioral and emotional factors are probable triggers of acute coronary syndromes in vulnerable individuals, and the pathophysiological processes elicited by these stimuli are being increasingly understood. The benefits to patients of knowledge to these processes have yet to accrue.
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Affiliation(s)
- Philip C Strike
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
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Parati G, Steptoe A. Stress reduction and blood pressure control in hypertension: a role for transcendental meditation? J Hypertens 2005; 22:2057-60. [PMID: 15480086 DOI: 10.1097/00004872-200411000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Unger T, Parati G. Acute stress and long-lasting blood pressure elevation: a possible cause of established hypertension? J Hypertens 2005; 23:261-3. [PMID: 15662210 DOI: 10.1097/00004872-200502000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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