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

Chronic Stress A Potential Suspect Zero of Atherosclerosis: A Systematic Review

Atherosclerosis (AS) is a chronic vascular inflammatory disease, in which the lipid accumulation in the intima of the arteries shows yellow atheromatous appearance, which is the pathological basis of many diseases, such as coronary artery disease, peripheral artery disease and cerebrovascular disease. In recent years, it has become the main cause of death in the global aging society, which seriously endangers human health. As a result, research on AS is increasing. Lesions of atherosclerosis contain macrophages, T cells and other cells of the immune response, together with cholesterol that infiltrates from the blood. Recent studies have shown that chronic stress plays an important role in the occurrence and development of AS. From the etiology of disease, social, environmental and genetic factors jointly determine the occurrence of disease. Atherosclerotic cardio-cerebrovascular disease (ASCVD) is often caused by chronic stress (CS). If it cannot be effectively prevented, there will be biological changes in the body environment successively, and then the morphological changes of the corresponding organs. If the patient has a genetic predisposition and a combination of environmental factors triggers the pathogenesis, then chronic stress can eventually lead to AS. Therefore, this paper discusses the influence of chronic stress on AS in the aspects of inflammation, lipid metabolism, endothelial dysfunction, hemodynamics and blood pressure, plaque stability, autophagy, ferroptosis, and cholesterol efflux.

Echo-tracking evaluation of changes in common carotid artery wall elasticity after smoking cessation

The aim of this study was to explore changes in the common carotid arterial wall elasticity after smoking cessation. Carotid artery ultrasonographic examination was performed in 136 patients, then 1 or 2 years after smoking cessation. We used echo-tracking (ET) to measure stiffness index (β), pressure-strain elasticity modulus (Ep), arterial compliance (AC), augmentation index (AI), and local pulse wave velocity (PWVβ). Patients were divided into four groups based on whether or not they successfully stopped smoking (groups M and N, respectively) and whether (groups M2 and N2, respectively) or not (groups M1 and N1, respectively) they showed comorbidities. In group M1, β, Ep and PWVβ were lower at 1 year than before smoking cessation, while AC and AI did not change. At 2 years, β, Ep, PWVβ, and AC, but not AI, improved further. In group M2, β, Ep, and PWVβ decreased at 2 years, whereas AC and AI did not change. In groups N1 and N2, none of the variables changed significantly. ET can be used quantitatively to evaluate the impact of smoking cessation on the elasticity of the common carotid artery wall.

Vital exhaustion and markers of low-grade inflammation in healthy adults: the Amsterdam Growth and Health Longitudinal Study

This study analyses distinct trajectories of vital exhaustion (VE; a measure of mental health incorporating signs of stress and depression) over a period of 15 years in healthy adults and investigates further the consequences for markers of low-grade inflammation as indicators of cardiovascular disease risk. Data of 341 participants of the Amsterdam Growth and Health Longitudinal Study were utilized. VE was measured by the Maastricht Questionnaire. Markers of low-grade inflammation included interleukin-6, interleukin-8 and tumour necrosis factor-α. Distinct trajectories of VE were obtained by latent class growth models, and consequences for markers of low-grade inflammation of the trajectories were analysed by linear regressions. We found comparable trajectories of VE for men and women; a 'never vitally exhausted' subgroup (16.9% and 25.1%, respectively), a 'stable preclinical VE' subgroup (51.7% and 68.1%) and a 'chronic VE state' subgroup (31.5% and 6.7%). The subgroups had similar levels of the markers investigated. This study is the first to analyse VE longitudinally in healthy adults and indicates that although distinct trajectories of VE were identified, differential consequences for cardiovascular disease risk were unapparent.

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

Background

The syndrome of vital exhaustion (VE), characterized by fatigue and irritability, may contribute to an increased risk of atherosclerosis. The aim of the study was to explore sex differences in the interactions of VE with endothelial dysfunction and VE with reduced carotid elasticity, the important contributors to the development of early atherosclerosis, on preclinical atherosclerosis.

Methods

The participants were 1002 women and 719 men aged 24-39 examined in the Cardiovascular Risk in Young Finns study. Vital exhaustion was measured using the Maastricht Questionnaire. Preclinical atherosclerosis was assessed by carotid intima-media thickness (IMT), endothelial function was measured by brachial flow-mediated dilatation (FMD), and arterial elasticity by carotid artery compliance (CAC) using ultrasound techniques.

Results

We found a significant CAC x VE interaction for IMT only for the men. Our results imply that high VE level significantly related to high IMT levels among the men with low CAC, but not among the women with low CAC or among the women or men with high CAC. No significant FMD x VE interactions for IMT for the women or men were found.

Conclusions

High VE may exert an effect on IMT for men with impaired arterial elasticity. The results suggest that high vitally exhausted men with reduced arterial elasticity are at increased risk of atherosclerosis in early life and imply men's decreased stress coping in relation to stressful psychological coronary risk factors.