van Nieuwenhuizen Benjamin P, Sekercan Aydin, Tan Hanno L, Blom Marieke T, Lok Anja, van den Born Bert-Jan H, Kunst Anton E, van Valkengoed Irene G M
Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, OLVG, Amsterdam, The Netherlands.
Int J Behav Med. 2022 Aug;29(4):426-437. doi: 10.1007/s12529-021-10027-9. Epub 2021 Sep 27.
This study investigated whether raised chronic stress in low education groups contributes to education differences in cardiovascular disease by altering sympathovagal balance.
This study included cross-sectional data of 10,202 participants from the multi-ethnic, population-based HELIUS-study. Sympathovagal balance was measured by baroreflex sensitivity (BRS), the standard deviation of the inter-beat interval (SDNN) and the root mean square of successive differences between normal heartbeats (RMSSD). The associations between chronic stressors (work, home, psychiatric, financial, negative life events, lack of job control and perceived discrimination) in a variety of domains and BRS, SDNN and RMSSD were assessed using linear regression, adjusted for age, ethnicity, waist-to-hip ratio and pack-years smoked. Mediation analysis was used to assess the contribution of chronic stress to the association between education and sympathovagal balance.
Modest but significant associations were observed between financial stress and BRS and SDNN in women, but not in RMSSD nor for any outcome measure in men. Women with the highest category of financial stress had 0.55% lower BRS (ms/mmHg; β = -0.055; CI = -0.098, -0.011) and 0.61% lower SDNN (ms; β = -0.061; CI = -0.099, -0.024) than those in the lowest category. Financial stress in women contributed 7.1% to the association between education and BRS, and 13.8% to the association between education and SDNN.
No evidence was found for the hypothesized pathway in which sympathovagal balance is altered by chronic stress, except for a small contribution of financial stress in women.
本研究调查了低教育水平人群中慢性应激增加是否通过改变交感迷走神经平衡导致心血管疾病的教育差异。
本研究纳入了来自多民族、基于人群的HELIUS研究的10202名参与者的横断面数据。通过压力反射敏感性（BRS）、心跳间期标准差（SDNN）和正常心跳之间连续差值的均方根（RMSSD）来测量交感迷走神经平衡。使用线性回归评估各个领域的慢性应激源（工作、家庭、精神、财务、负面生活事件、缺乏工作控制和感知到的歧视）与BRS、SDNN和RMSSD之间的关联，并对年龄、种族、腰臀比和吸烟包年数进行了调整。中介分析用于评估慢性应激对教育与交感迷走神经平衡之间关联的贡献。
在女性中观察到财务压力与BRS和SDNN之间存在适度但显著的关联，但在RMSSD中未观察到，在男性中也未观察到任何结果指标的关联。财务压力最高类别的女性比最低类别的女性BRS低0.55%（ms/mmHg；β = -0.055；CI = -0.098，-0.011），SDNN低0.61%（ms；β = -0.061；CI = -0.099，-0.024）。女性的财务压力对教育与BRS之间的关联贡献了7.1%，对教育与SDNN之间的关联贡献了13.8%。
除了女性的财务压力有较小贡献外，未发现慢性应激改变交感迷走神经平衡这一假设途径的证据。
