Kamarck T W, Everson S A, Kaplan G A, Manuck S B, Jennings J R, Salonen R, Salonen J T
Department of Psychology, University of Pittsburgh, Pa 15260, USA. tkam+@pitt.edu
Circulation. 1997 Dec 2;96(11):3842-8. doi: 10.1161/01.cir.96.11.3842.
Exaggerated cardiovascular reactivity to mental stress is hypothesized to increase atherosclerotic risk. We examined this hypothesis using cross-sectional data from the Kuopio Ischemic Heart Disease study, a population-based epidemiological sample.
901 Eastern Finnish men from four age cohorts (age, 42 to 60 years) were administered a standardized testing battery to assess cardiovascular reactivity to mental stress. Ultrasound measures of intima-medial thickness (IMT) and plaque height from the common carotid arteries were used as noninvasive markers of atherosclerosis. Diastolic blood pressure (DBP) responses to mental stress were significantly associated with mean IMT (b=.021, P=.006), maximum IMT (b=.026, P=.013), and mean plaque height (b=.017, P=.041). Significant associations were also shown between stress-related systolic blood pressure (SBP) reactivity and mean IMT (b=.0151, P=.042). When examined separately by age, associations with IMT were significant only in the youngest half of the sample (age, 46 and 52 years, n=433; for mean IMT, DBP b=.033, P=.0002, SBP b=.0266, P=.003; for maximum IMT, DBP b=.039, P=.002, SBP b=.032, P=.011). Results remained significant in the younger subjects after adjustment for smoking, lipid profiles, fasting glucose, and resting blood pressure (b=.024, P=.011); results also remained significant in a subgroup of unmedicated younger subjects without symptomatic cardiovascular disease (n=135; for SBP reactivity, b=.031, P=.036; for DBP, b=.037, P=.007).
The tendency to show exaggerated pressor responses to mental stress is a significant independent correlate of atherosclerosis in this population sample of Finnish men. The effect does not appear to be accounted for by the confounding influence of other risk factors or preexisting clinical disease.
心血管对精神压力的反应过度被认为会增加动脉粥样硬化风险。我们使用基于人群的流行病学样本库奥皮奥缺血性心脏病研究的横断面数据来检验这一假设。
对来自四个年龄组（年龄42至60岁）的901名东芬兰男性进行了标准化测试组合，以评估心血管对精神压力的反应。颈总动脉内膜中层厚度（IMT）和斑块高度的超声测量值被用作动脉粥样硬化的无创标志物。舒张压（DBP）对精神压力的反应与平均IMT（b = 0.021，P = 0.006）、最大IMT（b = 0.026，P = 0.013）和平均斑块高度（b = 0.017，P = 0.041）显著相关。压力相关的收缩压（SBP）反应性与平均IMT之间也显示出显著关联（b = 0.0151，P = 0.042）。按年龄分别检查时，与IMT的关联仅在样本中较年轻的一半人群（年龄46和52岁，n = 433；对于平均IMT，DBP b = 0.033，P = 0.0002，SBP b = 0.0266，P = 0.003；对于最大IMT，DBP b = 0.039，P = 0.002，SBP b = 0.032，P = 0.011）中显著。在调整吸烟、血脂谱、空腹血糖和静息血压后，年轻受试者的结果仍然显著（b = 0.024，P = 0.011）；在没有症状性心血管疾病的未用药年轻受试者亚组（n = 135；对于SBP反应性，b = 0.031，P = 0.036；对于DBP，b = 0.037，P = 0.007）中结果也仍然显著。
在这个芬兰男性人群样本中，对精神压力表现出过度升压反应的倾向是动脉粥样硬化的一个显著独立相关因素。这种影响似乎不能由其他风险因素或既往临床疾病的混杂影响来解释。
