Introduction:
Arterial stiffness is an important marker of cardiovascular risk which worsens with acute mental stress. Psychological conditions, particularly depression, have been linked to recurrent cardiac events and death, but the mechanisms are unclear. We examined whether depressive symptoms, anxiety and anger worsen arterial stiffness induced by mental stress.
Methods:
In 81 subjects with a history of MI in the previous 6 months, we used the SphygmoCor® Pulse Wave Velocity system at rest and 60 minutes after a standardized psychological stress (via speech task) and after a conventional physical (exercise or pharmacological) stress test. The central augmentation index (CAIx) was derived by pulse wave analysis software and the difference between CAIx after each stress condition and the respective resting phase was calculated. Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II), state and trait anxiety with the State-Trait Anxiety Inventory (STAI), and state and trait anger with the State-Trait Anger Expression Inventory (STAXI-II). Linear regression models were used to model the association between change in CAIx with each stress (dependent variable) and BDI total score, anxiety and anger subscales as individual predictors, adjusting for potential confounding factors.
Results:
Forty-one subjects were ≤ 50 years of age, 41 were female and 46 were non-white. Systolic and diastolic blood pressure and heart rate significantly increased in response to mental stress (48 ± 23 and 30 ± 13 (mmHg), and 28 ± 18 (bpm); p<0.001 for each), but this increase was not related to psychosocial risk factors. None of the psychosocial risk factors were associated with baseline/resting phase CAix. In unadjusted analysis, BDI total score, trait anger and trait anxiety were all significantly associated with an increase in CAIx with mental stress. After adjustment for demographic factors, CAD risk factors, CAD severity, and hemodynamic changes induced by mental stress, each 1-point increase in the BDI total score was associated with 0.34 units increase in mental stress-induced change in CAIx (95% CI: 0.10 - 0.57, p=0.005). The association did not persist for trait anger and anxiety, however. None of the psychological factors were related to changes in CAIx induced by physical stress.
Conclusion:
Higher depressive, but not anxiety or anger symptoms are associated with an increase in arterial stiffness during mental stress. This finding may provide a mechanistic link for the association between depression and adverse cardiovascular outcomes.
Ideal cardiovascular health and psychosocial risk factors among Finnish female municipal workers
