Racial Differences in Vascular Function in Response to Mental Stress

Background: Evidence supports that peripheral vasoconstriction during mental stress predicts mental stress induced ischemia (MSIMI). However, whether a dose response relationship exists with ischemia severity has not been evaluated; additionally, whether peripheral vascular function during the recovery phase is also related to MSIMI is not known. Hypothesis: We hypothesized that increased digital microvascular constriction during both mental stress and recovery are predictive of increased severity of mental stress ischemia. Methods: We evaluated 204 patients with stable CAD with high quality vascular data using a standardized mental stress test using a public speaking task. Peripheral artery tonometry (PAT) (Itamar Inc) was used to assess digital microvascular tone. Vasoconstriction was calculated as the ratio of pulse wave amplitude during speech/recovery and the last 3 minutes of baseline, with lower ratio indicating more vasoconstriction. 99mTc sestamibi myocardial perfusion imaging was performed at rest and with mental stress. A summed difference score (SDS) quantifying severity of reversible perfusion defects (inducible ischemia) comparing rest and stress images was computed using a standard 17-segment model. Four categories of increasing severity were based on cut points of 0, 3, and 6. Results: The mean (SD) age was 64 (8), 16% were women, and 28% were African American. Each category of increase in ischemia severity was associated with a 10% (p=0.04) decrease in speech PAT ratio (Figure) and 11% (p=0.02) decrease in recovery PAT ratio. After multivariable adjustment for sociodemographics, traditional risk factors, medical history, medication use, and psychological risk factors, the associations persisted, with B=-11%, p=0.02 for speech PAT ratio, and B=-8%, p=0.04 for recovery ratio. Conclusion: Peripheral vasoconstriction during mental stress speech as well as recovery predicts MSI severity in a dose-response relationship.

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Abstract P537: Reduced Cardiovascular Regenerative Capacity is Associated With Enhanced Inflammatory Response to Acute Psychological Stress

Circulation ◽

10.1161/circ.141.suppl_1.p537 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Zakaria Almuwaqqat ◽

Jeong Hwan Kim ◽

Muhammad Hammadah ◽

Shabatun Islam ◽

Bruno B Lima ◽

...

Keyword(s):

Inflammatory Response ◽

Vascular Function ◽

Mental Stress ◽

Mononuclear Cells ◽

Patient Characteristics ◽

Adverse Outcomes ◽

Regenerative Capacity ◽

Vascular Regeneration ◽

Before And After ◽

Artery Disease

Background: Bone marrow-derived progenitor cells (PCs) are involved in vascular regeneration and correlate with vascular function and cumulative cardiovascular risk. Systemic inflammation is associated with increased mobilization and differentiation of circulating PCs (CPCs) which may ultimately lead to exhaustion of vascular regenerative capacity. Individuals with coronary artery disease (CAD) exhibit a pro-inflammatory response to a mental stress challenge that has been associated with an elevated risk of adverse outcomes. We sought to determine whether subjects with reduced numbers of circulating PCs (CPCs) are at higher risk of a pro-inflammatory response to acute mental stress. Methods: 500 outpatients with stable CAD were enrolled into the Mental Stress Ischemia Prognosis study and underwent a laboratory-based mental stress protocol. Mononuclear cells expressing CD45med, CD34 and CXCR4 epitopes, known to be enriched for hematopoietic PCs, were enumerated using flow cytometry. Interleukin-6 (IL6) and C-Reactive Protein (CRP) levels were measured before and after mental stress. Baseline and changes in IL6 levels were compared across CPC tertiles using linear regression after adjusting for patient characteristics. Results: Mean age was 63± 9 years, 77% male, 70% white. Median CD34+ CPC count was 1.64 (1.02-2.43 cells/μL. CPC levels were not associated with either the baseline IL6 level (Beta= 0.071 95%CI, -0.091, 0.23) or CRP levels (Beta, 0.60, 95%CI, -0.25, 0.44). However, independent of demographics, CAD risk factors and baseline IL6 levels, lower CD34+/CXCR4+ CPC counts were associated with a higher inflammatory response during mental stress, measured as a rise in IL6 level (Beta= -0.11, 95%CI, -0.20, -0.028). Conclusions: Patients with reduced CPC levels have a greater pro-inflammatory response to mental stress. Thus, the observed higher risk in subjects with impaired regenerative capacity might be at least partly due to a higher stress-related pro-inflammatory response.

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NT-proBNP, race and endothelial function in the Multi-Ethnic Study of Atherosclerosis

Heart ◽

10.1136/heartjnl-2019-314707 ◽

2019 ◽

Vol 105 (20) ◽

pp. 1590-1596 ◽

Cited By ~ 1

Author(s):

Sushan Yang ◽

Shi Huang ◽

Lori B Daniels ◽

Joseph Yeboah ◽

Joao A C Lima ◽

...

Keyword(s):

African American ◽

African Americans ◽

Endothelial Function ◽

Racial Differences ◽

Asian American ◽

Vascular Function ◽

Chinese Americans ◽

Mediation Effect ◽

Linear Regression Models ◽

Ethnic Study

ObjectiveNatriuretic peptides (NPs) are hormones with cardioprotective effects. NP levels vary by race; however, the pathophysiological consequences of lower NP levels are not well understood. We aimed to quantify the association between NPs and endothelial function as measured by flow-mediated dilation (FMD) and the contribution of NP levels to racial differences in endothelial function.MethodsIn this cross-sectional study of 2938 Multi-Ethnic Study of Atherosclerosis participants (34% Caucasian, 20% African-American, 20% Asian-American and 26% Hispanic) without cardiovascular disease at baseline, multivariable linear regression models were used to examine the association between serum N-terminal pro-B-type NP (NT-proBNP) and natural log-transformed FMD. We also tested whether NT-proBNP mediated the relationship between race and FMD using the product of coefficients method.ResultsAmong African-American and Chinese-American individuals, lower NT-proBNP levels were associated with lower FMD, β=0.06 (95% CI: 0.03 to 0.09; p<0.001) and β=0.06 (95% CI: 0.02 to 0.09; p=0.002), respectively. Non-significant associations between NT-proBNP and FMD were found in Hispanic and Caucasian individuals. In multivariable models, endothelial function differed by race, with African-American individuals having the lowest FMD compared with Caucasians, p<0.001. Racial differences in FMD among African-Americans and Chinese-Americans were mediated in part by NT-proBNP levels (African-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01); Chinese-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01)).ConclusionsLower NP levels are associated with worse endothelial function among African-Americans and Chinese-Americans. A relative NP deficiency in some racial/ethnic groups may contribute to differences in vascular function.

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Racial Differences in Cardiovascular Reactivity to Mental Stress in Essential Hypertension

Journal of Hypertension ◽

10.1097/00004872-198606000-00011 ◽

1986 ◽

Vol 4 (3) ◽

pp. 325-331 ◽

Cited By ~ 39

Author(s):

Mats Fredrikson

Keyword(s):

Essential Hypertension ◽

Racial Differences ◽

Cardiovascular Reactivity ◽

Mental Stress

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Blunted Hyperemic Response to Mental Stress in Young, Non-Hispanic Black Men is not Impacted by Acute Dietary Nitrate Supplementation

Journal of Applied Physiology ◽

10.1152/japplphysiol.00453.2020 ◽

2021 ◽

Author(s):

John D. Akins ◽

Bryon M. Curtis ◽

Jordan C. Patik ◽

Guillermo Olvera ◽

Aida Nasirian ◽

...

Keyword(s):

Blood Flow ◽

Vascular Function ◽

Mental Stress ◽

Forearm Blood Flow ◽

Phase 1 ◽

Nitrate Content ◽

Phase 2 ◽

Dietary Nitrate ◽

Nitrate Supplementation ◽

No Bioavailability

Non-Hispanic black individuals have an elevated prevalence of cardiovascular disease in large part, related to impaired vascular function, secondary to reduced nitric oxide (NO) bioavailability. Nitrate supplementation increases NO bioavailability and improves vascular function. This study tested the hypothesis that forearm blood flow responses in young, non-Hispanic, black (BL) men during mental stress are blunted relative to, non-Hispanic, white (WH) men and that acute dietary nitrate supplementation would improve this response in BL men. This study was comprised of two parts. Phase 1 investigated the blood flow responses between young, BL and WH men whereas Phase 2 investigated the effect of acute nitrate supplementation in a subset of the BL men. Eleven (9 for Phase 2) BL and 8 WH men (23 ± 3 vs. 24 ± 4 y, respectively) participated. During each visit, brachial artery blood flow was assessed during 3 min of mental stress. Phase 1 was completed in one visit, while Phase 2 was completed over two visits separated by ~1-wk. During Phase 2, data were collected before and 2-h post-consumption of a beverage high in nitrate content or nitrate depleted. In Phase 1, peak forearm blood flow (FBF, P < 0.01), total FBF (P < 0.05), and forearm vascular conductance (P < 0.001) were blunted in the BL. During Phase 2, pre-beverage responses were unaffected following beverage consumption (P > 0.05 for all). Young, BL men have blunted microvascular vasodilatory responses to acute mental stress, which may not be altered following acute nitrate supplementation.

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PO-21 RACIAL DIFFERENCES IN VASCULAR FUNCTION

Artery Research ◽

10.1016/j.artres.2014.09.027 ◽

2014 ◽

Vol 8 (4) ◽

pp. 173

Author(s):

Heather Grimm ◽

Jan Kretzschmar ◽

Michael D. Brown

Keyword(s):

Racial Differences ◽

Vascular Function

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Racial differences in central blood pressure and vascular function in young men

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00902.2008 ◽

2008 ◽

Vol 295 (6) ◽

pp. H2380-H2387 ◽

Cited By ~ 98

Author(s):

Kevin S. Heffernan ◽

Sae Young Jae ◽

Kenneth R. Wilund ◽

Jeffrey A. Woods ◽

Bo Fernhall

Keyword(s):

Blood Pressure ◽

African American ◽

Carotid Artery ◽

Racial Differences ◽

Vascular Function ◽

Wave Reflection ◽

African American Men ◽

White Men ◽

Central Blood Pressure ◽

Resistance Artery

Young African-American men have altered macrovascular and microvascular function. In this cross-sectional study, we tested the hypothesis that vascular dysfunction in young African-American men would contribute to greater central blood pressure (BP) compared with young white men. Fifty-five young (23 yr), healthy men (25 African-American and 30 white) underwent measures of vascular structure and function, including carotid artery intima-media thickness (IMT) and carotid artery β-stiffness via ultrasonography, aortic pulse wave velocity, aortic augmentation index (AIx), and wave reflection travel time (Tr) via radial artery tonometery and a generalized transfer function, and microvascular vasodilatory capacity of forearm resistance arteries with strain-gauge plethysmography. African-American men had similar brachial systolic BP (SBP) but greater aortic SBP ( P < 0.05) and carotid SBP ( P < 0.05). African-American men also had greater carotid IMT, greater carotid β-stiffness, greater aortic stiffness and AIx, reduced aortic Tr and reduced peak hyperemic, and total hyperemic forearm blood flow compared with white men ( P < 0.05). In conclusion, young African-American men have greater central BP, despite comparable brachial BP, compared with young white men. Diffuse macrovascular and microvascular dysfunction manifesting as carotid hypertrophy, increased stiffness of central elastic arteries, heightened resistance artery constriction/blunted resistance artery dilation, and greater arterial wave reflection are present at a young age in apparently healthy African-American men, and conventional brachial BP measurement does not reflect this vascular burden.

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