Bianca D'Antono

Cognitive depressive symptoms associated with delayed heart rate recovery following interpersonal stress in healthy men and women

Among cardiac patients, research suggests that somatic depressive symptoms are more strongly associated with altered cardiovascular responses to stress than cognitive depressive symptoms. This study sought to determine whether this was also the case in healthy individuals. One hundred and ninety-nine adults from the community completed the Beck Depression Inventory II (BDI-II) and underwent psychological laboratory stressors while their blood pressure, heart rate, and heart rate variability were monitored. A cognitive-affective factor and somatic-affective factor were identified within the BDI-II, but only the cognitive factor was associated with reduced heart rate recovery following the stressors in multivariate analyses examining both factors simultaneously. This suggests that cognitive depressive symptoms may be more strongly related to altered stress physiology following psychological stressors.

Physiological stress responses in defensive individuals: Age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe-Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.

The relation between hostility and concurrent levels of inflammation is sex, age, and measure dependent

BACKGROUND AND OBJECTIVE Hostility may be associated with greater systemic inflammation. However, contradictory evidence exists. Certain individuals or dimensions of hostility may be more susceptible to these effects. Main and interactive effects of hostility with sex and/or age were evaluated on markers of inflammation, independently of traditional risk factors for coronary artery disease. METHODS 199 healthy men (81) and women (118), aged 20-64 years (M=41 ± 11 years) were recruited. Hostility was assessed using the Cook-Medley Hostility Inventory (CMHo) and ecological momentary assessments (EMA) of quarrelsome behavior and angry affect in daily living. Blood samples were drawn to measure inflammatory activity (Il-6, TNF-α, hsCRP, Il-8, Il-10, Il-18, MCP-1) and lipid oxidation (Myeloperoxidase; MPO). Correlations and hierarchical regression analyses were performed controlling for pertinent behavioral, psychological, medical, and socio-demographic factors. RESULTS Significant univariate associations emerged between CMHo and Il-6, TNF-α, MCP-1 (p<.05). Hierarchical regressions showed interactions of hostility with sex (Il-6, TNF-α; p<.05) and age (hsCRP, Il-6, TNF-α; p<.05). For example, in simple slope analyses, hostility was positively related to TNF-α in women (b=0.009, p=0.006) but not men. Greater hostility was also related to greater Il-6 levels among younger women (b=. 027, p=0.000). CONCLUSION Hostility, particularly cynical hostility, may be detrimental to (younger) women. The TNF-α, Il-6, CRP triad appears vulnerable to psychological and behavioral factors, and may be one mechanism by which cynical hostility (CMHo) contributes to increased cardiovascular risk in women. Prospective research is needed to verify this.

An Internet-Based Counseling Intervention With Email Reminders that Promotes Self-Care in Adults With Chronic Heart Failure: Randomized Controlled Trial Protocol

Background Chronic heart failure (CHF) is a public health priority. Its age-standardized prevalence has increased over the past decade. A major challenge for the management of CHF is to promote long-term adherence to self-care behaviors without overtaxing available health care resources. Counseling by multidisciplinary health care teams helps to improve adherence to self-care behaviors and to reduce the rate of death and hospitalization. In the absence of intervention, adherence to self-care is below recommended standards. Objective This trial aims to establish and evaluate a Canadian e-platform that will provide a core, standardized protocol of behavioral counseling and education to facilitate long-term adherence to self-care among patients with CHF. Methods Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) is a multi-site, double blind, randomized controlled trial with a 2 parallel-group (e-Counseling + Usual Care vs e-Info Control + Usual Care) by 3 assessments (baseline, 4-, and 12-month) design. We will identify subjects with New York Heart Association Class II or III systolic heart failure from collaborating CHF clinics and then recruit them (n=278) by phone. Subjects will be randomized in blocks within each site (Toronto, Montreal, and Vancouver). The primary outcome will be improved quality of life, defined as an increased number of subjects with an improvement of ≥5 points on the summary score of the Kansas City Cardiomyopathy Questionnaire. We will also assess the following secondary outcomes: (1) diet habits, depression, anxiety, smoking history, stress level, and readiness for change using self-report questionnaires, (2) physical activity level, current smoking status, and vagal-heart rate modulation by physiological tests, and (3) exercise capacity, prognostic indicators of cardiovascular functioning, and medication adherence through medical chart review. The primary outcome will be analyzed using generalized estimation equations with repeated measures on an intention-to-treat basis. Secondary outcomes will be analyzed using repeated-measures linear mixed models with a random effects intercept. All significant main effects or interactions in the statistical models will be followed up with post hoc contrasts using a Bonferroni correction with a 2-sided statistical significance criterion of P<.05. Results This 3.5-year, proof-of-principle trial will establish the e-infrastructure for a pan-Canadian e-platform for CHF that is comprised of a standardized, evidence-based protocol of e-Counseling. Conclusions CHF-CePPORT is designed to improve long-term adherence to self-care behaviors and quality of life among patients with CHF. It will demonstrate a distinct Canadian initiative to build capacity for preventive eHealth services for patients with CHF. Trial Registration ClinicalTrials.gov NCT01864369; http://clinicaltrials.gov/ct2/show/NCT01864369 (Archived by WebCite at http://www.webcitation.org/6Iiv6so7E).

The metabolic costs of hostility in healthy adult men and women: Cross-sectional and prospective analyses

BACKGROUND Hostility is associated with altered metabolic activity but little research has examined sex and/or age differences using a global index of metabolic dysfunction or examined different aspects of hostility. METHODS The moderating effect of sex and age on the associations between three aspects of hostility (cynical attitude, angry affect, quarrelsome behavior in daily living) and metabolic burden (number of metabolic parameters in the higher quartile) were evaluated in 188 healthy men and women (M(age)=41; SD=11.34). Three years later, metabolic burden was measured again in 133 participants. RESULTS At study onset, quarrelsome behavior was associated with greater metabolic burden in men and women (Beta=.144; p<.05). After 3 yrs, cynical hostility predicted increased metabolic burden among mid-age and older individuals (b=.013 and .046 respectively; p<.001). CONCLUSION The aspect of hostility that is most closely associated with metabolic burden depends on the age of the participants and whether measures are concurrent or prospective.

Evaluation of Autonomic Reserves in Cardiac Surgery Patients

OBJECTIVE Autonomic nervous system dysfunction is a well-recognized but rarely evaluated risk factor for patients undergoing cardiac surgery. By measuring autonomic reserves in patients scheduled for cardiac surgery, the authors aimed to identify those with autonomic dysfunction and to evaluate their risk of perioperative complications. DESIGN This was a prospective, observational study. SETTING The study was conducted in a single academic center. PARTICIPANTS Sixty-seven patients completed the study. INTERVENTIONS Autonomic reserves were evaluated using analysis of heart rate variability (HRV) and blood pressure variability (BPV) after a Valsalva maneuver. MEASUREMENTS AND MAIN RESULTS The patients were divided into 2 groups depending on their response to the autonomic challenge, a group with autonomic reserves (AR, n = 38) and a group with negligible autonomic reserves (NAR, n = 29). The groups were compared for baseline psychologic distress, demographic and medical profiles, autonomic response to morphine premedication and the induction of anesthesia, hemodynamic instability, the occurrence of decreases in cerebral oxygen saturation, and postoperative complications. Patients in the NAR group had significantly higher psychologic distress scores (p < 0.001), a higher baseline parasympathetic tone (p = 0.003), were unable to increase parasympathetic tone with morphine premedication, had more severe hypotension at the induction of anesthesia (p < 0.001), more episodes of decreases in cerebral saturation (p = 0.0485), and a higher overall complication rate (p = 0.0388) independent of other variables studied. CONCLUSIONS Patients with diminished autonomic reserves can be identified before cardiac surgery using analysis of HRV and BPV of the response to the Valsalva maneuver, and some evidence suggests that they may be at increased risk of perioperative complications.

Three‐year stability of cardiovascular and autonomic nervous system responses to psychological stress

Chronically heightened physiological reactivity to or delayed recovery from stress may contribute to cardiovascular (CV) risk and mortality. Long-term stability of physiological stress responses has received little attention. Our objectives were to evaluate the 3-year stability of reactivity and recovery change scores across CV and autonomic parameters and assess whether sex and age moderate stability. A total of 134 healthy participants underwent two laboratory stress protocols, including four 5-min interpersonal stressors, each followed by a 5-min recovery period. Heart rate (HR), blood pressure (BP), and HR variability (high frequency, low frequency, very low frequency [VLF]) were obtained. Spearman rank correlations and linear regressions were performed. Significant correlations emerged for all physiological measures except diastolic BP and VLF recovery. No significant sex or age differences were found. Stress responses represent stable individual traits little affected by sex or age.

Psychological Distress and Exertional Angina in Men and Women Undergoing Thallium Scintigraphy

The relation between psychological factors and angina has mostly been studied in male patients with confirmed CAD and few have evaluated this relation during actual provocation of ischemia. This study evaluated gender differences in the association between psychological distress and angina pain experience in 907 Caucasian patients (479 women, mean age = 60 years) undergoing exercise stress testing with thallium scintigraphy. Data were analyzed separately for patients with and without exercise related ischemia using a series of 2 (low/high distress) × 2 (gender) ANOVAs as well as binary logistic regressions. Among all patients, distress and gender were associated with greater risk and intensity of angina pain during testing (p < 0.05) and more angina following exertion (p < 0.05) or stress (p < 0.05) at home. Conclusion: angina pain was more severe in women and individuals with high levels of distress, regardless of their ischemic status. A generalized hypersensitivity to pain/symptoms may be indicated in these patients.