Jane F. Owens

Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being.

The effect of dispositional optimism on recovery from coronary artery bypass surgery was examined in a group of 51 middle-aged men. Patients provided information at three points in time--(a) on the day before surgery, (b) 6-8 days postoperatively, and (c) 6 months postoperatively. Information was obtained relating to the patients rate of physical recovery, mood, and postsurgical quality of life. Information was also gathered regarding the manner in which the patients attempted to cope with the stress of the surgery and its aftermath. As expected, dispositional optimism proved to be an important predictor of coping efforts and of surgical outcomes. More specifically, dispositional optimism (as assessed prior to surgery) correlated positively with manifestations of problem-focused coping and negatively with the use of denial. Dispositional optimism was also associated with a faster rate of physical recovery during the period of hospitalization and with a faster rate of return to normal life activities subsequent to discharge. Finally, there was a strong positive association between level of optimism and postsurgical quality of life at 6 months.

Sleep disturbance in healthy middle-aged women

OBJECTIVES The objectives of the study were to (a) describe the sleep patterns of a sample of healthy middle-aged women, (b) to characterize the psychological, behavioral and biological profiles of middle-aged women who report sleep disturbance, and (c) to determine the influence of change in menopausal status on the quality and quantity of self-reported sleep. METHODS A total of 521 women of varying menopausal status were evaluated in a clinic setting. Measurements included blood pressure, height, weight, waist/hip ratio, and self-reported sleep disturbances, demographic and family characteristics, psychosocial questionnaires, physical activity and nutritional intake. The women who were premenopausal at this initial visit were later evaluated, in an identical protocol, when they became postmenopausal. RESULTS A total of 42% of the women reported some type of sleep disturbance. Trouble sleeping was associated with higher levels of anxiety, depression, stress, tension and public self-consciousness. Women with trouble falling asleep had higher systolic and diastolic blood pressures and greater waist/hip ratios. Women who woke earlier than desired had higher systolic and diastolic blood pressures. Sleep disturbance was independent of menopausal status in cross-sectional analyses. In longitudinal analyses, the transition from pre- to postmenopausal status was associated with a significant increase in sleep disturbance in women who chose to not take hormone replacement therapy. CONCLUSIONS There is a high level of sleep disturbance in middle-aged women. Sleep disturbance is associated with worse mood, higher blood pressure and higher waist/hip ratios. Transition into postmenopausal status is associated with deleterious changes in sleep patterns among women who do not take hormone replacement therapy.

Effects of Optimism, Pessimism, and Trait Anxiety on Ambulatory Blood Pressure and Mood During Everyday Life

This study tested whether disposition^ measures of optimism, pessimism, and anxiety affected ambulatory blood pressure (BP) and mood and whether any cardiovascular effects of dispositions were moderated by mood. Pessimistic and anxious adults had higher BP levels and felt more negative and less positive than did optimists or low anxious adults throughout the monitoring. The few times that optimists did feel negative were associated with levels of BP as high as those observed among pessimists or anxious individuals, regardless of their mood. To the extent that trait anxiety measures neuroticism, these findings suggest that neuroticism is directly related to health indicators rather than simply to illness behavior. Furthermore, the results suggest that pessimism has broad physiological and psychological consequences.

Hemodynamic adjustments to laboratory stress: the influence of gender and personality.

&NA; Exaggerated cardiovascular reactivity to psychological stress is a potential pathophysiological mechanism linking behavior and cardiovascular disease. Because of the recognized gender differences in incidence of cardiovascular disease, potential gender differences in cardiovascular reactivity to laboratory stressors have been evaluated. The current study examined the cardiovascular responses of a total of 42 young women (N = 22) and men (N = 20) undergoing a laboratory protocol including the following: a nonverbal math task, a mirror tracing task, the Stroop Color‐Word interference task, and an isometric handgrip task. In addition to the assessment of heart rate and blood pressure, cardiac output, stroke volume, total peripheral resistance and preejection period were assessed by impedance cardiography. A number of personality characteristics that vary in prevalence by gender were also measured to evaluate their ability to explain potential gender differences in cardiovascular responses. Results indicated that men responded with greater total peripheral resistance and systolic and diastolic blood pressure responses than did women on a subset of tasks, whereas women exhibited larger increases in heart rate on a subset of tasks. Thus, men were more likely to be “vascular” reactors, with women being more likely to be “cardiac” reactors. Personality characteristics did differ between men and women, but did not explain significant variance in the gender differences in cardiovascular responses. We conclude that additional studies should focus on experimental manipulations of potential physiological mechanisms responsible for these differences, such as reproductive hormones.

Menopausal status influences ambulatory blood pressure levels and blood pressure changes during mental stress.

BackgroundFrequent and large cardiovascular and neuroendocrine responses to psychological stress are thought to enhance an individuals risk for cardiovascular diseases. Preliminary data suggest that levels of reproductive hormones affect the magnitude of stress responses, perhaps contributing to the protective effect of ovarian hormones on premenopausal womens rates of coronary heart disease. Methods and ResultsHealthy middle-aged men and premenopausal and postmenopausal women performed a series of standardized mental and physical challenges while blood pressure, heart rate, plasma catecholamines, lipids, and lipoproteins were measured. Subjects then wore an ambulatory blood pressure monitor during two consecutive workdays. Results showed that postmenopausal women had larger mean±SEM stress-induced increases in systolic blood pressure (24.7±2.2 mm Hg) and diastolic blood pressure (143±1.0 mm Hg) compared with either premenopausal women (16.9±1.3 and 10.2±0.9 mm Hg) or men (17.7±1.5 and 10.9 ± 1.1 mm Hg, respectively). Postmenopausal women and men had higher mean±SEM ambulatory diastolic blood pressure levels (75.5±3.2 and 76.4±±1.8 mm Hg) than did premenopausal women (69.9±2.2 mm Hg). Large blood pressure responses during public speaking were associated with high cholesterol levels and low educational attainment. ConclusionMenopause is associated with enhanced stress-induced cardiovascular responses and elevated ambulatory blood pressure during the workday. These effects may contribute to the risk of cardiovascular morbidity and mortality after the menopause.

ARE HOSTILITY AND ANXIETY ASSOCIATED WITH CAROTID ATHEROSCLEROSIS IN HEALTHY POSTMENOPAUSAL WOMEN

Objective In this article, we evaluated the prospective association between measures of trait anger, hostility, and anxiety and indices of carotid atherosclerosis in 200 healthy middle-aged postmenopausal women. Methods Starting in 1983, 541 premenopausal women were evaluated for their levels of standard cardiovascular risk factors and psychosocial attributes, including their scores on Spielberger Trait Anger, Anxiety, and Anger-in, and Public Self-Consciousness. Starting in 1991, the Cook-Medley Hostile Attitudes Scale was also administered. Starting in 1993, 200 women who had been menopausal for at least 5 years were scanned for carotid atherosclerosis using B-mode ultrasound. The scans were scored for average intima-media thickness (IMT) and plaque index. Results Women who had high Trait Anger, Anger-In, and Public Self-Consciousness scores had high IMT scores on average 10 years later. Women who had high Cook-Medley scores also had high IMT scores on average 1.5 years later. Multivariate analyses adjusting for the standard cardiovascular risk factors that most highly predicted IMT scores indicated that holding anger in, being self aware, and having hostile attitudes were significant predictors of IMT. Women with higher plaque scores also tended to report holding in their anger. Conclusions Anger suppression and hostile attitudes do predict womens carotid IMT in midlife. Ultrasound measures of carotid atherosclerosis can be used to advance our understanding of the early development of atherosclerosis in women.

Influence of race and socioeconomic status on sleep: Pittsburgh SleepSCORE project.

Objective: To examine the independent and interactive effects of race and socioeconomic status (SES) on objective indices and self-reports of sleep. Methods: The sleep of 187 adults (41% black; mean age = 59.5 ± 7.2 years) was examined. Nine nights of actigraphy and two nights of inhome polysomnography (PSG) were used to assess average sleep duration, continuity, and architecture; self-report was used to assess sleep quality. Psychosocial factors, health behaviors, and environmental factors were also measured. Results: Blacks had shorter sleep duration and lower sleep efficiency, as measured by actigraphy and PSG, and they spent less time proportionately in Stage 3–4 sleep, compared with others (p < .01). Lower SES was associated with longer actigraphy-measured latency, more wake after sleep onset as measured by PSG, and poorer sleep quality on the Pittsburgh Sleep Quality Index (p < .05). Conclusions: Blacks and perhaps individuals in lower SES groups may be at risk for sleep disturbances and associated health consequences. SES = socioeconomic status; PSG = polysomnography; WASO = wake after sleep onset; HeartSCORE = Heart Strategies Concentrating On Risk Evaluation; PSQI = Pittsburgh Sleep Quality Index; ESS = Epworth Sleepiness Scale; EOG = electro-oculogram; EMG = electromyogram; ECG = electrocardiogram; REM = rapid eye movement; AHI = apnea/hypopnea index; BMI = body mass index; CES-D = Center for Epidemiological Studies Depression Scale; STAI = Spielberger Trait Anxiety Inventory; Ho = Cook-Medley Hostility Scale; SEI = Sleep Environment Inventory.

Stress-induced pulse pressure change predicts women's carotid atherosclerosis.

BACKGROUND AND PURPOSE Individuals who exhibit large increases in blood pressure and heart rate during mental stress may be at risk for accelerated atherosclerosis. This report evaluates the association between stress-induced hemodynamic responses and carotid atherosclerosis in 254 healthy postmenopausal women. METHODS The magnitude of change in blood pressure and heart rate from rest to public speaking and mirror image tracing, two stressful tasks, was measured. Average intima-media thickness (IMT) and focal plaque in the common carotid artery, bulb, and internal carotid artery were measured with the use of duplex ultrasonography on average 2.3 years later. RESULTS The average IMT was 0.77 mm, with a range of 0.60 to 1.37; 52.5% had at least one plaque. Correlational analysis showed that greater IMT was associated with greater pulse pressure change during mental stress (r = 0.17, P < 0.01). Statistical adjustments for possible confounders (age, hormone replacement therapy use, resting pulse pressure, smoking status, and triglyceride levels) did not alter the results. The plaque index was associated with greater pulse pressure change during the mirror image tracing task (odds ratio = 1.47, P = 0.01) for women with a plaque score of > or = 2 versus 1 or 0, adjusted for possible confounders. CONCLUSIONS Mental stress-induced pulse pressure changes may influence the development of early atherosclerosis in the carotid artery of women. Widening of pulse pressure during stress, as well as at rest, may be a marker of compromised compliance in the vessel wall.

Chronic stress influences cardiovascular and neuroendocrine responses during acute stress and recovery, especially in men.

This study tests the influence of chronic stress on cardiovascular and neuroendocrine responses to and recovery from acute stressors and whether the effects are gender specific. Sixty-two healthy, middle-aged persons (50% women) performed mental-arithmetic and public-speaking tasks and relaxed thereafter for 1 hr while their cardiovascular and neuroendocrine function was measured. Participants with higher levels of chronic stress showed lower systolic blood pressure (SBP) and epinephrine (E; men only) and marginally lower levels of norepinephrine (NE) responses to the tasks and showed lower levels of cortisol and marginally lower NE responses during recovery. Relative to women, men had high diastolic blood pressure (DBP) responses to the tasks and high SBP, DBP, and E responses during recovery. Gender differences in cardiovascular disease in midlife may be due to gender differences in the inability to recover quickly, in addition to enhanced acute-stress response.

Can physical activity mitigate the effects of aging in middle-aged women?

Background Aging is associated with an increased risk of women dying from coronary heart disease as well as from all causes combined. Alterations in the major biological risk factors for early coronary heart disease and all-cause mortality are frequently seen in aging. Methods and Results The present investigation tested the hypothesis that high levels of physical activity could protect against age-associated changes in biological risk factor levels. In the Healthy Women Study, 507 women were evaluated at study entry and 3 years later. Weekly physical activity level was measured at each examination via the Paffenbarger Physical Activity Questionnaire. During the 3-year period, women increased significantly in weight, blood pressure, levels of total and low-density lipoprotein cholesterol, triglycerides, and insulin and decreased significantly in levels of total high-density lipoprotein cholesterol (HDL-C) and HDL2-C. Conclusions Consistent with the study hypothesis, women who reported higher levels of activity at baseline had less weight gain over time. Furthermore, women who increased their activity during the 3-year interval had the smallest increases in weight and tended to have the smallest decreases in total HDL-C and HDL2-C. The changes in lipids due to activity were largely independent of changes in body weight.