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FIBRINOGEN RESPONSE TO STRESS IS ASSOCIATED WITH FUTURE ENDOTHELIAL FUNCTION
2337 JACC April 5, 2016 Volume 67, Issue 13
Vascular Medicine FIBRINOGEN RESPONSE TO STRESS IS ASSOCIATED WITH FUTURE ENDOTHELIAL FUNCTION Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Vascular Medicine: New Risk Predictors for Arterial Disease Abstract Category: 44. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1260-218 Authors: Elizabeth A. Ellins, D. Aled Rees, John E. Deanfield, Andrew Steptoe, Julian Halcox, Swansea University, Swansea, United Kingdom, UCL, London, United Kingdom
Background: Stress influences the risk of cardiovascular disease (CVD). Acute mental stress (AMS) can induce both low-grade inflammation and endothelial dysfunction. The relationship between inflammatory stress responses and emergence of endothelial dysfunction is unexplored. We investigated associations between inflammatory responses to AMS and future endothelial function (flowmediated dilatation [FMD]).
Methods: 158 men and women (523 years) from the Whitehall II study underwent AMS testing (colour-word interference task and mirror tracing) and assessment of FMD 3 years later. Blood pressure (BP), heart rate (HR) and inflammatory markers (Fibrinogen [Fbg], IL-6 and TNFα) were assessed. Measurements were made before stress (all), during tasks (BP & HR) and immediately (Fbg), 20 minutes (BP & HR) and 45 minutes - (all) post-stress. Anthropometric variables, lipids, glucose, socio-economic status and smoking status were determined.
Results: Systolic- and diastolic-BP and HR rose post mental stress (p<0.001). Fbg and IL-6 also increased post-stress (p= <0.001 & 0.003) but TNFα was unchanged (p=0.09). When grouped according to the highest and lowest 40% of the stress response for each variable, FMD was lower in those with the greatest change in Fbg at 45 minutes (p= 0.006). An independent negative association between FMD and change in Fbg at 45 minutes (β= -0.047 p= 0.016) remained after multiple adjustment (baseline Fbg, baseline diameter, reactive hyperemia, age, gender, and other CVD risk factors). There was no association between FMD and change in IL-6 or TNFα. Participants were arranged into four groups by adverse and normal lipid profile and by above- (F+) and below-median (F-) Fbg stress response. FMD differed between the four groups (F=3.71 p=0.013) after adjustment for baseline Fbg, baseline diameter and reactive hyperemia; post-hoc testing showed that those with F+ had lower FMD than those with F- irrespective of lipid status. Conclusions: Participants with an elevated Fbg response 45 minutes post stress had impaired endothelial function 3 years later independent of other CVD risk factors; this may be a pathway through which stress contributes to the development of CVD.
Vascular Medicine FIBRINOGEN RESPONSE TO STRESS IS ASSOCIATED WITH FUTURE ENDOTHELIAL FUNCTION Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Vascular Medicine: New Risk Predictors for Arterial Disease Abstract Category: 44. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1260-218 Authors: Elizabeth A. Ellins, D. Aled Rees, John E. Deanfield, Andrew Steptoe, Julian Halcox, Swansea University, Swansea, United Kingdom, UCL, London, United Kingdom
Background: Stress influences the risk of cardiovascular disease (CVD). Acute mental stress (AMS) can induce both low-grade inflammation and endothelial dysfunction. The relationship between inflammatory stress responses and emergence of endothelial dysfunction is unexplored. We investigated associations between inflammatory responses to AMS and future endothelial function (flowmediated dilatation [FMD]).
Methods: 158 men and women (523 years) from the Whitehall II study underwent AMS testing (colour-word interference task and mirror tracing) and assessment of FMD 3 years later. Blood pressure (BP), heart rate (HR) and inflammatory markers (Fibrinogen [Fbg], IL-6 and TNFα) were assessed. Measurements were made before stress (all), during tasks (BP & HR) and immediately (Fbg), 20 minutes (BP & HR) and 45 minutes - (all) post-stress. Anthropometric variables, lipids, glucose, socio-economic status and smoking status were determined.
Results: Systolic- and diastolic-BP and HR rose post mental stress (p<0.001). Fbg and IL-6 also increased post-stress (p= <0.001 & 0.003) but TNFα was unchanged (p=0.09). When grouped according to the highest and lowest 40% of the stress response for each variable, FMD was lower in those with the greatest change in Fbg at 45 minutes (p= 0.006). An independent negative association between FMD and change in Fbg at 45 minutes (β= -0.047 p= 0.016) remained after multiple adjustment (baseline Fbg, baseline diameter, reactive hyperemia, age, gender, and other CVD risk factors). There was no association between FMD and change in IL-6 or TNFα. Participants were arranged into four groups by adverse and normal lipid profile and by above- (F+) and below-median (F-) Fbg stress response. FMD differed between the four groups (F=3.71 p=0.013) after adjustment for baseline Fbg, baseline diameter and reactive hyperemia; post-hoc testing showed that those with F+ had lower FMD than those with F- irrespective of lipid status. Conclusions: Participants with an elevated Fbg response 45 minutes post stress had impaired endothelial function 3 years later independent of other CVD risk factors; this may be a pathway through which stress contributes to the development of CVD.