Risk For Heart Disease Elevated By Combined Hostility And Depression

12 Feb 2008

Researchers led by Jesse Stewart, Ph.D., assistant professor of psychology at Indiana University-Purdue University Indianapolis, report that hostility and depression appear to act together in a complex way to elevate inflammatory proteins in the human body, possibly putting hostility plus depression on the list of risk factors for heart disease along with high blood pressure, elevated cholesterol, and smoking.

The findings, that hostility enhances inflammatory processes relevant to heart disease only in the presence of depressive symptoms, are published in the February-March 2008 issue of Psychosomatic Medicine.

Dr. Stewart and colleagues examined associations of depressive symptoms and hostility with blood levels of two inflammatory proteins, interleukin-6 and C-reactive protein, that are predictive of future heart disease.

Participants in the study were 316 healthy men and women aged 50-70. Previous studies have found depression to be associated with raised inflammatory protein levels.

Other studies have confirmed links between hostility and inflammatory proteins that are predictive of heart disease.

But this study is the first to find that, among older adults, the relationship between hostility and these inflammatory proteins depends on the level of depression.

"In our study, we looked at depression and hostility simultaneously, and we found that the relationship of these negative emotions to inflammatory markers is more complex and much stronger than depression or hostility individually," said Dr. Stewart, who notes that depression and hostility tend to co-occur within individuals.

Psychological risk factors for heart disease merit further study.

According to Dr. Stewart, the strength of the association of psychological factors with future heart disease is similar to that of traditional risk factors like smoking, high blood pressure, and elevated cholesterol.

"There are of course mental health reasons to treat depression and hostility. Now we know there is a physical health reason - the link to cardiovascular diseases," said Dr. Stewart, a clinical health psychologist at IUPUI's School of Science, is an IU Center for Aging Research affiliated scientist.

Article adapted by Medical News Today from original press release.

C-Reactive Protein, Inflammatory Conditions, and Cardiovascular Disease Risk

C-Reactive Protein, Inflammatory Conditions, and Cardiovascular Disease Risk

American Journal of Medicine.

Volume 120, Issue 12, Pages 1054-1062 (December 2007)


Ravi Dhingra, MDabc, Philimon Gona, PhDad, Byung-Ho Nam, PhDad, Ralph B. D’Agostino Sr, PhDad, Peter W.F. Wilson, MDae, Emelia J. Benjamin, MD, MSaf, Christopher J. O’Donnell, MD, MPHagh


Abstract

Background
It is uncertain to what extent high C-reactive protein (CRP) concentrations reflect the presence of inflammatory conditions in the community.

Methods
We evaluated 3782 Framingham Offspring Study participants (mean age 55 years; 52% women) free of baseline cardiovascular disease. Logistic regression models examined the prevalence of common inflammatory conditions by CRP categories, while a separate matched case-referent analysis evaluated the prevalence of uncommon inflammatory conditions. Cox models were used to assess the influence of common inflammatory conditions on relations between CRP and incident cardiovascular disease.

Results
Common inflammatory conditions were reported by nearly half of the participants; these individuals were more likely to have markedly high CRP concentrations (>10 mg/L, P for trend=.001). In multivariable models, there were increased odds of having at least one common inflammatory condition with CRP concentrations of 1-3.0, 3.01-10, and >10 mg/L, compared with the referent category (<1>10 mg/L compared with those with CRP <1 mg/L (12.1% vs 6.6%; P=.0001). In multivariable models, higher CRP categories were not associated with incident cardiovascular disease, and with additional adjustment for inflammatory conditions, results remained unchanged.

Conclusion
There is high prevalence of common and uncommon inflammatory conditions in individuals with high CRP concentrations. Higher CRP concentrations should be interpreted with caution in cardiovascular disease risk assessment

AHA - 2007: Oral contraceptives increase risk of plaques

Oral contraceptives increase risk of plaques


Orlando, FL - A team of Belgian researchers has made the surprise discovery that women who have used oral contraceptives (OCs) for some time appear to be at increased risk of atherosclerosis in the carotid and femoral arteries. They also found that those taking the pill had three times higher C-reactive protein (CRP) levels than those not using it.


Dr Ernest Rietzschel (Ghent University, Belgium) reported the findings at the American Heart Association (AHA) 2007 Scientific Sessions last week. He told heartwire: "This is the first time that this has been documented. It was an accidental finding. We were stunned by the large elevations in CRP that you see in women taking the pill, so we then performed a safety analysis to see whether there was a link between past pill use and atherosclerosis measured by echo in both the carotid and femoral arteries. Our null hypothesis was that we would see no effect, but in hindsight that was probably naive."


He stressed, however, that this research should not mean that women should cease using oral contraceptives: "I'm certainly not advocating stopping use of the pill," he noted. First, the findings need to be replicated, "that's really important," he said, "and then we need more research. It's staggering that for a drug that is being used by 80% of women, there is so little information about the long-term safety. That's really incredible."

OCs an important factor in global atherosclerotic burden


Rietzschel and colleagues started out by assessing novel risk factors for atherosclerosis in women participating in the Asklepios study, a blinded sample of men and women volunteers aged 35 to 55 years in the Belgian population who were free from overt cardiovascular disease. Rietzschel said that there has been one prior report of increased CRP in OC users, from the Cardiovascular Risk in Young Finns study.


Of 1301 women (mean age 45.7 years) in Asklepios, 27.4% were taking OCs and 10.0% were taking hormone replacement therapy (HRT). Past OC use was much higher, however, with 81% of women having taken it for at least one year, with a median exposure of 13 years.


After multivariate adjustment, women who were not taking OCs or HRT had high-sensitivity CRP of 1.0 mg/L compared with 1.2 for those currently taking HRT and 3.3 for women currently taking OCs. Effects on other inflammatory markers, such as interleukin-6, were far less pronounced, the researchers note.


"Contraceptive therapy is a major cause of CRP rise. The magnitude of CRP rise (threefold) far exceeds other population-prevalent noninfectious stimuli and is much larger than the CRP rise for HRT. Future research should take into account this effect when reporting CRP data in women, aim to qualify its biological significance, and assess the potential of CRP as a tool to select those women at high thrombotic risk under hormonal therapy," Rietzschel et al say.



This finding spurred Rietzschel and his team to look at past OC use, "something we might not have considered a plausible candidate for atherosclerosis," he explained to heartwire. After multivariate adjustment, they found the odds ratios (OR) per 10 years of OC exposure were 1.17 for carotid plaque and 1.28 for femoral plaque. They also looked at prevalence of bilateral disease as a more stringent phenotype of atherosclerosis and found ORs per 10 years of OC exposure of 1.42 for carotid plaque and 1.34 for femoral plaque.


"Use of contraceptive therapy is very common and is associated with an unexpected increase in the prevalence of carotid and femoral atherosclerosis in otherwise young, apparently healthy women. Our data suggest a 20% to 30% increased prevalence of plaque in the carotid and femoral arteries per 10 years of OC exposure. In the light of widespread and usually prolonged OC use, these results suggest OC use could be an important factor in the global atherosclerotic burden," the scientists observe.


A unique opportunity to intervene



While Rietzschel stresses that women should not stop taking the pill on the basis of this research, he says, "Perhaps women should be wary of taking the pill for longer than they need to. At a certain point, don't prolong it out of habit."


Women seeking oral contraception also present a unique opportunity for doctors to give advice on the prevention of cardiovascular disease at an early age, he notes. "Young women have an idea that they won't succumb to cardiovascular disease, which is entirely wrong, because more women die of cardiovascular disease than men. Maybe this is a good time to start talking with young women. Okay, you want to take the pill, but think about the long-term implications. You should stop smoking, check your weight, and be more physically active. Also, we know the pill has effects on blood pressure and lipid profiles, so these should be checked."


The pharmaceutical industry must also contribute, Rietzschel says: "We would like to ask them to develop safer pills." He says he has been approached by some OC manufacturers following his presentation last week but declined to say which ones.


At this time, it is also impossible to say whether any specific type of pill is more hazardous than any other, he noted. "We know that estrogen has a beneficial effect on lipid profiles and it is probably the progestin component of the pill that has adverse effects on lipids, but with regard to the blood-pressure rises seen, it's not clear what raises BP."

Systemic inflammation may underlie poor lung function link with CVD

Systemic inflammation may underlie poor lung function link with CVD


Thorax 2007; Advance online publication

MedWire News:

The link between poor lung function and cardiovascular disease (CVD) may be mediated by an inflammatory mechanism, says an international team of researchers.

The team identified an association between lung volumes and serum C-reactive protein (CRP) levels in young adults, which was of similar strength in men and women and was independent of smoking, asthma, and body mass index.

"Impaired lung function not only leads to increased respiratory mortality, but is also associated with adverse cardiovascular events, including myocardial infarction, stroke, and cardiovascular death," write Robert Hancox (University of Otago, Dunedin, New Zealand) and colleagues.

Furthermore, some studies have shown a reduction in the lung function measure forced expiratory volume in 1 second (FEV1) is a stronger indicator of cardiovascular risk than are traditional measures such as cholesterol levels, they add.

To investigate the extent to which this link is mediated by smoking, chronic airway disease, and/or established atherosclerosis, the researchers studied associations between spirometric lung function measures and serum CRP levels in a population-based birth cohort of around 1000 New Zealanders at ages 26 and 32 years.

The mean FEV1 was significantly lower at age 32 years than age 26 years (p=0.0003), and the fall in FEV1 between the two ages was greater for men (0.22 liters) than for women (0.05 liters; p<0.0001).

Analysis of CRP levels categorized as low, medium, and high according to American Heart Association guidelines showed that increasing CRP was associated with decreasing percentage of predicted FEV1 at both ages in women and at 32 years in men (p<0.01).

Further analysis showed that FEV1 values were inversely associated with log-CRP levels at both age 26 and 32 years after adjusting for gender, height, body mass index, smoking, and asthma (both p<0.001).

Associations between lung function and CRP were not significantly different between women and men or between Maori and non-Maori individuals, the team notes.

Finally, the decrease in FEV1 between age 26 and 32 years was a significant predictor of log-CRP at age 32 years, and this longitudinal association was of similar magnitude in men and women.

The authors conclude in the journal Thorax: "While the underlying reason for this association is uncertain, the findings suggest a plausible mechanism by which a reduced FEV1 is associated with an increased risk of CVD in a manner that is independent of smoking and known respiratory disease."

Symptomless Hypertension Too Often Ignored

Symptomless Hypertension Too Often Ignored

High blood pressure, the "silent killer," too often gets overlooked by people who have conditions that cause them pain or severe distress, a new study finds.

A survey of more than 51,000 people enrolled in a Pennsylvania state prescription drug program found that people with either physical or psychological problems were markedly less likely to take the pills needed to control their blood pressure, according to a report in the June 28 issue of Hypertension. "It's not so surprising," said study author Dr. Philip Wang. "But what was notable was the consistency with which the presence of other conditions decreased use of antihypertensives [drugs for high blood pressure].

" A wide array of conditions affected use of those drugs, said Wang, an assistant professor of psychiatry, medicine and health-care policy at Harvard Medical School. For example, someone with both high blood pressure and asthma or another chronic lung disease was 57 percent less likely to take blood pressure medication than someone without such a condition. Use of blood pressure medication was 50 percent lower in people with depression, 41 percent lower for people with gastrointestinal complaints, and 37 percent less likely for people with osteoarthritis. The blame lies with both patients and doctors, Wang said.

"A patient with several conditions might deal with those that cause discomfort, even though hypertension is probably as important an issue," he said. "And patients may have financial barriers to taking multiple medications. Or maybe they just run out of time." Doctors know that high blood pressure is a major risk factor for heart attack and stroke, Wang said, so they also play a role in its neglect, though "probably not intentionally.

" He pointed out that doctors usually have a limited amount of time to spend with individual patients "and if you have to deal with multiple conditions in 15 minutes, hypertension might get short shrift."

The study illustrates "the complexity of the illnesses that older people have these days, and the challenge of dealing with them," said Dr. Daniel W. Jones, dean of the University of Mississippi School of Medicine and a spokesman for the American Heart Association. The complexity of the American health-care system also plays a role, Jones said. "It's hard to tell what part cost plays in it," he added.

The overall lesson "for patients and their physicians is that blood pressure medications are effective at improving the length and quality of life," Jones said. "Physicians should take care that the problem doesn't fall between the cracks."

A report in the June 28 issue of Circulation highlighted the importance for older people of another silent risk factor -- C-reactive protein. A study of nearly 4,000 people aged 65 and older found that a high blood level of C-reactive protein is an independent risk factor for heart disease, comparable to high cholesterol levels, the report said. People with the highest levels of C-reactive protein had a 45 percent increase in the risk of developing heart disease over the 10-year course of the study.

"There have been other studies with a shorter-term follow-up, three or four years," said study co-author Dr. Bruce M. Psaty, a professor of pathology and biochemistry at the University of Vermont. "This is the first long-term prospective study in the elderly."

C-reactive protein was almost unknown a decade ago, but a blood test now "is widely available, and is becoming more so over time," Psaty said. There are several ways to lower levels of the protein, including the use of cholesterol-busting statin drugs, he said. And since "one of the biggest things associated with C-reactive protein is obesity, one of the best ways to control it is to lose weight," Psaty added.