The significance of psychosocial factors in predicting coronary disease in patients with valvular heart disease

Several prognostic indices for predicting various aspects of coronary artery disease were significantly improved by the inclusion of psychosocial factors. 218 patients with valvular heart disease who had undergone routine coronary arteriography before valve replacement were studied in terms of cigarettes smoked, family history of ischaemic heart disease, HDL:cholesterol ratio, angina, sex, blood pressure and four psychosocial characteristics (i.e. social support, work stress, life events and Type A behavior). It was found that the psychosocial factors improved the preoperative predictive power of significant coronary artery disease on four criteria: previous history of hypertension, previous history of myocardial infarction, signs of peripheral vascular disease and ECG evidence of myocardial infarction.     

Hypertension as a disease of modern society.

About 50 per cent of people in modern societies have blood pressure sufficiently elevated to result in increased mortality. This proportion is much smaller in undisrupted societies of hunter-gatherers. In most cases the elevated blood pressure in modern societies is associated with physiological changes characteristic of chronic stress. The difference between blood pressure in modern populations and that in undisrupted hunter-gatherer societies cannot be accounted for by genetic differences or differences in salt consumption. Two primary features of modern society which contribute to the elevation of blood pressure are community disruption and increased work pressure. Drug therapy and relaxation therapies for hypertension attempt to counteract the physiological effects of social stress. However, it is more appropriate to use the occurrence of hypertension as an indicator of fundamental social problems which need to be solved.     

Anthropology and the study of chronic disease: adolescent blood pressure in Corpus Christi, Texas

In this anthropological study, the influence of psychosocial adaptation, and social and biological factors upon the blood pressures of Mexican-American adolescents and adolescents of European descent (Anglo-Americans) in Corpus Christi, Texas were examined. Black Americans have one of the highest rates of hypertension of any population in the world. The reasons for this are not entirely clear. Epidemiologic studies have shown that although clinically defined hypertension usually does not appear until adulthood, systematic differences in the average blood pressures of black and white history of discrimination and prejudice are in some way related to the prevalence of hypertension among black Americans, then Mexican-Americans of south Texas, who also have experienced a high rate of poverty and a history of discrimination, might also be expected to have a higher rate of hypertension than other Americans. Mexican-American youths were found to have a significantly higher mean systolic pressure than Anglo youths. Mexican-Americans also were found to have significantly more problematic psychosocial adaptation. There was little relationship, however, between problematic psychosocial adaptation and high blood pressure. Subsequent statistical analyses, including an analysis of covariance, indicated that other variables, including the heaviness of body build and length of residences in Corpus Christi, were of much greater importance in predicting blood pressure. Implications of these findings for social epidemiology and health promotion are discussed.     

Dietary salt and blood pressure

Research evidence on the role of dietary sodium in the etiology and pathogenesis of hypertension is briefly reviewed. This matter is assuming new importance at present, given new data on the efficacy of normalization of blood pressure for adults with so-called "mild" hypertension (average diastolic 90-104 mm Hg), hence the need for safe nutritional-hygienic alternatives to years-long drug treatment for millions of people with such hypertension. Two trials by the authors deal with some unresolved questions in this area. The first, a preliminary study, involved 21 lacto-ovo-vegetarian high school students living in a boarding school. With decrease in daily Na intake from 216 to 72 meq for the experimental compared with the control group, red blood cell Na concentration was significantly lower in the former; systolic pressure was slightly but not significantly lower. The second trial, the Primary Prevention of Hypertension, involves over 200 hypertension-prone persons aged 30-44, and explores the ability in the experimental group to reduce blood pressure and prevent development of hypertension by safe nutritional-hygienic means (weight reduction, dietary Na decrease, avoidance of excess alcohol, rhythmic exercise). Initial results at 6 months are presented. Trials on the prevention and control of hypertension by nonpharmacologic means, including reduced Na intake, and involving analyses of the inter-relationships among dietary Na, other dietary factors, Na metabolism, and blood pressure in samples from different population strata, are an important present-day research need.     

Self-reported stress and subsequent hospital admissions as a result of hypertension,varicose veins and haemorrhoids

BACKGROUND: This study examines a cohort in which individuals of privileged socio-economic position report greater psychological stress. We have previously shown in this cohort that stress is unrelated to coronary heart disease as measured by hospital discharge diagnosis and cause-specific death. In contrast, stress and hospitalization for cardiovascular conditions not requiring mandatory admission were associated. We hypothesized that psychosocial factors, in particular reporting tendency, are the likely mediator of this association, and the present study considers this further. METHODS: A total of 5,596 men underwent a health screening during which they completed the Reeder Stress Inventory. Details of hospital admissions were retrieved from the Scottish Morbidity Records over a 21 year follow-up. Relationships between stress and admission were evaluated using proportional hazards regression. RESULTS: Compared with low stress, reported high stress was found to be associated with increased numbers of admissions for each of three most common cardiovascular causes of non-mandatory admission: adjusted hazard ratios were 3.43 for essential hypertension (95 per cent confidence interval (CI) 1.36-8.65), 1.91 for lower limb varicose veins (95 per cent CI 1.12-3.24), and 2.01 for haemorrhoids (95 per cent CI 1.16-3.51). Stress and blood pressure at baseline were not associated. CONCLUSION: The association between stress and admissions as a result of hypertension appears unlikely to be mediated by blood pressure. More likely is a mechanism based upon the reporting of symptoms, or the recording of discharge diagnoses. There is no obvious medical explanation for associations between stress and hospitalization as a result of varicose veins or haemorrhoids, and again it is likely that psychosocial factors provide the mechanism.     

Casual blood pressure: Its relationship to several cardiovascular risk factors in middle-aged men

The relationship between casual blood pressure and other cardiovascular risk factors in presumably healthy middle-aged men (in the age range of 50–60 years) was investigated in a cross-sectional study. It was found that people with high casual blood pressure (> 160 and/or > 95 mmHg) and who have no history of previous cardiovascular disease were older, heavier, had higher heart rates and blood glucose, smoked more and had more evidence of L.V.H. on E.C.G. than a control group who had normal or borderline casual blood pressure. It was concluded that even casually found hypertension in seemingly healthy individuals is associated with higher prevalence and degree of certain behavioral, physical and biochemical parameters frequently seen in people with ischaemic heart disease.     

Intrauterine Programming of Hypertension: Nutrient-Hormone Interactions

Geographic, retrospective, and prospective epidemiologic studies have revealed evidence that the environment in utero is a major determinant of later degenerative disease. Observations from Britain, Sweden, Jamaica, Australia, India, and China support the hypothesis that disproportionate retardation of fetal growth results in increased blood pressure and increased risk of cardiovascular mortality. On the basis of what has been a limited pool of observations linking maternal undernutrition and fetal growth retardation, it has been proposed that hypertension and coronary heart disease are "programmed" by nutrition status.     

Social networks and psychosocial support among disabled people

Analysis of the network characteristics and nature of social ties among physically disabled people living in an inner London borough showed network size rather than network type was related to the availability of psychosocial support, reflecting the important role of both related and non-related people in the provision of this form of support. The study also questioned three commonly held assumptions. Firstly, in contrast to the image of physically disabled people as lacking social ties, those with a high level of disability, although having a lower level of social contact outside the household than other groups, did not differ significantly in other aspects of their network structures and support. Secondly, in contrast to the characterisation of inner city areas as relatively homogeneous and as lacking locally based ties, the inner London area studied comprised a variety of network types with a large proportion of respondents deriving support from people living in close proximity. Thirdly, whereas the presence of household members, and especially a spouse, tend to be equated with the availability of strong emotional support, considerable numbers of married people lacked such support. This suggests measures to promote psychosocial support need to be fairly broadly based and cautions against using marital status as a proxy measure of support.     

Cardiovascular diseases in Chile

In 1938, Chile became the first developing country to establish a state health system for the prevention of cardiovascular diseases (CVD). Although prevalence of CVD risk factors (smoking, high cholesterol and triglycerides, hypertension, and atherosclerosis) is lower than in industrialized countries, over the last 50 years CVD incidence in Chile has increased considerably. Cardiovascular disease is diagnosed in 25% of outpatients in departments of the National Health Service. Hypertension is the first cause of morbidity among the adult population (10%). Between 1960 and 1980, CVD mortality increased from 14 to comprise 27% of all deaths. Age-specific mortality for ischemic heart disease increased during the same period from 407 to 699 per 100,000 population. Surveys of the general adult population showed a prevalence of hypertension of almost 20%. Community hypertension follow-up programs obtained only 50% compliance, and blood pressure was normalized in only one-third of hypertensive patients. It is probable that the low standard of living may have influenced the poor results of prevention programs.     

Neighborhood-level stressors, social support, and diurnal patterns of cortisol: the Chicago Community Adult Health Study

Neighborhood disadvantage has consistently been linked to increased rates of morbidity and mortality, but the mechanisms through which neighborhood environments may get "under the skin" remain largely unknown. Differential exposure to chronic environmental stressors has been identified as a potential pathway linking neighborhood disadvantage and poor health, particularly through the dysregulation of stress-related biological pathways such as cortisol secretion, but the majority of existing observational studies on stress and neuroendocrine functioning have focused exclusively on individual-level stressors and psychosocial characteristics. This paper aims to fill that gap by examining the association between features of the neighborhood environment and the diurnal cortisol patterns of 308 individuals from Chicago, Illinois, USA. We found that respondents in neighborhoods with high levels of perceived and observed stressors or low levels of social support experienced a flatter rate of cortisol decline throughout the day. In addition, overall mean cortisol levels were found to be lower in higher stress, lower support neighborhoods. This study adds to the growing evidence of hypocortisolism among chronically stressed adult populations and suggests hypocortisolism rather than hypercortisolism as a potential mechanism linking social disadvantage to poor health.     

Psychosocial stress and utilization of medical services after coronary bypass operation

This study examines the relationship between psychosocial stress and social support before coronary surgery and the amount of health care utilization in a sample of 136 patients during postoperative hospitalization. The aim of the study is to test the hypothesis that there is a correlation between a high psychosocial stress profile and the utilization of medical care (so called high utilizers). The sample consists of 80.7% men and 19.3% women aged between 31 and 78 years (mean 64; sd 9.1). In this first data analysis psychosocial impact is assessed by anxiety, depression and social support (HADS-D, F-SOZU). Detailed somatic factors concerning severity of the illness, inpatient course and the utilization of health care (medication, technical examinations, consultations) are assessed by means of a documentation system. With regard to anxiety, depression and social support the sample is located within the normal range. In contrast to our expectations the results show that high scores of anxiety and depression as well as a low level of emotional support do not correlate significantly with an increased use of medication, the number of consultations and technical examinations. Furthermore no correlation has been found between the length of hospitalization and preoperative comorbidity as compared to the mentioned psychosocial stress variables. On the other hand the data analysis showed that about 30% of the patients during the postoperative period utilize about half of the total amount of the different medical treatments. In the postoperative period these high utilizers cannot be distinguished from the other patients, neither by sociodemographic variables nor by means of an increased psychosocial stress or severity of illness.     

原发性高血压易感基因多态性研究进展

原发性高血压是一种由多因素。多基因表达异常共同导致血压升高的疾病,是心脑血管疾病的致命性危险因素[1],已经对人类健康造成了严重的影响。并且原发性高血压发病率之广令人震惊,根据调查显示：我国成人EH的患病率达18.8%[2]。目前随着人类基因多态性的发展,人类已经证实基因与高血压的相关性,并发现几百种高血压的相关基因,如肾素、血管紧张素醛固酮系统基因等[3,4],尽管如此,但是原发性高血压的病理机制却仍不是很明朗。探寻高血压易感基因,有助于从其遗传本质入手对其治疗、预后、预防及为新药物的研制找到依据。本研究主要对近年来人类已发现的原发性高血压的易感基因及研究中存在的一些问题做一简要阐述。     

Need to prevent and control high-normal and high blood pressure, particularly so-called "mild" hypertension: epidemiological and clinical data

The need to prevent and control high blood pressure (HBP), including so-called "mild" hypertension [diastolic blood pressure (DBP) 90-104 mm Hg in adults age 30+] stems from the extensive data on the increased risks due to these common blood pressure (BP) levels, including risk of catastrophic cardiovascular events (coronary, cerebrovascular, etc.), both nonfatal and fatal. Prospective population data from the national cooperative Pooling Project and the Chicago Heart Association Detection Project in Industry illustrate the extensively documented facts. They also show that only a small minority of middle-aged and older Americans have optimal low-normal BP levels, i.e., DBP less than 80 mm Hg (SBP less than 120). Thus, the problem of BP above optimal level for health over a long life span is a population-wide problem. The data also show that the great majority of excess catastrophic events attributable to elevated BP occur among people with DBP 90-104 and 80-89 mm Hg, levels very common in the population. Most people with such BP levels also have one or more other major risk factors (e.g., hypercholesterolemia, cigarette use, ECG abnormalities) and thus are at markedly increased risk, both relative and absolute. In addition to these excess risks for major illness, disability, and death, people with BP above optimal levels are more highly prone to other events, clinical and subclinical, that have adverse effects on long-term prognosis, including development of target organ damage and severe hypertension. These data lead to the following inferences about medical care and public health strategy: (a) A key task is, by safe nutritional-hygienic means, to shift the entire population distribution of BP downward, for both primary and secondary prevention of HBP. Such means include prevention and control of obesity, high sodium and alcohol intake, and sedentary habit, from early childhood on. (b) People with DBP 80-89 mm Hg need to be identified promptly, with institution of nutritional-hygienic measures to prevent development of frank hypertension and to correct other risk factors. (c) People with DBP 90-104 and higher need to be identified promptly, with institution of measures to normalize BP and control other major risk factors, by nutritional-hygienic means alone whenever possible or in combination with drug treatment for HBP when necessary to prevent organ system damage, serious illness, disability, and premature death.(ABSTRACT TRUNCATED AT 400 WORDS)     

The mechanisms that associate community social capital with post-disaster mental health: A multilevel model

Many scholars have advocated that the time has come to provide empirical evidence of the mechanisms that associate community social capital with individual disaster mental health. For this purpose we conducted a study (n = 232) one year after a flood (2008) in Morpeth, a rural town in northern England. We selected posttraumatic stress as an indicator of disaster mental health. Our multilevel model shows that high community social capital is indirectly salutary for individual posttraumatic stress. In particular, in communities (defined as postcode areas) with high structural social capital, the results suggest that individuals confide in the social context (high cognitive social capital) to address disaster-related demands (high collective efficacy), and employ less individual psychosocial resources (i.e. coping strategies and social support). This “conservation of individual psychosocial resources” in a salutary social context decreases the association between the appraisal of the disaster and posttraumatic stress. As a result of this mechanism, individuals suffer less from posttraumatic stress in communities with high social capital. These findings provide new insights how intervention policies aimed at strengthening both objective and subjective dimensions of social capital may reduce post-disaster mental health.     

The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: The Jackson Heart Study

It is often hypothesized that psychosocial stress may contribute to associations of socioeconomic position (SEP) with risk factors for cardiovascular disease (CVD). However, few studies have investigated this hypothesis among African Americans, who may be more frequently exposed to stressors due to social and economic circumstances. Cross-sectional data from the Jackson Heart Study (JHS), a large population-based cohort of African Americans, were used to examine the contributions of stressors to the association of SEP with selected cardiovascular (CVD) risk factors and subclinical atherosclerotic disease. Among women, higher income was associated with lower prevalence of hypertension, obesity, diabetes and carotid plaque and lower levels of stress. Higher stress levels were also weakly, albeit positively, associated with hypertension, diabetes, and obesity, but not with plaque. Adjustment for the stress measures reduced the associations of income with hypertension, diabetes and obesity by a small amount that was comparable to, or larger, than the reduction observed after adjustment for behavioral risk factors. In men, high income was associated with lower prevalence of diabetes and stressors were not consistently associated with any of the outcomes examined. Overall, modest mediation effects of stressors were observed for diabetes (15.9%), hypertension (9.7%), and obesity (5.1%) among women but only results for diabetes were statistically significant. No mediation effects of stressors were observed in men. Our results suggest that stressors may partially contribute to associations of SEP with diabetes and possibly hypertension and obesity in African American women. Further research with appropriate study designs and data is needed to understand the dynamic and interacting effects of stressors and behaviors on CVD outcomes as well as sex differences in these effects.     

Coconut Oil Supplementation Does Not Affect Blood Pressure Variability and Oxidative Stress: A Placebo-Controlled Clinical Study in Stage-1 Hypertensive Patients

Exploring an alternative to improve the clinical management of hypertension, we tested the hypothesis that food supplementation with coconut oil (EVCO), alone or combined with aerobic exercise training, could exert an antihypertensive effect (primary outcome) in patients with stage 1 hypertension. Forty-five hypertensive volunteers of both genders participated in a placebo-controlled clinical trial. The volunteers were submitted to 24-hour ambulatory blood pressure monitoring, analysis of blood pressure variability (BPV), measurement of serum malondialdehyde (MDA) and nutritional assessment. Results indicate that EVCO consumption had no adverse effects. The supplementation did not increase the caloric intake compared with placebo, and the dietary constituents were similar between groups, except for the saturated fats, especially lauric acid. The analysis of blood pressure indicated absence of antihypertensive effect of EVCO alone or combined with physical training. Furthermore, no effects on blood pressure variability and oxidative stress were observed in the supplemented hypertensive patients. Thus, despite the results observed in pre-clinical studies, the current clinical study did not provide evidence to support the use of coconut oil as an adjuvant in the management of hypertension in humans.     

Modifiable cardiovascular risk factors among individuals in low socioeconomic communities and homeless shelters

To understand cardiovascular health in low socioeconomic populations, we analyzed the data from 426 low socioeconomic community-dwelling males and females and 287 homeless males in Philadelphia. Despite higher prevalence of smoking and hypertension, the proportion of homeless participants at increased risk for coronary heart disease was comparable with that of low socioeconomic community-dwelling participants. Among various characteristics, emotional stress was significantly associated with coronary heart disease risk in low socioeconomic community-dwelling participants only, suggestive of a differential psychosocial effect of stress. Our findings suggest that low socioeconomic populations are heterogeneous with respect to their risk factors and needs for interventions.     

The contribution of social-environmental factors to the emotional adjustment of Israeli religious Jewish women coping with infertility

The community is often considered a resource for coping with health-related stress but has potential for negative effects when coping with fertility problems. In this study, we examined the associations between the social–environmental variables (seeking the support of the community, perception of pressure from the community, and perception of spouse support as a possible moderator of this pressure) and emotional adjustment to fertility problems among religious Jewish women in Israel, a highly pronatalist society. Data were collected from January to August 2011. Structural equation modeling using data from 186 women indicated that perception of pressure from the community was associated with poorer emotional adjustment. This association was not moderated by perceived spouse support, but spouse support was associated with better adjustment. Seeking the support of the community was found to be composed of two dimensions: Seeking Ties and Belonging to the Community, which was associated with poorer adjustment, and Seeking Approval and Recognition from the Community, which was associated with better adjustment. These results point to the complexity of dealing with health-related stress when it comes to important community values. Understanding this complexity can help professionals conduct culturally sensitive evaluation and treatment that will contribute to women’s emotional adjustment to fertility problems.     

Social support and hypertension among blacks and whites in a rural, southern community

The association between social support and the prevalence of hypertension was examined in a randomly selected, biracial sample of 2,030 adult residents of Edgecombe County, North Carolina, who were surveyed in 1980. Two types of support, instrumental and emotional, were measured and evaluated in the 2,009 individuals for whom complete data were available. Blacks were more likely to have low levels of both kinds of social support. Low emotional support was unrelated to the prevalence of hypertension. In unadjusted analyses, low instrumental support was associated with increased hypertension for both races. After controlling for other correlates of blood pressure, the association no longer held for whites (odds ratio (OR) = 1.1), but remained statistically significant for blacks (OR = 1.5, 95 per cent confidence interval = 1.1-2.0). Further analyses revealed that these results were specific to low income blacks (OR = 1.7). These findings are consistent with the results of ecologic studies of social ties and hypertension-related mortality in North Carolina.     

高温工人HSP70基因多态性与高血压易感性

目的 探讨HSP70基因多态性与高温作业工人高血压发病易感性关系.方法 选取某钢铁企业158名炼钢、轧钢工人为高温组,同厂的76名库工为对照组.使用统一的调查表收集个人信息并测定血压值,聚合酶链式反应-限制性片断长度多态性(PCR - RFLP)方法分析HSP70基因多态性,运用PHASE 2.0遗传分析软件计算单倍型.结果 HSP70各基因型在高温组与对照组及高血压与非高血压人群中的分布差异均无统计学意义(P＞0.05).进一步将研究对象分为正常血压组、血压高值组和高血压组后发现,高温组血压高值组明显高于高血压组(P＜0.05);高温组和对照组2组合并后的总人群中,具有C/C基因型的人群与具有G/G基因型的人群比较,易感血压高值的调整OR(95％CI)为3.52(1.02 ～12.11).高温组血压高值组HSP70 -2基因G/G基因型频率明显高于高血压组及正常血压组,而HSP70 -2基因G/A基因型在血压高值组的分布频率低于高血压组与正常血压组;经Logistic回归分析,高温组具有HSP70-2基因G/A基因型的人群与G/G基因型的人群比较,易感血压高值的调整OR(95％CI)为0.25(0.08～0.78).单倍型对分析,高温组具有GAT/***单倍型的人群与GAT/GAT单倍型对的人群比较,易感高血压的调整OR(95％CI)为1.29(1.02 ～12.44).结论 HSP70 -1基因C/C基因型与人群血压高值有关联.HSP70 -2基因G/G基因型与高温作业工人血压高值有关联,G/A基因型可降低高温作业工人血压高值的风险性,GAT/***单倍型与高温作业工人高血压的易感性有关.