Is Brachial Artery Flow-Mediated Dilation Associated with Negative Affect?
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Trait negative affect has been implicated as a risk marker for cardiovascular disease, but the mechanisms underlying this association are uncertain.
Our aim was to examine associations between trait measures of anger, hostility, depression, and anxiety with endothelial dysfunction via brachial artery flow-mediated dilation (FMD), an early indicator of cardiovascular disease.
FMD was examined in 332 healthy older adults. Measures included Beck Anxiety and Depression Inventories, Cook–Medley Hostility Scale, and Spielberger State-Trait Anger Expression Inventory (Anger In, Anger Out, and Trait Anger).
Mean age was 60.5 ± 4.8 years; 83% of participants were Caucasian and 49% were female. FMD was greater in women compared to men (6.17% vs. 4.07%, p < 0.001). Women reported significantly greater Anxiety (p < 0.001), and men reported greater Hostility (p = 0.004). In separate multivariable linear regression models controlling for cardiovascular risk factors, plus current hormone therapy for women, smaller FMD was associated with higher Anger In for women (β = −0.222, p = 0.04) and showed a trend with higher Hostility for men (β = −0.082, p = 0.09).
Endothelial dysfunction, as indicated by less vasodilatation of the brachial artery, is positively associated with measures of hostility and anger suppression in healthy older adults. Thus, associations between negative affect and cardiovascular health may be apparent early in the disease process.
- Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469–500. CrossRef
- Smith TW, Ruiz JM. Psychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice. J Consult Clin Psychol. 2002;70:548–68. CrossRef
- Matthews KA, Gump BB, Harris KF, Haney TL, Barefoot JC. Hostile behaviors predict cardiovascular mortality among men enrolled in the Multiple Risk Factor Intervention Trial. Circulation. 2004;109:66–70. CrossRef
- Williams JE, Nieto FJ, Sanford CP, Couper DJ, Tyroler HA. The association between trait anger and incident stroke risk: the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 2002;33:13–9. CrossRef
- Bleil ME, McCaffery JM, Muldoon MF, Sutton-Tyrrell K, Manuck SB. Anger-related personality traits and carotid artery atherosclerosis in untreated hypertensive men. Psychosom Med. 2004;66:633–9. CrossRef
- Everson-Rose SA, Lewis TT, Karavolos K, Matthews KA, Sutton-Tyrrell K, Powell LH. Cynical hostility and carotid atherosclerosis in African American and white women: the Study of Women's Health Across the Nation (SWAN) Heart Study. Am Heart J. 2006;152:982–13.
- Paterniti S, Zureik M, Ducimetiere P, Touboul PJ, Feve JM, Alperovitch A. Sustained anxiety and 4-year progression of carotid atherosclerosis. Arterioscler Thromb Vasc Biol. 2001;21:136–41.
- Raikkonen K, Matthews KA, Sutton-Tyrrell K, Kuller LH. Trait anger and the metabolic syndrome predict progression of carotid atherosclerosis in healthy middle-aged women. Psychosom Med. 2004;66:903–8. CrossRef
- Matthews KA, Owens JF, Kuller LH, Sutton-Tyrrell K, Jansen-McWilliams L. Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women? Psychosom Med. 1998;60:633–8.
- Iribarren C, Sidney S, Bild DE, Liu K, Markovitz JH, Roseman JM, et al. Association of hostility with coronary artery calcification in young adults: the CARDIA study. Coronary Artery Risk Development in Young Adults. J Am Med Assoc. 2000;283:2546–51. CrossRef
- Agatisa PK, Matthews KA, Bromberger JT, Edmundowicz D, Chang YF. Coronary and aortic calcification in women with a history of major depression. Arch Intern Med. 2005;165:1229–36. CrossRef
- Kop WJ. Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosom Med. 1999;61:476–87.
- Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005;131:260–300. CrossRef
- Martin R, Watson D, Wan CK. A three-factor model of trait anger: dimensions of affect, behavior, and cognition. J Pers. 2000;68:869–97. CrossRef
- Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111–5. CrossRef
- Herrington DM, Fan L, Drum M, Riley WA, Pusser BE, Crouse JR, et al. Brachial flow-mediated vasodilator responses in population-based research: methods, reproducibility and effects of age, gender and baseline diameter. J Cardiovasc Risk. 2001;8:319–28. CrossRef
- Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, et al. International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002;39:257–65. CrossRef
- Reddy KG, Nair RN, Sheehan HM, Hodgson JM. Evidence that selective endothelial dysfunction may occur in the absence of angiographic or ultrasound atherosclerosis in patients with risk factors for atherosclerosis. J Am Coll Cardiol. 1994;23:833–43. CrossRef
- Benjamin EJ, Larson MG, Keyes MJ, Mitchell GF, Vasan RS, Keaney JF Jr, et al. Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study. Circulation. 2004;109:613–9. CrossRef
- Anderson TJ, Uehata A, Gerhard MD, Meredith IT, Knab S, Delagrange D, et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995;26:1235–41. CrossRef
- Gokce N, Keaney JFJ, Hunter LM, Watkins MT, Nedeljkovic ZS, Menzoian JO, et al. Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease. J Am Coll Cardiol. 2003;41:1769–75. CrossRef
- Yeboah J, Crouse JR, Hsu FC, Burke GL, Herrington DM. Brachial flow-mediated dilation predicts incident cardiovascular events in older adults: the Cardiovascular Health Study. Circulation. 2007;115:2390–97. CrossRef
- Yeboah J, Sutton-Tyrrell K, McBurnie MA, Burke GL, Herrington DM, Crouse JR. Association between brachial artery reactivity and cardiovascular disease status in an elderly cohort: the cardiovascular health study. Atherosclerosis. 2008;197:768–76. CrossRef
- Harris KF, Matthews KA, Sutton-Tyrrell K, Kuller LH. Associations between psychological traits and endothelial function in postmenopausal women. Psychosom Med. 2003;65:402–9. CrossRef
- Broadley AJM, Korszun A, Jones CJH, Frenneaux MP. Arterial endothelial function is impaired in treated depression. Heart. 2002;88:521–3. CrossRef
- Rajagopalan S, Brook R, Rubenfire M, Pitt E, Young E, Pitt B. Abnormal brachial artery flow-mediated vasodilation in young adults with major depression. Am J Cardiol. 2001;88:196–8. Erratum appears in Am J Cardiol 2001 Sep 15;88(6):722. CrossRef
- Wagner JA, Tennen H, Mansoor GA, Abbott G. History of major depressive disorder and endothelial function in postmenopausal women. Psychosom Med. 2006;68:80–6. CrossRef
- Sherwood A, Hinderliter AL, Watkins LL, Waugh RA, Blumenthal JA. Impaired endothelial function in coronary heart disease patients with depressive symptomatology. J Am Coll Cardiol. 2005;46:656–9. CrossRef
- Gottdiener JS, Kop WJ, Hausner E, McCeney MK, Herrington D, Krantz DS. Effects of mental stress on flow-mediated brachial arterial dilation and influence of behavioral factors and hypercholesterolemia in subjects without cardiovascular disease. Am J Cardiol. 2003;92:687–91. CrossRef
- Janicki DL, Kamarck TW, Shiffman S, Sutton-Tyrrell K, Gwaltney CJ. Frequency of spousal interaction and 3-year progression of carotid artery intima medial thickness: the Pittsburgh Healthy Heart Project. Psychosom Med. 2005;67:889–96. CrossRef
- Kamarck TW, Janicki DL, Shiffman S, Polk DE, Muldoon MF, Liebenauer LL, et al. Psychosocial demands and ambulatory blood pressure: a field assessment approach. Physiol Behav. 2002;77:699–704. CrossRef
- Kamarck TW, Muldoon MF, Shiffman S, Sutton-Tyrrell K, Gwaltney C, Janicki DL. Experiences of demand and control in daily life as correlates of subclinical carotid atherosclerosis in a healthy older sample. Health Psychol. 2004;23:24–32. CrossRef
- Stewart JC, Janicki DL, Muldoon MF, Sutton-Tyrrell K, Kamarck TW. Negative emotions and 3-year progression of subclinical atherosclerosis. Arch Gen Psychiatry. 2007;64:225–33. CrossRef
- Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7. CrossRef
- Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory. 2nd ed. San Antonio: Psychological; 1996.
- Cook WW. Proposed hostility and Pharisaic-virtue scales for the MMPI. J Appl Psychol. 1954;38:414–8. CrossRef
- Spielberger CD, Jacobs GA, Russell SF, Crane RS. Assessment of anger: the State-Trait Anger Scale. In: Butcher JN, Spielberger CD, editors. Advances in personality assessment, vol. 2. Hillsdale: LEA; 1983.
- Herrington DM, Espeland MA, Crouse JRIII, Robertson J, Riley WA, McBurnie MA, et al. Estrogen replacement and brachial artery flow-mediated vasodilation in older women. Arterioscler Thromb Vasc Biol. 2001;21:1955–61. CrossRef
- Belsley DA, Kuh E, Welsch RE. Regression Diagnostics. New York: Wiley; 1980. CrossRef
- Cook RD, Weisberg S. Residuals and influence in regression. London: Chapman and Hall; 1982.
- Rymaszewska J, Kiejna A, Hadry T. Depression and anxiety in coronary artery bypass grafting patients. European Psychiatry: the Journal of the Association of European Psychiatrists. 2003;18:155–60.
- Raynor DA, Pogue-Geile MF, Kamarck TW, McCaffery JM, Manuck SB. Covariation of psychosocial characteristics associated with cardiovascular disease: genetic and environmental influences. Psychosom Med. 2002;64:191–203.
- Sherwood A, Hughes JW, Kuhn C, Hinderliter AL. Hostility is related to blunted beta-adrenergic receptor responsiveness among middle-aged women. Psychosom Med. 2004;66:507–13. CrossRef
- Suarez EC, Kuhn CM, Schanberg SM, Williams RBJ, Zimmermann EA. Neuroendocrine, cardiovascular, and emotional responses of hostile men: the role of interpersonal challenge. Psychosom Med. 1998;60:78–88.
- Markovitz JH, Matthews KA, Kiss J, Smitherman TC. Effects of hostility on platelet reactivity to psychological stress in coronary heart disease patients and in healthy controls. Psychosom Med. 1996;58:143–9.
- Matthews KA, Schott LL, Bromberger J, Cyranowski J, Everson-Rose SA, Sowers MF. Associations between depressive symptoms and inflammatory/hemostatic markers in women during the menopausal transition. Psychosom Med. 2007;69:124–30. CrossRef
- Brummett BH, Babyak MA, Siegler IC, Mark DB, Williams RB, Barefoot JC. Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease. Am J Cardiol. 2003;92:529–32. CrossRef
- Pulkki L, Kivimaki M, Elovainio M, Viikari J, Keltikangas-Jarvinen L. Contribution of socioeconomic status to the association between hostility and cardiovascular risk behaviors: a prospective cohort study. Am J Epidemiol. 2003;158:736–42. CrossRef
- DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7. CrossRef
- Weidner G, Rice T, Knox SS, Ellison RC, Province MA, Rao DC, et al. Familial resemblance for hostility: the National Heart, Lung, and Blood Institute Family Heart Study. Psychosom Med. 2000;62:197–204.
- Pyke KE, Tschakovsky ME. The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function. J Physiol. 2005;568:357–69. CrossRef
- Modena MG, Bonetti L, Coppi F, Bursi F, Rossi R. Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol. 2002;40:505–10. CrossRef
- Is Brachial Artery Flow-Mediated Dilation Associated with Negative Affect?
International Journal of Behavioral Medicine
Volume 16, Issue 3 , pp 241-247
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
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- Flow-mediated dilation
- Endothelial dysfunction
- Author Affiliations
- 1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A546 Crabtree Hall, Pittsburgh, PA, 15261, USA
- 2. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- 3. Department of Psychiatry, University of Pittsburgh/University of Pittsburgh Medical Center, Pittsburgh, PA, USA