Skip to main content
SpringerLink
Log in

Job-Related Anxiety and Carotid Atherosclerosis

  • Original Research Articles
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Objective: Several studies have shown that mental stress may favour the development of hypertension and coronary artery disease, particularly in men. Among the factors causing mental stress, we focused on job-related anxiety (JRA). The aim of this study was to evaluate the association of individual perception of JRA with the prevalence of atherosclerosis.

Participants and methods: Among all the patients referred in 2001 to the outpatient hypertension clinic of our university for a cardiological check-up, 154 patients were found with JRA, whom we frequency matched for age with 155 patients who denied having JRA. JRA was assessed by asking participants whether they would consider their job stressful. Left ventricular (LV) hypertrophy and carotid artery intima-media thickness (IMT) were evaluated with a high-resolution echo-Doppler technique. IMT >1mm and ≤1.3mm was defined as wall thickening, whereas IMT >1.3mm was defined as discrete plaque. Blood pressure was measured at the end of echocardiographic evaluation.

Results: The prevalence of atherosclerosis was higher in patients with JRA (p < 0.0001). The association between higher values of IMT and JRA remains statistically significant after adjustment for covariates (p = 0.0003). However, LV mass index, relative wall thickness and endocardial shortening were similar in the two groups. Patients with JRA exhibited lower values of systolic, diastolic, pulse pressure, and heart rate.

Conclusion: The presence of JRA is associated with high values of IMT independently from the blood pressure values and LV geometry.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1
Table III

Similar content being viewed by others

References

  1. Pickering TG. Mental stress as a causal factor in the development of hypertension and cardiovascular disease. Curr Hypertens Rep 2001; 3: 249–54

    Article  PubMed  CAS  Google Scholar 

  2. Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q 1979; 24: 285–308

    Article  Google Scholar 

  3. Karasek RA, Theorell T. Healthy work: stress, productivity and the reconstruction of working life. New York: Basic Books, 1990

    Google Scholar 

  4. Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annu Rev Public Health 1994; 15: 381–411

    Article  PubMed  CAS  Google Scholar 

  5. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114: 345–52

    PubMed  CAS  Google Scholar 

  6. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322: 1561–6

    Article  PubMed  CAS  Google Scholar 

  7. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997; 146: 483–94

    Article  PubMed  CAS  Google Scholar 

  8. Hulthe J, Wikstrand J, Emanuelsson H, et al. Atherosclerotic changes in the carotid artery bulb as measured by B-mode ultrasound are associated with the extent of coronary atherosclerosis. Stroke 1997; 28: 1189–94

    Article  PubMed  CAS  Google Scholar 

  9. Okin PM, Roman MJ, Devereux RB, et al. Association of carotid atherosclerosis with electrocardiographic myocardial ischemia and left ventricular hypertrophy. Hypertension 1996; 28: 3–7

    Article  PubMed  CAS  Google Scholar 

  10. de Simone G, Pasanisi F, Contaldo F. Link of non-hemodynamic factors to hemodynamic determinants of left ventricular hypertrophy. Hypertension 2001; 38: 13–8

    Article  PubMed  Google Scholar 

  11. Snaith RP, Constantopoulos AA, Jardine MY, et al. A clinical scale for the self-assessment of irritability. Br J Psychiatry 1978; 132: 164–71

    Article  PubMed  CAS  Google Scholar 

  12. Matthews KA, Owens JF, Kuller LH, et al. Stress-induced pulse pressure change predicts women’s carotid atherosclerosis. Stroke 1998; 29: 1525–30

    Article  PubMed  CAS  Google Scholar 

  13. Barnett PA, Spence JD, Manuck SB, et al. Psychological stress and the progression of carotid artery disease. J Hypertens 1997; 15: 49–55

    Article  PubMed  CAS  Google Scholar 

  14. Paterniti S, Zureik M, Ducimetiere P, et al. Sustained anxiety and 4-year progression of carotid atherosclerosis. Arterioscler Thromb Vasc Biol 2001; 21: 136–41

    Article  PubMed  CAS  Google Scholar 

  15. Whiteman MC, Deary IJ, Fowkes FG. Personality and social predictors of atherosclerotic progression: Edinburgh Artery Study. Psychosom Med 2000; 62: 703–14

    PubMed  CAS  Google Scholar 

  16. Castillo-Richmond A, Schneider RH, Alexander CN, et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000; 31: 568–73

    Article  PubMed  CAS  Google Scholar 

  17. Rosvall M, Östergren PO, Hedblad B, et al. Work-related psychosocial factors and carotid atherosclerosis. Int J Epidemiol 2002; 31: 1169–78

    Article  PubMed  CAS  Google Scholar 

  18. Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151–83

    Google Scholar 

  19. Trimarco B, DeLuca N, Rosiello G, et al. Effects of long-term antihypertensive treatment with tertatolol on diastolic function in hypertensive patients with and without left ventricular hypertrophy. Am J Hypertens 1989; 2: 278–83S

    Google Scholar 

  20. Bonaduce D, Breglio R, Conforti G, et al. Myocardial hypertrophy and left ventricular diastolic function in hypertensive patients: an echo Doppler evaluation. Eur Heart J 1989; 10: 611–21

    PubMed  CAS  Google Scholar 

  21. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977; 55: 613–8

    Article  PubMed  CAS  Google Scholar 

  22. de Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992 Nov 1; 20(5): 1251–60

    Article  PubMed  Google Scholar 

  23. de Simone G, Devereux RB, Ganau A, et al. Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and Doppler echocardiography. Am J Cardiol 1996; 78: 801–7

    Article  PubMed  Google Scholar 

  24. Mercuri M, Devi K. Quantitative ultrasonographic evaluation of the carotid arteries in hypertension. J Cardiovasc Risk 1995; 2: 27–33

    Article  PubMed  CAS  Google Scholar 

  25. Heiss G, Sharrett AR, Barnes R, et al. Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study. Am J Epidemiol 1991; 134: 250–6

    PubMed  CAS  Google Scholar 

  26. Tang R, Hennig M, Thomasson B, et al. Baseline reproducibility of B-mode ultrasonic measurement of carotid artery intima-media thickness: the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2000; 18: 197–201

    Article  PubMed  CAS  Google Scholar 

  27. Lembo G, De Luca N, Battagli C, et al. A common variant of endothelial nitric oxide synthase (Glu298Asp) is an independent risk factor for carotid atherosclerosis. Stroke 2001; 32: 735–40

    Article  PubMed  CAS  Google Scholar 

  28. SAS Institute Inc. SAS/STAT user guide, Version 8.2 for Windows. Cary (NC): SAS Institute Inc., 1989

  29. Schechtman KB, Barzillai B, Rost K, et al. Measuring physical activity with a single question. Am J Public Health 1991; 81: 771–3

    Article  PubMed  CAS  Google Scholar 

  30. Macleod J, Davey Smith G, Heslop P, et al. Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men. BMJ 2002; 324: 1247–51

    Article  PubMed  Google Scholar 

  31. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–70

    Article  PubMed  CAS  Google Scholar 

  32. Snaith RP, Taylor CM. Irritability: definition, assessment and associated factors. Br J Psychiatry 1985; 147: 127–36

    Article  PubMed  CAS  Google Scholar 

  33. Frese M, Zapf D. Methodological issues in the study of work stress: objective vs subjective measurement of work stress and the question of longitudinal studies. In: Cooper CL, Payne R, editors. Causes, coping and consequences of stress at work. Chichester: Wiley, 1990: 375–411

    Google Scholar 

  34. Heslop P, Davey Smith G, Carroll D, et al. Perceived stress and coronary heart disease risk factors: the contribution of socio-economic position. Br J Health Psychol 2001; 6: 167–78

    Article  PubMed  CAS  Google Scholar 

  35. Rosengren A, Tibblin G, Wilhelmsen L. Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men. Am J Cardiol 1991; 68: 1171–5

    Article  PubMed  CAS  Google Scholar 

  36. Noll G, Wenzel RR, Schneider M, et al. Increased activation of sympathetic nervous system and endothelin by mental stress in normotensive offspring of hypertensive parents. Circulation 1996; 93: 866–9

    Article  PubMed  CAS  Google Scholar 

  37. Eisenhofer G, Lambie DG, Johnson RH. Beta-adrenoceptor responsiveness and plasma catecholamines as determinants of cardiovascular reactivity to mental stress. Clin Sci (Lond) 1985; 69: 483–92

    CAS  Google Scholar 

  38. James GD, Cates EM, Pickering TG, et al. Parity and perceived job stress elevate blood pressure in young normotensive working women. Am J Hypertens 1989; 2: 637–9

    PubMed  CAS  Google Scholar 

  39. Kamarck TW, Everson SA, Kaplan GA, et al. Exaggerated blood pressure responses during mental stress are associated with enhanced carotid atherosclerosis in middle-aged Finnish men: findings from the Kuopio Ischemic Heart Disease Study. Circulation 1997; 96: 3842–8

    Article  PubMed  CAS  Google Scholar 

  40. Schnall PL, Pieper C, Schwartz JE, et al. The relationship between ‘job strain’, workplace diastolic blood pressure, and left ventricular mass index: results of a case-control study. JAMA 1990; 263: 1929–35

    Article  PubMed  CAS  Google Scholar 

  41. Devereux RB, Roman MJ, Ganau A, et al. Cardiac and arterial hypertrophy and atherosclerosis in hypertension. Hypertension 1994; 23: 802–9

    Article  PubMed  CAS  Google Scholar 

  42. Skantze HB, Kaplan J, Pettersson K, et al. Psychosocial stress causes endothelial injury in cynomolgus monkeys via beta1-adrenoceptor activation. Atherosclerosis 1998; 136: 153–61

    Article  PubMed  CAS  Google Scholar 

  43. Kivimaki M, Paivi LA, Luukkonen R, et al. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002; 325: 857–61

    Article  PubMed  Google Scholar 

  44. Devereux RB, Lutas EM, Casale PN, et al. Standardization of M-mode echocardiographic LV anatomic measurements. J Am Coll Cardiol 1984; 4: 1222–30

    Article  PubMed  CAS  Google Scholar 

  45. Levy D, Savage DD, Garrison RJ, et al. Echocardiography criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987; 59: 956–60

    Article  PubMed  CAS  Google Scholar 

  46. de Simone G, Devereux RB, Roman MJ, et al. Gender differences in left ventricular anatomy, blood viscosity and volume regulatory hormones in normal adults. Am J Cardiol 1991; 68: 1704–8

    Article  PubMed  Google Scholar 

  47. Zanchetti A, Bond MG, Hennig M, et al. Risk factors associated with alterations in carotid intima-media thickness in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis. J Hypertens 1998; 16: 949–61

    Article  PubMed  CAS  Google Scholar 

  48. Bots ML, Hoes AW, Koudstaal PJ, et al. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 96: 1432–7

    Article  PubMed  CAS  Google Scholar 

  49. Davis PH, Dawson JD, Riley WA, et al. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine Study. Circulation 2001; 104: 2815–9

    Article  PubMed  CAS  Google Scholar 

  50. Hedblad B, Wikstrand J, Janzon L, et al. Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: main results from the β-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001; 103: 1721–6

    Article  PubMed  CAS  Google Scholar 

  51. Devereux RB, Alderman MH. Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 1993; 88: 1444–55

    Article  PubMed  CAS  Google Scholar 

  52. Chowdhary S, Townend JN. Nitric oxide and hypertension: not just an endothelium derived relaxing factor. J Hum Hypertens 2001; 5: 219–27

    Article  Google Scholar 

  53. Sander M, Victor RG. Neural mechanisms in nitric-oxide-deficient hypertension. Curr Opin Nephrol Hypertens 1999; 8: 61–73

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Dr Licia Iacoviello for helpful suggestions and Miss Alexandra Cianci for preparing the manuscript.

The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this article.

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples “Federico II”, Via Panisi 5, 80137, Naples, Italy

    Nicola De Luca,  Roberto Trotta, Raffaele Izzo, Gianni Luigi Iovino & Bruno Trimarco

  2. Department of Clinical and Experimental Medicine, University of Naples “Federico II”, Naples, Italy

    Giovanni de Simone

  3. Centre for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy

    Augusto Di Castelnuovo

Authors
  1. Nicola De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni de Simone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Trotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaele Izzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianni Luigi Iovino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Augusto Di Castelnuovo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruno Trimarco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Trotta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Luca, N., de Simone, G., Trotta, R. et al. Job-Related Anxiety and Carotid Atherosclerosis. High Blood Press Cardiovasc Prev 11, 99–105 (2004). https://doi.org/10.2165/00151642-200411030-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00151642-200411030-00002

Keywords

Search

Navigation