Psychophysiological and cortisol responses to psychological stress in depressed and nondepressed older men and women with elevated cardiovascular disease risk.
OBJECTIVE
The objective of this study was to compare psychophysiological and cortisol reactions to psychological stress in older depressed and nondepressed patients at risk for cardiovascular disease (CVD).


METHODS
Forty-eight depressed participants and 20 controls with elevated cardiovascular risk factors underwent a psychological stress test during which cardiovascular variables were measured. Salivary cortisol was collected after each test segment. Traditional (e.g., lipids) and atypical (e.g., C-reactive protein) CVD risk factors were also obtained.


RESULTS
At baseline, the groups did not differ on lipid levels, flow-mediated vasodilation, body mass index, or asymmetric dimethylarginine. However, the depressed patients had significantly higher C-reactive protein levels. Contrary to our hypothesis, there were no differences in baseline cortisol levels or diurnal cortisol slopes, but depressed patients showed significantly lower cortisol levels during the stress test (p = .03) and less cortisol response to stress. Compared with nondepressed subjects, depressed subjects also showed lower levels of respiratory sinus arrhythmia (RSA(TF)) during the stress test (p = .02).


CONCLUSIONS
In this sample, older depressed subjects with elevated risk for CVD exhibited a hypocortisol response to acute stress. This impaired cortisol response might contribute to chronic inflammation (as reflected in the elevated C-reactive proteins in depressed patients) and in other ways increase CVD risk. The reduced RSA(TF) activity may also increase CVD risk in depressed patients through impaired autonomic nervous system response to cardiophysiological demands.
Taylor
C Barr
CB
Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5722, USA. btaylor@stanford.edu
Conrad
Ansgar
A
Wilhelm
Frank H
FH
Neri
Eric
E
DeLorenzo
Allyson
A
Kramer
Marie A
MA
Giese-Davis
Janine
J
Roth
Walton T
WT
Oka
Roberta
R
Cooke
John P
JP
Kraemer
Helena
H
Spiegel
David
D
D000367:Age Factors; D001341:Autonomic Nervous System / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002940:Circadian Rhythm; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry*; D013315:Stress, Psychological / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D011795:Surveys and Questionnaires
D002097:C-Reactive Protein; D006854:Hydrocortisone