title: Early atherosclerosis and cardiac autonomic responses to mental stress: a population-based study of the moderating influence of impaired endothelial function.
abstract: BACKGROUND
  Acute mental stress may contribute to the cardiovascular disease progression via autonomic nervous system controlled negative effects on the endothelium. The joint effects of stress-induced sympathetic or parasympathetic activity and endothelial function on atherosclerosis development have not been investigated. The present study aims to examine the interactive effect of acute mental stress-induced cardiac reactivity/recovery and endothelial function on the prevalence of carotid atherosclerosis.
  
  
  METHODS
  Participants were 81 healthy young adults aged 24-39 years. Preclinical atherosclerosis was assessed by carotid intima-media thickness (IMT) and endothelial function was measured as flow-mediated dilatation (FMD) using ultrasound techniques. We also measured heart rate, respiratory sinus arrhythmia (RSA), and pre-ejection period (PEP) in response to the mental arithmetic and speech tasks.
  
  
  RESULTS
  We found a significant interaction of FMD and cardiac RSA recovery for IMT (p = 0.037), and a significant interaction of FMD and PEP recovery for IMT (p = 0.006). Among participants with low FMD, slower PEP recovery was related to higher IMT. Among individuals with high FMD, slow RSA recovery predicted higher IMT. No significant interactions of FMD and cardiac reactivity for IMT were found.
  
  
  CONCLUSIONS
  Cardiac recovery plays a role in atherosclerosis development in persons with high and low FMD. The role of sympathetically mediated cardiac activity seems to be more important in those with impaired FMD, and parasympathetically mediated in those with relatively high FMD. The development of endothelial dysfunction may be one possible mechanism linking slow cardiac recovery and atherosclerosis via autonomic nervous system mediated effect.
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, PO Box 9, FIN-00014 Helsinki, Finland.
authors.forename: Nadja
authors.initials: N
authors.lastname: Chumaeva
authors.forename: Mirka
authors.initials: M
authors.lastname: Hintsanen
authors.forename: Taina
authors.initials: T
authors.lastname: Hintsa
authors.forename: Niklas
authors.initials: N
authors.lastname: Ravaja
authors.forename: Markus
authors.initials: M
authors.lastname: Juonala
authors.forename: Olli T
authors.initials: OT
authors.lastname: Raitakari
authors.forename: Liisa
authors.initials: L
authors.lastname: Keltikangas-Järvinen
mesh_terms: D000328:Adult; D001146:Arrhythmia, Sinus; D001341:Autonomic Nervous System / Q000502:physiology*; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D002404:Catheterization; D015897:Comorbidity; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008606:Mental Processes / Q000502:physiology; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D014463:Ultrasonography