title: Psychological distress, cortisol stress response and subclinical coronary calcification.
abstract: OBJECTIVE
  Poor mental health has been associated with coronary heart disease (CHD). One hypothesized underlying mechanism is hypothalamus pituitary adrenal axis dysfunction. We examined the associations between psychological distress, cortisol response to laboratory-induced mental stress and subclinical coronary artery calcification (CAC).
  
  
  METHODS
  527 volunteers free of CHD (mean age=63.0 ± 5.7 years), drawn from the Whitehall II cohort.
  
  
  METHODS
  CAC was measured using electron beam computed tomography. Current distress at time of the heart scan was indicated by a Short Form-36 mental health score, whereas long-term distress was based on the averaged scores of six assessments over the 15 preceding years. Salivary cortisol was measured in response to mental stressors (Stroop, mirror tracing).
  
  
  RESULTS
  Detectable CAC was found in 56.4% (mild/moderate: 46.9%; severe: 9.5%) of the sample. After adjustment for sociodemographics and conventional risk factors, long-term but not current psychological distress was associated with a higher risk of severe CAC (OR per SD increase=1.49, 95%CI=1.03-2.16). Psychological distress was not significantly associated with cortisol stress response. A trend for interaction (p=.09) indicated that individuals with long-term poor mental health and high cortisol reactivity showed the highest odds for severe CAC.
  
  
  CONCLUSIONS
  Long-term but not current psychological distress is associated with severe CAC in healthy older subjects. Although psychological distress generally was not associated with cortisol stress responses, participants with both long-term distress and increased cortisol response were especially at risk for severe calcification.
authors.affiliation: VUMC, Department of Psychiatry, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. a.seldenrijk@ggzingeest.nl
authors.forename: Adrie
authors.initials: A
authors.lastname: Seldenrijk
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Avijit
authors.initials: A
authors.lastname: Lahiri
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000523:psychology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism; D057566:Self Report; D013315:Stress, Psychological / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology*
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone