Associations between life stress and subclinical cardiovascular disease are partly mediated by depressive and anxiety symptoms.
BACKGROUND
Stress experienced during childhood or adulthood has been associated with cardiovascular disease (CVD), but it is not clear whether associations are already prevalent on a subclinical cardiovascular level. This study investigates associations between indicators of life stress and subclinical CVD, and whether these are mediated by depression and anxiety.


METHODS
Subjects were 650 participants of the Netherlands Study of Depression and Anxiety, aged 20-66 years, with or without (27.5%) depressive and anxiety disorders. Life stress included childhood trauma, negative life events and recently experienced daily hassles or job strain. Subclinical CVD was measured as 1) carotid atherosclerosis (intima-media thickness and the presence of plaques) using B-mode ultrasonography, and 2) central arterial stiffness (heart rate normalized augmentation index) using calibrated radial applanation tonometry.


RESULTS
Increased central arterial stiffness was shown in subjects who had experienced childhood trauma (per SD increase: β=.07; p=.01), or reported recently experienced daily hassles (per SD increase: β=.06; p=.02), negative life events (per SD increase: β=.05; p=.03), or job strain (high versus low: β=.09; p=.01). Associations between life stress and arterial stiffness appeared to be partly mediated by severity of depressive and anxiety symptoms. No significant associations were found for childhood life events, nor between indicators of life stress and carotid atherosclerosis.


CONCLUSIONS
Childhood trauma and recent life stress were associated with increased central arterial stiffness. This suggests that life stress - partly via depression and anxiety - might enhance the development and progression of CVD.
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Health Sciences, VU University Medical Center, Amsterdam, The Netherlands.
Hanna
H
Bomhof-Roordink
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
Adrie
A
Seldenrijk
Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands.
Hein P J
HP
van Hout
Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands.
Harm W J
HW
van Marwijk
Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Michaela
M
Diamant
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: b.penninx@vumc.nl.
Brenda W J H
BW
Penninx
D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D002340:Carotid Artery Diseases / Q000523:psychology; D059168:Carotid Intima-Media Thickness; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D059289:Vascular Stiffness; D017132:Workplace / Q000523:psychology*
Anxiety; Arterial stiffness; Carotid atherosclerosis; Depression; Stress; Subclinical cardiovascular disease