The interaction between systemic inflammation and psychosocial stress in the association with cardiac troponin elevation: A new approach to risk assessment and disease prevention

PREVENTIVE MEDICINE

卷:93

Article

Lazzarino, Antonio Ivan^1,2  Hamer, Mark⁵  Gaze, David³  Collinson, Paul³  Rumley, Ann⁴  Lowe, Gordon⁴  Steptoe, Andrew² 

[1] London Sch Hyg & Trop Med, Room 142b,Keppel St, London WC1E 7HT, England

[2] UCL, Dept Epidemiol & Publ Hlth, 1-19 Torrington Pl, London WC1E 6BT, England

[3] St Georges Healthcare NHS Trust, Chem Pathol Clin Blood Sci, Blackshaw Rd, London SW17 0QT, England

[4] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow G12 8TA, Lanark, Scotland

[5] Univ Loughborough, Natl Ctr Sport & Exercise Med, Sch Sport Exercise & Hlth Sci, Loughborough LE11 3TU, Leics, England

关键词: Allostasis;    Atherosclerosis;    Cardiovascular diseases;    Fibrinogen;    Neuroendocrinology;    Psychological stress;    Socioeconomic factors;    Troponin T;   

DOI  :  10.1016/j.ypmed.2016.09.018

来源: Elsevier

【 摘 要 】

We have previously shown that there is a complex and dynamic biological interaction between acute mental stress and acute release of inflammatory factors into the blood stream in relation to heart disease. We now hypothesize that the presence of chronic psychosocial stress may modify the weight of single test results for inflammation as a predictor of heart disease. Using a cross-sectional design, 500 participants free from heart disease drawn from the Whitehall II study in UK in 2006-2008 were tested for plasma fibrinogen as an inflammatory factor, financial strain as a marker of chronic psychosocial stress, coronary calcification measured using computed tomography, and for plasma high-sensitivity cardiac troponin T (HS-CTnT) as a marker of cardiac risk. Fibrinogen concentration levels above the average were associated with a 5-fold increase in the odds of HS-CTnT positivity only among individuals with financial strain (N= 208, OR= 4.73, 95% CI= 1.67 to 13.40, P= 0.003). Fibrinogen was in fact not associated with HS-CTnT positivity in peoplewithout financial strain despite the larger size of that subsample (n= 292, OR= 0.84, 95% CI= 0.42 to 1.67, P= 0.622). A test for interaction on the full sample (N= 500) showed a P value of 0.010 after adjusting for a range of demographics, health behaviours, traditional cardiovascular risk factors, psychosocial stressors, inflammatory cytokines, and coronary calcification. In conclusion, elevated fibrinogen seems to be cardio-toxic only when is combined with financial strain. Chronic psychosocial stress may modify the meaning that we should give to single test results for inflammation. Further research is needed to confirm our results. (C) 2016 The Authors. Published by Elsevier Inc.

【 授权许可】

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