Anxiety and Extraversion in Lupus-Related Atherosclerosis

Abstract

Objectives: Patients with systemic lupus erythematosus (SLE) are characterized by increased cardiovascular disease (CVD) risk as well as heightened rates of psychological distress. Since a link between psychological issues and CV morbidity has been previously suggested, the influence of psychological burden on subclinical atherosclerosis in SLE patients was investigated.Methods: 71 SLE patients were assessed for the presence of subclinical atherosclerosis—defined either as carotid and/or femoral plaque formation or arterial wall thickening [Intima Media Thickness (IMT) levels > 0.90 mm by Doppler ultrasound]; personality traits, anxiety and depression, sleeping habits and fatigue levels were also evaluated by specific questionnaires including Eysenck Personality Questionnaire Scale, State-Trait Anxiety Inventory (STAI), Zung Depression Scale, Athens Insomnia Scale and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Disease related clinical and laboratory features and traditional risk factors for atherosclerosis were documented. Univariate and multivariate analysis were performed.Results: SLE patients with arterial wall thickening displayed higher STAI anxiety scores (either as a current state or as a personality trait) compared to those without (49.8 ± 5.6 vs. 46.9 ± 5.4, p-value: 0.03 and 49.2 ± 4.4 vs. 45.7 ± 6.8, p-value: 0.009, respectively). In a multivariate model, trait anxiety and extraversion personality scores were found to be independently associated with arterial wall thickening and plaque formation, respectively [OR95%(CI):1.2(1.0–1.5) and 0.7(0.6–1.0), respectively], following adjustment for potential confounders. No other associations were detected.Conclusions: Anxiety and extraversion personality traits have been independently associated with subclinical atherosclerosis in lupus patients, implying psychoneuroimmunological interactions as contributors in SLE related atherosclerosis.

Psychophysiological and affective reactivity to vicarious police violence

“…Longstanding work in health psychology and epidemiology supports the notion that negative affect can potentiate greater susceptibility to infections, such as the common cold, while also being associated with higher risk for cardiovascular and metabolic diseases and a shorter lifespan (e.g., Carnethon et al, 2003). In contrast, positive affect can offer health‐protective qualities, including lower disease risk factors such as atherosclerosis, lower incidence of diseases such as coronary heart disease, and lower mortality rates (Giannelou et al, 2018; Jokela et al, 2014; Pressman & Cohen, 2005). Thus, combining psychophysiological and affective self‐report methods enables us to take a multi‐pronged approach to concurrent reactivity processes while adding to broader perspectives on the role of discrimination as one chronic pathway to health disparities (Cyders & Coskunpinar, 2011).…”

Is stressor‐evoked cardiovascular reactivity a pathway linking positive and negative emotionality to preclinical cardiovascular disease risk?

“…In contrast to longstanding interest in the health impairing attributes of negative emotionality and associated traits, positive emotionality has only recently attracted interest as related to cardiovascular disease risk. Early evidence suggests that extraversion and trait positive affect are associated with fewer strokes (Jokela et al., 2014), lesser coronary heart disease (Davidson et al., 2010), less atherosclerosis (Giannelou et al., 2018), and lower mortality (Chida & Steptoe, 2008; Hoen et al., 2013; but also see Brummett et al, 2005). Therefore, positive and negative emotionality appear to have complementary and possibly reciprocal associations with health.…”

“…Although there are more studies that have associated indicators of negative emotionality with cardiovascular health outcomes, the majority of these studies do not include any markers of positive emotionality (Almas et al., 2017; Appels & Mulder, 1988; Čukić & Bates, 2015; Shipley et al., 2007). In contrast, the majority of studies on positive emotionality and health overwhelmingly control for negative emotionality in their analyses (Brummett et al, 2005; Davidson et al., 2010; Giannelou et al., 2018; Hoen et al., 2013; Jokela et al., 2014). Given this limitation, an open question remains as to whether positive and negative emotionality are complementary or separate predictors of cardiovascular disease risk.…”

Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient‐Reported Outcomes in Rheumatologic Diseases

“…The AIS has been used to evaluate insomnia in cancer (167), chronic pain (168,172), kidney transplant (170), OSA (173), RA (95,97,171,174), SLE (175), and Sjögren syndrome (176). In these studies, the role of the AIS has varied from studying sleep disorders, insomnia, and fatigue in specific comorbidities alongside other measures, such as the PSQI, the ISI, the BQ, or actigraphy.…”