Greater Neurobiological Resilience to Chronic Socioeconomic or Environmental Stressors Associates With Lower Risk for Cardiovascular Disease Events

Abstract

Background: Chronic exposure to socioeconomic or environmental stressors associates with greater stress-related neurobiological activity (ie, higher amygdalar activity [AmygA]) and higher risk of major adverse cardiovascular events (MACE). However, among individuals exposed to such stressors, it is unknown whether neurobiological resilience (NBResilience, defined as lower AmygA despite stress exposure) lowers MACE risk. We tested the hypotheses that NBResilience protects against MACE, and that it does so through decreased bone marrow activity and arterial inflammation. Methods: Individuals underwent 18 F-fluorodeoxyglucose positron emission tomography/computed tomography; AmygA, bone marrow activity, and arterial inflammation were quantified. Chronic socioeconomic and environmental stressors known to associate with AmygA and MACE (ie, transportation noise exposure, neighborhood median household income, and crime rate) were quantified. Heightened stress exposure was defined as exposure to at least one chronic stressor (ie, the highest tertile of noise exposure or crime or lowest tertile of income). MACE within 5 years of imaging was adjudicated. Relationships were evaluated using linear and Cox regression, Kaplan-Meier survival, and mediation analyses. Results: Of 254 individuals studied (median age [interquartile range]: 57 years [46–67], 36.7% male), 166 were exposed to at least one chronic stressor. Among stress-exposed individuals, 12 experienced MACE over a median follow-up of 3.75 years. Among this group, higher AmygA (ie, lower resilience) associated with higher bone marrow activity (standardized β [95% CI]: 0.192 [0.030–0.353], P =0.020), arterial inflammation (0.203 [0.055–0.351], P =0.007), and MACE risk (standardized hazard ratio [95% CI]: 1.927 [1.370–2.711], P =0.001). The effect of NBResilience on MACE risk was significantly mediated by lower arterial inflammation ( P <0.05). Conclusions: Among individuals who are chronically exposed to socioeconomic or environmental stressors, NBResilience (AmygA <1 SD above the mean) associates with a >50% reduction in MACE risk, potentially via reduced arterial inflammation. These data raise the possibility that enhancing NBResilience may decrease the burden of cardiovascular disease.

Blood Pressure and Arterial Stiffness in Association With Aircraft Noise Exposure:Long-Term Observation and Potential Effect of COVID-19 Lockdown

“…30 Neurobiological resilience defined as lower amygdalar activity despite stress exposure including transportation noise may protect against major adverse cardiac events. 31 Available human data are consistent with animal experiments demonstrating an increased release of stress hormones (catecholamines and cortisol), endothelial dysfunction, and oxidative stress in aircraft noiseexposed mice. 32 Of note, a recent experimental study in mice indicated that aircraft noise exposure during the sleep phase but not awake phase caused increased BP, endothelial dysfunction, increased markers of vascular/ systemic oxidative stress, and inflammation.…”

“… 30 Neurobiological resilience defined as lower amygdalar activity despite stress exposure including transportation noise may protect against major adverse cardiac events. 31 …”

Mind body medicine: a modern bio-psycho-social model forty-five years after Engel

“…Tawakol and colleagues (2017) looked at PET/CT scans in a series of subjects who had ruled out for a cancer diagnosis and found a significant correlation among heightened psychosocial stress-related AmygA and bone marrow activation resulting in myelopoeisis and downstream arterial inflammation [ 50 ]. The authors propose that higher AmygA associates with increased cardiovascular disease (CVD) risk through this cascade involving heightened arterial inflammation (ArtI) as an endpoint signifying increasing risk for major adverse cardiovascular disease events (MACE) [ 50 , 55 ]. This line of research offers a window onto the biopsychosocial determinants of health and illness.…”

“…In further research, the Tawakol team went on to ask whether, among individuals exposed to such stressors, increased neurobiological resilience (NBResilience), defined as lower AmygA despite stress exposure, reduces MACE risk. They also asked if this potential positive effect of resilience is secondary to decreases in bone marrow activity and arterial inflammation (ArtI) [ 55 ].…”

Mental Stress and Its Effects on Vascular Health

“… 185 Curiously, amygdala activity varies among individuals, even if all are uniformly exposed to stress; and individuals with lower amygdala activity despite exposure to stress were protected from CVD. 186 Such neurobiological-resilient individuals may provide insight into how individual perceptions of one’s circumstance can influence regional brain activity and subsequent disease. In this way, the pathogenic effects of stress seem to be transduced along a neuroendocrine immunologic axis, terminating downstream on the vasculature where it then manifests as CVD.…”