Psychosocial Factors, Sex Differences, and Atherosclerosis

Kaplan,; Mr, Adams; Tb, Clarkson; Sb, Manuck; Ca, Shively

doi:10.1097/00006842-199611000-00008

Cited by 122 publications

(82 citation statements)

References 77 publications

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“…171,172 Subordinate monkeys have estradiol concentrations of Ϸ60 pg/mL, contrasting significantly with dominants at 130 pg/mL. 173 Furthermore, these subordinate, ovary-impaired females, compared with their dominant counterparts, develop exacerbated atherosclerosis and abnormalities in coronary reactivity.…”

Section: Sex Differencesmentioning

confidence: 99%

“…179,180 Psychogenic stress is often linked to functional hypothalamic hypogonadism in women. 172,[181][182][183] One particular expression of this syndrome, functional hypothalamic amenorrhea, is associated with abnormal luteinizing hormone pulse generator activity and is accompanied by hypercortisolemia and other neuroendocrine and behavioral indicators of stress. 184,185 Furthermore, recent data suggest that subclinical ovarian abnormalities sufficient to cause premenopausal bone loss may affect a substantial number of women.…”

Section: Sex Differencesmentioning

confidence: 99%

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Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

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Section: Sex Differencesmentioning

confidence: 99%

Section: Sex Differencesmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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“…R. Williams & Collins, 1995). In both human and animal models, there are gender differences in the association between psychosocial risk factors and CHD, as well as in the likely underlying mechanisms (J. R. Kaplan et al, 1996;Kiecolt-Glaser & Newton, 2001). Ultimately, interventions should be evaluated in specific underrepresented sociodemographic groups (cf.…”

Section: Emerging Issuesmentioning

confidence: 99%

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Smith¹,

Ruiz²

2002

Journal of Consulting and Clinical Psychology

292

208

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Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.Coronary heart disease (CHD) is the leading cause of death in the United States; each year about 450,000 people die from CHD, and 1,000,000 experience an initial or recurrent coronary event (American Heart Association, 2001). Among healthy 40-year olds, between 40% and 50% of men and between 25% and 35% of women will later develop CHD (Lloyd-Jones, Larson, Beiser, & Levy, 1999). Over $100 billion is spent on CHD each year in the United States in direct medical costs, disability payments, and lost productivity (American Heart Association, 2001). This disease involves the three major topics composing behavioral medicine and health psychology, making it a central focus throughout their 30-year history. In the first (i.e., health behavior and prevention), modifiable behavioral risk factors (e.g., smoking, activity level, diet) are important risk factors for the development of CHD (Stamler et al., 1999;Wannamethee, Shaper, Walker, & Ebrahim, 1998), and behavior change is an essential component of prevention. In the second topic (i.e., stress and disease or psychosomatics), other psychological and social factors have more direct effects on the development and course of CHD through the intervening psychobiological effects of stress and negative emotions. In the third (i.e., psychosocial aspects of medical illness and care), established CHD has extensive emotional and social impacts on patients and their families, behavior is a key element of standard care (e.g., medication adherence, dietary change, exercise), and psychosocial interventions are useful additions to traditional medical and surgical treatment.Like the article on CHD in the previous special issue on behavioral medicine in this journal (Thoresen & Powell, 1992), we focused primarily on the second major topic-psychosocial influences on the development and course of CHD. We also reviewed one aspect of the third topic-interventions targeting psychosocial risk factors and their underlying psychophysiological mechanisms. Perhaps the most important implication of research on psychosocial risk factors for coronary disease is that interventions targeting these factors could reduce cardiac morb...

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“…Dados provenientes de estudos em animais e humanos indicam que o estresse psicológico pode determinar alteração relevante sobre a função menstrual (Kaplan et al, 1996;Fenster et al, 1999;Hatch et al, 1999).…”

Section: Introductionunclassified

“…Estudos controlados mostram que macacas sinomólogas submetidas à condição social de subordinação apresentaram alterações na função ovariana, com baixa concentração de estrogê-nios circulantes, comparadas às primatas mantidas com os mesmos hábitos de vida (Kaplan, 1996). Em mulheres, no entanto, pequenos eventos estressantes como os encontrados no dia-a-dia não têm sido tão bem documentados quanto o efeito sobre o ciclo menstrual.…”

Section: Introductionunclassified

Irregularidades menstruais: inter-relações com o psiquismo

Melo¹,

Machado²,

Fernandes³

2006

Rev. psiquiatr. clín.

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ResumoDados provenientes de estudos em animais e humanos indicam que o estresse psicológico pode determinar alteração relevante sobre a função menstrual. Vários estudos procuraram analisar eventos estressores comuns -novo emprego, dificuldades financeiras, discussões diárias -e sua relação com características menstruais, como o intervalo e quantidade do fluxo, bem como com quadros de amenorréia. Sugere-se que as alterações menstruais funcionais resultam primariamente da ação direta dos hormônios do eixo hipotálamo-hipófise-adrenal, provavelmente modulados por CRH, induzindo maior atividade de ACTH e ß-endorfina. Clinicamente, os quadros mais freqüentemente associados aos distúrbios psíquicos referem-se às anovulações de origem central e às amenorréias hipotalâmicas. A caracterização do envolvimento psíquico nessas condições representa elemento fundamental para a adequada abordagem terapêutica.Palavras-chave: Menstruação, amenorréia, sangramento disfuncional, aspectos emocionais, estresse. AbstractData from both animal and human research indicate that psychological stress is associated with altered menstrual function. A number of studies have examined the relationship between more common stressors (job strain, financial worries, daily hassles) and menstrual cycle characteristics, such as cycle length and quality of bleeding, as well as amenorrhea. Numerous investigators have suggested that functional reproductive deficits result primarily from direct actions of the hypothalamic-pituitary-adrenocortical, probably modulated by a CRH-stimulated increase in the opioid beta-endorphin. The characterization of the psychic envolvement in these conditions represents basic element for the adequate therapeutical approach.

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Psychosocial Factors, Sex Differences, and Atherosclerosis

Cited by 122 publications

References 77 publications

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Irregularidades menstruais: inter-relações com o psiquismo

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