Psychosocial stress in relation to blood pressure and cardivascular disease - epidemiological and genetic aspects

Abstract

Psychosocial stress has been linked to both hypertension and cardiovascular disease



(CVD), and hypertension has been proposed to be one mediator of the increased CVD



risk in subjects reporting stress. Genetic susceptibility for blood pressure elevation in



relation to stress has been proposed, but so far there is little evidence. We aimed to



study the prospective CVD risk of chronic stress (Paper I), and the prospective effect on



blood pressure levels of work-related stress (Paper II). In Papers III-IV the aim was to



explore a hypothesised work stress?gene interaction in relation to blood pressure.



In Paper I, 13,306 participants (2741 women) from the population-based screening and



intervention programme Malmö Preventive Project were followed for a median of 21



years. Men and women with self-reported chronic stress at baseline suffered an



increased risk of cardiovascular events compared to those without baseline stress (RR



1.27; 95%CI 1.15-1.27). The statistical significances were stronger in men than in



women.



In Papers II-IV different sub-cohorts from the population-based Malmö Diet and Cancer



Study (MDCS) were included. Work stress was assessed according to the Karasek



demand-control model. In Paper II, men with baseline job strain (?stress?) had a



significantly greater systolic blood pressure (SBP) and diastolic blood pressure (DBP)



elevation at follow-up compared to men with relaxed working conditions (significance for



difference; SBP p= 0.025, DBP p=0.003, adjustments for age and follow-up time). In



women, baseline job strain was associated with higher blood pressures at baseline, but



no significant differences in blood pressure changes between groups with different work



characteristics were seen at follow-up.



In Paper III, an I/D polymorphism in the adrenergic ?2B-receptor was studied in women



and men (n=2964). Men with the DD-variant of the receptor and job strain had higher



SBP and DBP than all other gene?work characteristic combinations. The interaction



between the DD polymorphism and job strain was significant; p=0.008 for SBP, and



p=0.03 for DBP, adjusted for age, body mass index, occupational status and country of



birth. The decision latitude dimension was more influential than the demand dimension.



In Paper IV, an interaction between work characteristics and the Arg389Gly



polymorphism in the ?1-adrenergic receptor in relation to blood pressure levels was



studied, with significant findings in men.



Our findings confirm previous results of the detrimental effects of chronic stress on the



prospective CVD risk. The findings in Paper II indicate that elevation of blood pressure



in men might mediate the increased CVD risk. For the first time, significant interactions



between genetic factors and job stress, associating with elevated blood pressures, have



been described. If these findings hold true in further research, they provide a new



understanding of the mechanisms of stress, with potential implications for



pharmacogenomics.

• author: Öhlin, Bertil
• supervisor: Peter Nilsson; Olle Melander
• opponent: Prof. Thelle, Dag, Oslo, Norway
• organization: Internal Medicine - Epidemiology (research group)
• publishing date: 2007
• type: Thesis
• publication status: published
• subject: Clinical Medicine
• keywords: Kardiovaskulära systemet, receptor, Cardiovascular system, Medicin (människa och djur), Medicine (human and vertebrates), adrenergic, alpha-2, beta-1, mortality, morbidity, prospective, studies, polymorphism, work, stress, blood pressure, hypertension
• in: Lund University Faculty of Medicine Doctoral Dissertation Series
• pages: 160 pages
• defense location: Aulan, Medicinska kliniken, Entrance 35, University Hospital, Malmö
• defense date: 2007-06-08 13:00:00
• ISSN: 1652-8220
• ISBN: 978-91-85559-79-4
• language: English
• LU publication?: yes
• additional info: B Öhlin, PM Nilsson, JÅ Nilsson and G Berglund. 2004. Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men. Eur Heart J, vol 25 pp 867-73.; B Öhlin, G Berglund, M Rosvall and PM Nilsson. 2007. Job strain in men, but not in women, predicts a significant rise in blood pressure after 6.5 years of follow-up. J Hypertens, vol 25 pp 525-31.; B Öhlin, G Berglund, PM Nilsson and O Melander. 2007. Job strain, decision latitude and alpha2B-adrenergic receptor polymorphism significantly interact, and associate with higher blood pressures in men. J Hypertens, (inpress); B Öhlin, G Berglund, PM Nilsson and O Melander. . Job strain, job demands and adrenergic beta1-receptor-polymorphism - a possible interaction affecting blood pressures in men. (manuscript)
• id: 67edbd1a-a2ec-47b6-bf54-f87ec5c6501f (old id 548880)
• date added to LUP: 2016-04-01 15:20:22
• date last changed: 2023-04-18 19:59:06