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

Öhlin, Bertil LU (2007) In Lund University, Faculty of Medicine Doctoral Dissertation Series
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,... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Prof. Thelle, Dag, Oslo, Norway
organization
publishing date
type
Thesis
publication status
published
subject
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
publisher
Department of Clinical Sciences, Lund University
defense location
Aulan, Medicinska kliniken, Entrance 35, University Hospital, Malmö
defense date
2007-06-08 13:00
ISSN
1652-8220
ISBN
978-91-85559-79-4
language
English
LU publication?
yes
id
67edbd1a-a2ec-47b6-bf54-f87ec5c6501f (old id 548880)
date added to LUP
2007-09-12 09:38:58
date last changed
2016-09-19 08:44:52
@phdthesis{67edbd1a-a2ec-47b6-bf54-f87ec5c6501f,
  abstract     = {Psychosocial stress has been linked to both hypertension and cardiovascular disease<br/><br>
<br/><br>
(CVD), and hypertension has been proposed to be one mediator of the increased CVD<br/><br>
<br/><br>
risk in subjects reporting stress. Genetic susceptibility for blood pressure elevation in<br/><br>
<br/><br>
relation to stress has been proposed, but so far there is little evidence. We aimed to<br/><br>
<br/><br>
study the prospective CVD risk of chronic stress (Paper I), and the prospective effect on<br/><br>
<br/><br>
blood pressure levels of work-related stress (Paper II). In Papers III-IV the aim was to<br/><br>
<br/><br>
explore a hypothesised work stress?gene interaction in relation to blood pressure.<br/><br>
<br/><br>
In Paper I, 13,306 participants (2741 women) from the population-based screening and<br/><br>
<br/><br>
intervention programme Malmö Preventive Project were followed for a median of 21<br/><br>
<br/><br>
years. Men and women with self-reported chronic stress at baseline suffered an<br/><br>
<br/><br>
increased risk of cardiovascular events compared to those without baseline stress (RR<br/><br>
<br/><br>
1.27; 95%CI 1.15-1.27). The statistical significances were stronger in men than in<br/><br>
<br/><br>
women.<br/><br>
<br/><br>
In Papers II-IV different sub-cohorts from the population-based Malmö Diet and Cancer<br/><br>
<br/><br>
Study (MDCS) were included. Work stress was assessed according to the Karasek<br/><br>
<br/><br>
demand-control model. In Paper II, men with baseline job strain (?stress?) had a<br/><br>
<br/><br>
significantly greater systolic blood pressure (SBP) and diastolic blood pressure (DBP)<br/><br>
<br/><br>
elevation at follow-up compared to men with relaxed working conditions (significance for<br/><br>
<br/><br>
difference; SBP p= 0.025, DBP p=0.003, adjustments for age and follow-up time). In<br/><br>
<br/><br>
women, baseline job strain was associated with higher blood pressures at baseline, but<br/><br>
<br/><br>
no significant differences in blood pressure changes between groups with different work<br/><br>
<br/><br>
characteristics were seen at follow-up.<br/><br>
<br/><br>
In Paper III, an I/D polymorphism in the adrenergic ?2B-receptor was studied in women<br/><br>
<br/><br>
and men (n=2964). Men with the DD-variant of the receptor and job strain had higher<br/><br>
<br/><br>
SBP and DBP than all other gene?work characteristic combinations. The interaction<br/><br>
<br/><br>
between the DD polymorphism and job strain was significant; p=0.008 for SBP, and<br/><br>
<br/><br>
p=0.03 for DBP, adjusted for age, body mass index, occupational status and country of<br/><br>
<br/><br>
birth. The decision latitude dimension was more influential than the demand dimension.<br/><br>
<br/><br>
In Paper IV, an interaction between work characteristics and the Arg389Gly<br/><br>
<br/><br>
polymorphism in the ?1-adrenergic receptor in relation to blood pressure levels was<br/><br>
<br/><br>
studied, with significant findings in men.<br/><br>
<br/><br>
Our findings confirm previous results of the detrimental effects of chronic stress on the<br/><br>
<br/><br>
prospective CVD risk. The findings in Paper II indicate that elevation of blood pressure<br/><br>
<br/><br>
in men might mediate the increased CVD risk. For the first time, significant interactions<br/><br>
<br/><br>
between genetic factors and job stress, associating with elevated blood pressures, have<br/><br>
<br/><br>
been described. If these findings hold true in further research, they provide a new<br/><br>
<br/><br>
understanding of the mechanisms of stress, with potential implications for<br/><br>
<br/><br>
pharmacogenomics.},
  author       = {Öhlin, Bertil},
  isbn         = {978-91-85559-79-4},
  issn         = {1652-8220},
  keyword      = {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},
  language     = {eng},
  pages        = {160},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Psychosocial stress in relation to blood pressure and cardivascular disease - epidemiological and genetic aspects},
  year         = {2007},
}