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From the Departments of Psychiatry (K.A.M., J.F.O.) and Surgery (S.K.W.),
University of Pittsburgh School of Medicine, and the Department of
Epidemiology, Graduate School of Public Health, University of Pittsburgh
(K.A.M., L.H.K., K.S.-T., H.C.L.), Pittsburgh, Pa.
Background and Purpose—Individuals
who exhibit large increases in blood pressure and heart rate during
mental stress may be at risk for accelerated
atherosclerosis. This report evaluates the association
between stress-induced hemodynamic responses and
carotid atherosclerosis in 254 healthy
postmenopausal women.
Methods—The magnitude of change in blood pressure and heart rate
from rest to public speaking and mirror image tracing, two stressful
tasks, was measured. Average intima-media thickness (IMT) and focal
plaque in the common carotid artery, bulb, and internal carotid artery
were measured with the use of duplex ultrasonography on average 2.3
years later.
Results—The average IMT was 0.77 mm, with a range of 0.60 to
1.37; 52.5% had at least one plaque. Correlational analysis
showed that greater IMT was associated with greater pulse pressure
change during mental stress (r=0.17,
P<0.01). Statistical adjustments for possible
confounders (age, hormone replacement therapy use, resting pulse
pressure, smoking status, and triglyceride levels) did not
alter the results. The plaque index was associated with greater pulse
pressure change during the mirror image tracing task (odds ratio=1.47,
P=0.01) for women with a plaque score of
Conclusions—Mental stress–induced pulse pressure changes may
influence the development of early atherosclerosis in
the carotid artery of women. Widening of pulse pressure during stress,
as well as at rest, may be a marker of compromised compliance in the
vessel wall.
© 1998 American Heart Association, Inc.
Original Contributions
Stress-Induced Pulse Pressure Change Predicts Women's Carotid Atherosclerosis
2 versus 1 or 0, adjusted for possible confounders.
Key Words: atherosclerosis • carotid arteries • risk factors • stress, psychological • women
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