Thursday, September 3, 2009

Hope Plays Role in Stroke Risk

By Todd Neale, Staff Writer, MedPage Today
Published: August 31, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

A feeling of hopelessness about the future appears to be associated with subclinical carotid atherosclerosis in apparently healthy, middle-age women, a cross-sectional study showed.

Those with greater degrees of hopelessness had higher mean (P=0.0139) and maximum (P=0.0297) carotid intimal-medial thickening compared with women who were more optimistic about their prospects in life, according to Susan Everson-Rose, PhD, MPH, of the University of Minnesota in Minneapolis, and colleagues.

This thickening is an early marker of atherosclerosis and stroke risk, they wrote online in Stroke: Journal of the American Heart Association.

Previous studies have linked depression and depressive symptoms -- including hopelessness -- to cardiovascular disease morbidity and mortality in men, but none has made the connection in women, the researchers said.

"This is the first study to suggest that hopelessness may be related to subclinical cardiovascular disease in women without clinical symptoms of heart disease and who are generally healthy," Everson-Rose said.

Her team looked at data from the Chicago and Pittsburgh sites of the Study of Women's Health Across the Nation (SWAN) Heart Study.

All 559 women included in the study were free from clinical cardiovascular disease.

Hopelessness was measured using a two-item questionnaire assessing expectations about the future and the ability to reach one's personal goals.

Intimal-medial thickening was measured using ultrasound.

Each 1-point increase in the hopelessness score was associated with a 0.0061-mm greater mean (P=0.0217) and 0.0074-mm greater maximum (P=0.0409) intimal-medial thickness.

The association remained significant after adjusting for demographic variables, depression, and cardiovascular risk factors.

Women who felt the most hopeless had an average intimal-medial thickness that was 0.066 mm greater than the rest (P=0.0008), which could be clinically significant, the researchers said.

"Such small incremental differences in intimal-medial thickness are associated with increased cardiovascular risk as well as incident cardiovascular disease and stroke," they said.

Although the mechanism underlying the association remains unclear, animal studies have shown that hopelessness -- demonstrated by exposure to learned helplessness and uncontrollable stressors -- causes autonomic, inflammatory, and neuroendocrine changes that can result in atherogenesis.

However, they said, the mechanism likely operates along multiple pathways, which need to be explored in future studies.

The authors acknowledged that the study was limited by its cross-sectional nature and said it is unclear whether hopelessness is associated with the progression of atherosclerosis.

In addition, they said, it is unknown whether the findings would apply to women who had poorer cardiovascular profiles or who were more socioeconomically disadvantaged.

Primary source: Stroke: Journal of the American Heart Association
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