By Mary Jane Dittmar
In April, the EuroPRevent 2013 Congress of the European Society of Cardiologists (ESC) was held in Rome. The two studies described below were presented at the Congress. They add to the international discussion of factors that may associated with the development of cardiovascular disease.
Study 1. Mental vulnerability and cardiovascular disease. Dr. Anders Borglykke, the study’s first author, who delivered the report at the Congress, said that although psychosocial factors and personality traits have been consistently associated with cardiovascular disease and all-cause mortality, their role in predicting risk was still not clear. The subjects of this study were a large population from the Research Centre for Prevention and Health at Glostrup University Hospital, Denmark. The finding was that people considered “mentally vulnerable” were at a significantly increased risk of fatal and non-fatal cardiovascular disease. Mental vulnerability was defined as “a tendency to experience psychosomatic symptoms or inadequate interpersonal reactions. Data from three prospective Danish population cohorts were included in the study.
Almost 11,000 individuals free of cardiovascular disease were followed up for a mean period of 15.9 years (a total of 166,787 person-years). All cardiovascular events–fatal and non-fatal–were recorded during this time. Mental vulnerability was measured at the beginning of the study on a validated 12-point scale originally constructed by the Military Psychology Services in Denmark. Subjects were categorized into three groups: 1) Non-vulnerable, 2) Latent, and 3) Mentally vulnerable.
Dr. Borglykke explained that the scale’s questions, covering both mental and physical symptoms, generally measures a level of stress or a personality that is more receptive to stress. These results were added to a statistical model that encompassed the classical risk factors for cardiovascular disease: age, sex, smoking, systolic blood pressure, and total cholesterol.
The following results were realized:
- During the follow-up period, 3,045 fatal and non-fatal cardiovascular events were recorded in the study population of 10,943 subjects.
- The statistical analysis showed that mental vulnerability was significantly associated with fatal and non-fatal cardiovascular events independently of the classical risk factors. The risk of events in the mentally vulnerable was 36 percent higher than in the non-vulnerable.
What does this mean? Dr. Borglykke explains: “Several studies have found risk factors for cardiovascular disease which are clearly independent but [that] within a broader context contribute little, if anything, to actual risk prediction.” One of the reasons for this, he added, is that the impact of the well-established risk factors tends to dominate the risk stratification models. Consequently, a risk factor such as the scale of mental vulnerability used in the study, although it clearly increases the risk by 36 percent, still does not improve risk prediction in the general population.
Dr. Borglykke concludes that mental vulnerability should not be ignored when assessing individual risk for cardiovascular disease. It might improve risk prediction or possibly emerge as a new marker to explain or reclassify some cardiovascular cases that cannot be attributed to the classical risk factors.
To study this issue further, Dr. Borglykke noted that there is the need to identify sub-groups of the population where mental vulnerability improves risk prediction beyond the classic risk factors. Ultimately, he suggested, further study may show how the triggers of chronic stress to which mentally vulnerable people are exposed can be diminished or eliminated.
Study 2. Demanding physical work associated with increased risk of cardiovascular disease. Two studies suggest that demanding physical work negatively affects an individual’s risk of developing coronary heart disease.
Dr. Demosthenes Panagiotakos, associate professor of biostatistics-epidemiology at Harokopio University, Athens, presented a case-control study in which the occupations of three populations were evaluated. Group 1 consisted of 250 consecutive patients with a first stroke, Group 2 had 250 people with a first acute coronary event, and Group 3 consisted of 500 equally matched controls. The occupations were assessed on a nine-unit scale (1 = physically demanding work and 9 = sedentary/mental work). The subjects suffering the stroke and coronary events were those who were more commonly engaged in physically demanding occupations than those of the control population.
After adjusting for potential confounding factors such as age, sex, body mass index, smoking, hypertension, hypercholesterolemia, diabetes, family history of cardiovascular disease, and adherence to the Mediterranean diet, the results indicated that the individuals with progressively less physically demanding jobs (that is, for each unit increase of the scale) showed a 20 percent lower likelihood of acute coronary events (a statistically significant odds ratio of 0.81 percent) or of ischemic stroke (odds ratio 0.83 percent).
Dr. Panagiotakos said that individuals with physically demanding manual jobs had a higher risk for cardiovascular disease and should be targeted for prevention initiatives.
Of special interest, Dr. Panagiotakos noted: “The somewhat paradoxical results could possibly be attributed to the stress experienced by people with physically demanding jobs.” He said that stress, may be one reason hard physical work may not be comparable to the physical exercise recommended for health and well-being, which tend to be non-stressful behaviors. He added: “Such work is often not well paid, which may restrict access to the health care system.”
Investigators in Belgium and Denmark support the view that physically demanding work is a risk factor for coronary heart disease, even when leisure-time activity is taken into account.
This cohort study involved more than 14,000 middle-aged men who were free of coronary disease at the outset of the study in 1994-1998. Standardized questionnaires were used to assess socio-demographic factors, job strain, and the level of physical activity at work and during leisure time. Classical coronary risk factors were measured through clinical examinations and questionnaires.
The incidence of coronary events was monitored during a mean follow-up time of 3.15 years; statistical modeling applied to assess the association between physical activity and coronary disease. Adjustments were made for age, education, occupational class, job strain, body mass index, smoking, alcohol consumption, diabetes, blood pressure, and cholesterol.
Results: There was an overall beneficial effect of leisure time physical activity but an adverse effect of demanding physical work. However, Dr. Els Clays, Department of Public Health at the University of Ghent, Belgium, cited that an “interaction effect” was evident in the results: While moderate-to-high physical activity during leisure time was associated with a 60 percent reduced risk of coronary events in men with low occupational physical activity (a statistically significant hazard rate of 0.40), this protective effect was not observed in workers who were also exposed to high physical work demands (HR 1.67).
After adjusting for socio-demographic and well established coronary risk factors, men with high physical job demands were more than four times likely to have coronary heart disease when they also engaged in physical activity during leisure time (HR 4.77), Dr. Clays explained.
Dr. Clays’ Comment: “From a public health perspective, it is very important to know whether people with physically demanding jobs should be advised to engage in leisure time activity. The results of this study suggest that additional physical activity during leisure time in those who are already physically exhausted from their daily occupation does not induce a ‘training’ effect but rather an overloading effect on the cardiovascular system.
“However, only few studies until now have specifically addressed this interaction among both types of physical activity, and conflicting findings have been reported. More research using detailed and objective measures of activity is needed.”
References
- Panagiotakos D, Georgousopoulou E, Kastorini CM, et al. “Physically demanding occupation is associated with higher likelihood of a non-fatal acute coronary syndrome or ischemic stroke: a case/case-control study.” Presented at EuroPRevent 2013 Final Programme Number P67.
- Clays E, De Bacquer D, Janssens H, et al. “Physical work demands and leisure time physical activity in relation to risk for coronary heart disease.” Presented at EuroPRevent 2013 Final Programme Number P76.
The European Society of Cardiology represents 80,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe. EuroPrevent, the world’s leading congress in preventive cardiology, is organized by the European Association for Cardiovascular Prevention and Rehabilitation.
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References
- Borglykke A, Ebstrup J, Jørgensen T, et al. Mental vulnerability as a predictor of cardiovascular disease and death. Presented at EuroPRevent 2013 Congress Final Programme Number P52.
- Eplov LF, Jørgensen T, Birket-Smith M, et al. “Mental vulnerability – a risk factor for ischemic heart disease,” J Psychosom Res 2006; 60: 169-76.
Blue-Green Algae Cut Pomegranate
Artery Cleansing Foods. For your information and guidance, I am sharing here a list of foods that can help to cleanse your arteries. The list was compiled by Jessica Smith, http://www.shape.com. Many of these foods were discussed in previous columns.
1. Avocados
2. Whole grains
3. Olive oil
4. Nuts (almonds, walnuts)
5. Plant sterols (can be found in margarines and other spreads and fortified foods such as milk, orange juice)
6. Salmon and other fatty fish
7. Asparagus
8. Pomegranate
9. Broccoli
10. Turmeric (curcumin)
11. Persimmons
12. Orange juice
13. Spirulina (blue-green algae)
14. Cinnamon
15. Cranberries
16. Coffee
17. Cheese (goat cheese, reduced fat, organic)
18. Green tea
19. Watermelon
20. Spinach
Photos courtesy of http://photos8.com.
MARY JANE DITTMAR is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.
