Daily psychological demands are associated with 6-year progression of carotid artery atherosclerosis: the Pittsburgh Healthy Heart Project

Abstract

Objective: We examine associations between the perception of ongoing psychological demands by ecological momentary assessment (EMA) and 6-year changes in carotid artery atherosclerosis by ultrasonography.

Methods: A total of 270 initially healthy participants collected ambulatory blood pressure (ABP) and recorded their daily experiences, using electronic diaries, during two 3-day periods. Mean intima-media thickness (IMT) and plaque were assessed in the carotid arteries using B-mode ultrasound at baseline and again during a 6-year follow-up (mean follow-up duration = 73 months).

Results: Among those who had no exposure to antihypertensive medications during the course of follow-up (n = 192), daily psychological demands were associated with greater progression of IMT as well as plaque, after adjusting for demographic and risk factor covariates. Associations between demands and plaque change were partially accounted for by ABP differences among those reporting high demands. Among those who were employed at baseline (n = 117), 6-year IMT changes were more strongly associated with ratings of daily demands than with traditional measures of occupational stress.

Conclusions: These data support the role of psychological demands as a correlate of subclinical atherosclerotic progression, they point to ABP as a potential mechanism facilitating these effects, and they highlight the utility of EMA measures for capturing daily psychological demands with potential effects on health.

Figure 1

Associations between mean momentary ratings of Task Demand during daily life at baseline and annualized 6-year changes in mean IMT. Subsample involves those free from antihypertensive medications only (n = 191). Covariates include baseline IMT, age, sex, current smoking status, clinic systolic blood pressure, fasting plasma glucose, LDL and HDL cholesterol, gasting insulin, and waist circumference. Error bars indicate standard errors.

Figure 2

Associations between mean momentary ratings of Task Demand during daily life at baseline and proportion of the sample showing increases in the number of observable carotid artery plaques. Subsample involves those free from antihypertensive medications only (n= 190). Covariates include baseline IMT, age, sex, current smoking status, clinic systolic blood pressure, fasting plasma glucose, LDL and HDL cholesterol, gasting insulin, and waist circumference.