Perceived daily psychological demands in healthy adults not taking blood pressure medication are associated with progression of carotid atherosclerosis

Abstract

QUESTION Question: Are perceived daily psychological demands in healthy adults associated with 6-year changes in atherosclerosis and are associations moderated by antihypertensives or employment status? People: In total, 340 initially healthy participants aged between 50 and 70 years are taking part in the Pittsburgh Healthy Heart Project. Of these, 270 (79%) had data available at baseline and follow-up (54% women and 14% non-white). People with a history of a long-term medical disorder (including symptomatic cardiovascular disease), blood pressure greater than 110/180 mm Hg or who had taken drug treatment for hypertension or hypercholesterolaemia in the past year were excluded. Employment status was assessed at baseline. Participants attended six additional assessments over 6 years. Setting: Pittsburgh, USA; 1998-2006. Risk factors: Perceived experiences of demand and control during daily life as assessed by the Job Content Questionnaire and ecological momentary assessment (EMA). EMA assessment included: self-measured ambulatory blood pressure (ABP) using an automated monitor, with each reading prompting a questionnaire adapted from the Diary of Ambulatory Behavioural States to characterise daily experience (including questions on task demand, task control and decisional choice) all recorded in an electronic diary. EMA data were collected every 45 min in the waking hours over two 3-day periods at baseline and once at 6-year follow-up. Data were analysed using regression models. Demographic and biological factors shown to be associated with carotid atherosclerosis from previous literature were considered as model covariates. Antihypertensive medication use and employment status were analysed as potential moderators. Outcomes: Change in carotid artery atherosclerosis as assessed by mean intima-media thickness (IMT) and number of plaques using ultrasonography. METHODS Design: Prospective cohort study. Follow-up period: 6 years. MAIN RESULTS At 6-year follow-up, 29% of participants reported current or past antihypertensive use, and 6% had experienced a cardiac event. Following adjustment, task demand was not significantly associated with plaque progression, but there was a significant interaction between antihypertensive drug use and task demand for the outcome of plaque progression (p=0.045). Increased daily task demands were associated with greater plaque progression among participants with no exposure to antihypertensives during follow-up (n=192, p=0.03) but not among those with past or current antihypertensive use (p=0.45). Task demand showed a non-significant trend towards association with IMT (p=0.08), with no significant interaction between antihypertensive drug use and task demand for the outcome of IMT (p=0.18). However, increased task demand was associated with greater IMT progression among participants with no exposure to antihypertensives during follow-up (p=0.03), but not among those with past or current antihypertensive use (p=0.65). The effects of task demand on IMT progression (p=0.48) but not plaque progression were moderated by baseline employment status. Participants employed at baseline showed significant associations between daily task demands and progression of IMT (n=117; p=0.01) but those who were unemployed did not (n=108; p=0.92). Task control was not associated with IMT progression (p=0.64) or plaque progression (p=0.43) and the relationship was not moderated by antihypertensive use. CONCLUSIONS Among initially healthy adults with no exposure to antihypertensive medication, perceived daily psychological demands are associated with subclinical atherosclerosis progression at 6 year follow-up.