Stressor-Evoked Brain Activity Linked With Preclinical Atherosclerosis via BP

A link exists between stressor-evoked brain activity and preclinical atherosclerosis, explained by stress-related blood pressure (BP), according to study findings published in the Journal of the American Heart Association.

Investigators tested whether stressor-evoked systolic BP responses affected concurrently measured brain activity and if they were associated with a vascular marker of preclinical atherosclerosis in the carotid arteries.

The investigators conducted a cross-sectional study using data from midlife, community-dwelling adults in the Pittsburgh Imaging Project (PIP; N=325; mean age, 40.89 years; 50% women; 70% White; 24% Black; 5% Asian; mean school years completed, 16.67) among whom 79.26% never smoked and 4.68% were current smokers. Additional data were used from the Neurobiology of Adult Health (NOAH) study. NOAH participants (N=299; mean age, 42.31 years; 60% women; 85% White; 6% Black; 6% Asian; mean school years completed, 17.63) included 20.00% former smokers and 16.92% current smokers. In the PIP cohort, individuals with self-reported cardiovascular disease history, neurologic disorder, or current treatment for a psychiatric condition were among those excluded as were those with regular use of medications with autonomic, cardiovascular, or neuroendocrine effects. In the NOAH cohort, individuals with self-reported use of medications with peripheral or central autonomic effects in the 14 days before testing or regular use of antianxiety, sleep, or asthma medications; antidepressants; glucocorticoids; or medical marijuana were among those excluded.

Participants in both cohorts completed information-conflict functional magnetic resonance imaging tasks with collection of concurrent systolic BP measurements. Ultrasonography was used to measure carotid artery intima-media thickness. Bootstrapping was used to identify brain areas where functional magnetic resonance imaging activity exhibited reliable direct and indirect effects.

The investigators stated that across distributed brain areas, task-averaged patterns of functional magnetic resonance imaging activity had a generalizable association with carotid artery intima-media thickness reliably mediated by an area under the curve measure of aggregate systolic blood pressure reactivity. Sensitivity analysis confirmed this effect. The amygdala, insula, anterior cingulate cortex, and the ventromedial prefrontal cortex were the implicated brain areas in this mediation.

Study limitations include limited generalizability, lack of a statistical test of possible moderators of the mediated associations, and cross-sectional study design.

“Using neuroimaging, blood pressure monitoring, mental stress testing, and machine-learning methods in midlife adults, brain patterns were identified that predicted subclinical atherosclerosis,” the investigators concluded. “The links between brain patterns and subclinical atherosclerosis were explained by stress-related blood pressure,” and, “Mental stress contributes to risk for cardiovascular disease. Neuroimaging may aid in identifying and intervening on the brain–body pathways that contribute to this stress-related risk.”

This article originally appeared on The Cardiology Advisor