Cortisol patterns and brachial artery reactivity in a high stress environment

School of Public Health and Health Professions, Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY 14214, USA.
Psychiatry Research (Impact Factor: 2.47). 09/2009; 169(1):75-81. DOI: 10.1016/j.psychres.2008.06.012
Source: PubMed


Chronic stress can result in frequent or persistent challenges of the hypothalamic-pituitary-adrenal (HPA) axis resulting in abnormal cortisol patterns and increased risk for cardiovascular disease (CVD). Police work is an environment replete with stress. The present article describes associations between cortisol, a biomarker of stress, and brachial artery flow mediated dilation (FMD) in police officers. A random sample stratified on gender (n=100, 33% women) was generated from officers in a mid-sized urban department. Four salivary cortisol parameters were derived: after awakening, following a standardized high protein meal challenge, during the entire day, and after a dexamethasone suppression test. Continuous scan B-Mode ultrasound was used to measure percent change in brachial artery FMD following occlusion and release. Elevated cortisol secretion after awakening was significantly associated with impaired FMD in women, reflected by an inverse trend. Adjustment for age, smoking, and alcohol consumption did not appreciably alter this trend. A similar result was not evident among male officers. Responses of other cortisol challenges to the HPA axis were not associated with FMD. In conclusion, increased cortisol secretion after awakening was independently associated with impaired FMD in female police officers only, indicating a possible link between HPA axis stress response and subclinical CVD. However, because associations were not found with other cortisol parameters and were not evident in male officers, replication of these findings with a prospective study design may be warranted.

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Available from: Luenda E Charles
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    • "Due to the known circadian variation in cortisol release, investigators in the studies reviewed often measured cortisol in a time series (Cohen et al., 2006; Dekker et al., 2008; DeSantis et al., 2011, 2012; Do et al., 2011; Juster et al., 2011; Lundberg & Hellstrom, 2002; Miller et al., 2008; Norris et al., 2009; Steptoe, Wardle et al., 2005; Thomas et al., 2009; Violanti et al., 2009). Most of the studies we reviewed treated awakening as a stress-generating event, measuring cortisol early in the morning upon awakening (Boyne et al., 2009; Eller et al., 2005; Grant et al., 2009; Hajat et al., 2010; Norris et al., 2009; Steptoe, Brydon, et al., 2005; Steptoe, Owen, et al., 2004; Violanti et al., 2009) and upon recovery from awakening. They also often measured its changes throughout the day (usually in late afternoon and at bedtime; Grant et al., 2009; Hajat et al., 2010; Kunz-Ebrecht et al., 2004). "
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    ABSTRACT: Background: The use of salivary biomarkers in stress research is increasing, and the precision and accuracy with which researchers are able to measure these biomarkers have dramatically improved. Chronic psychosocial stress is often linked to the pathogenesis of cardiovascular disease (CVD). Salivary biomarkers represent a noninvasive biological method of characterizing the stress phenomenon that may help to more fully describe the mechanism by which stress contributes to the pathogenesis and outcomes of CVD. Objectives: We conducted a systematic review of 40 research articles to identify the salivary biomarkers researchers have most commonly used to help describe the biological impact of chronic psychosocial stress and explore its associations with CVD risk. We address strengths and weaknesses of specimen collection and measurement. Methods: We used PubMed, CINAHL, EBSCOhost, Web of Science, BIOSIS Previews, Biological Sciences (ProQuest), and Dissertations/Theses (ProQuest) to retrieve 387 initial articles. Once we applied our inclusion/exclusion criteria to specifically target adult human studies dealing with chronic stress rather than acute/laboratory-induced stress, 40 studies remained, which we synthesized using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Results: Cortisol was the biomarker used most frequently. Sources of psychosocial stress included job strain, low socioeconomic status, and environmental factors. Overall, psychosocial stress was associated with CVD risks such as vascular pathology (hypertension, blood pressure fluctuation, and carotid artery plaque) as well as metabolic factors such as abnormal blood glucose, dyslipidemia, and elevated cardiac enzymes. Conclusion: Diverse salivary biomarkers have been useful in stress research, particularly when linked to CVD risks.
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    • "Furthermore, plasma cortisol levels are higher at rest and in response to acute mental stress in firefighters and police officers compared to controls (Tomei et al., 2003; Rosati et al., 2011; Robinson et al., 2013). These reported elevations in cortisol levels have been associated with impaired FMD in police offices (Violanti et al., 2009). These findings suggest that the challenges of the HPA axis experienced by high-stress occupations may lead to an increased risk of CVD. "
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    ABSTRACT: Psychological stress has been proposed as a major contributor to the progression of cardiovascular disease (CVD). Acute mental stress can activate the sympathetic-adrenal-medullary (SAM) axis, eliciting the release of catecholamines (NE and EPI) resulting in the elevation of heart rate (HR) and blood pressure (BP). Combined stress (psychological and physical) can exacerbate these cardiovascular responses, which may partially contribute to the elevated risk of CVD and increased proportionate mortality risks experienced by some occupations (e.g., firefighting and law enforcement). Studies have supported the benefits of physical activity on physiological and psychological health, including the cardiovascular response to acute stress. Aerobically trained individuals exhibit lower sympathetic nervous system (e.g., HR) reactivity and enhanced cardiovascular efficiency (e.g., lower vascular reactivity and decreased recovery time) in response to physical and/or psychological stress. In addition, resistance training has been demonstrated to attenuate cardiovascular responses and improve mental health. This review will examine stress-induced cardiovascular reactivity and plausible explanations for how exercise training and physical fitness (aerobic and resistance exercise) can attenuate cardiovascular responses to stress. This enhanced functionality may facilitate a reduction in the incidence of stroke and myocardial infarction. Finally, this review will also address the interaction of obesity and physical activity on cardiovascular reactivity and CVD.
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    • "Circadian rhythms help maintain homeostasis in a variety of physiological processes, such as the immune, endocrine, cardiovascular, and autonomic nervous systems, and when disrupted may increase susceptibility to disease, including cancer. There is also an elevated prevalence of alcohol use [Violanti et al., 2009a] and obesity [Ramey et al., 2009], and in some cases a reduction in physical activity [Richmond et al., 1998] or sleep quality [Charles et al., 2007a] among police officers compared to general US or other populations. Although the prevalence of smoking among police officers was similar to that of the general US population in one study [Nelson et al., 1994], exposures to other known or suspected carcinogens in this population include traffic-related airborne particulate matter [Riediker et al., 2004], other air pollutants [Hu et al., 2007], and shift work, including nights and rotating shifts [Violanti et al., 2009b; IARC, 2010]. "
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    ABSTRACT: Background: This review summarizes peer-reviewed studies examining cancer risks among police officers. It provides an overview of existing research limitations and uncertainties and the plausible etiologic risk factors associated with cancer in this understudied occupation. Methods: Previous cancer studies among police officers were obtained via a systematic review of the MEDLINE, CABDirect, and Web of Science bibliographic databases. Results: Quality observational studies of cancer among police officers are sparse and subject to limitations in exposure assessment and other methods. Results from three studies suggested possible increased mortality risks for all cancers, and cancers of the colon, kidney, digestive system, esophagus, male breast, and testis, as well as Hodgkin's disease. Few incidence studies have been performed, and results have been mixed, although some associations with police work have been observed for thyroid, skin, and male breast cancer. Conclusions: Police are exposed to a mix of known or suspected agents or activities that increase cancer risk. Epidemiologic evidence to date is sparse and inconsistent. There is a critical need for more research to understand the biological and social processes underlying exposures and the suggested disproportionate risks and to identify effective prevention strategies.
    Full-text · Article · Apr 2013 · American Journal of Industrial Medicine
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