April 2010
Reviewer: Jeff C. Huffman, MD
Adverse impact of mood on flow-mediated dilation
Psychosom Med 2010; 72(2):122-127
Background: As with the Lavoie study, this area is important because endothelial dysfunction may be an important mechanism in the link between depression and adverse cardiac outcomes. Given that subclinical depressive symptoms appear to be associated with adverse cardiac outcomes, this study aimed to assess whether mood symptoms were associated with endothelial dysfunction in a cohort of healthy adults without psychiatric illness.
Methods: Healthy subjects without psychiatric illness, significant medical illness, or substance use disorders were recruited through advertisements; older men and postmenopausal women were also excluded. Subjects underwent evaluation of psychological distress using the Profile of Mood States (POMS), a standardized and validated instrument with several subscales (depression/dejection, tension/anxiety, anger/hostility, confusion/bewilderment, fatigue/inertia, and vigor/activity); there is also a summed “total mood disturbance” (TMD) score. Subjects were also administered a scale of social desirability to assess their propensity to over- or under-report distress. Baseline variables that may affect endothelial function measurements (gender, age, BMI, resting blood pressure, race, smoking status, and hypertension status) were collected, and when associated in differences in FMD or POMS scores, these baseline variables were included in data analysis. Flow mediated dilation (FMD), a well-established measure of endothelial function, was used to assess endothelial function.
Results: A total of 70 subjects, mean age 36 (gender not listed), were enrolled. On bivariate correlations, the POMS TMD (mood disturbance) score was marginally associated (p=0.065) with poorer endothelial function (FMD). When all relevant covariates were entered into a multivariate linear regression model, TMD was significantly associated with poorer endothelial function (lower FMD; p=0.005), independent of other variables, and appeared to account for 10% of the variability in FMD. On evaluation of POMS subscales (e.g., depression, anxiety, and anger), each subscale appeared to be significantly associated with FMD, with confusion/bewilderment having the largest effect by a small margin.
Commentary: This carefully-controlled/designed study also bolsters a connection between mood and endothelial function. It also supports the notion that additional facets of psychological distress, such as anxiety and anger, may be connected with the function of the endothelium, above and beyond the effects of depression. Furthermore, given that patients with psychiatric illness were excluded, it suggests that even milder mood/psychological symptoms may impact endothelial function. This study also used the most-commonly used measure of endothelial function (FMD), in contrast to the above study.
However, this study is less clinically compelling than the Lavoie study. It was a small study, included healthy volunteers of a relatively young age, excluded persons with any psychiatric illness/medical illness or substance use disorder, and did not allow older subjects. Psychiatric symptoms were measured using a self-report scale rather than clinical diagnosis. In short, this was hardly a clinical sample, and indeed one would be hard pressed to find any such patients in a clinic or hospital.
Still, it was a clean sample that suggests a link between psychological state and endothelial function, and it should spur additional research on the effects of depression, anxiety, and anger on blood vessel function as we try to discover how psychiatric illnesses may impact medical health.