Letter to the Editor Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited.
Response to Letter Regarding Article, “Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness”
We thank Santilli et al for their interest in our article and for emphasizing the potential important contribution of psychological factors to the development of subclinical atherosclerosis. Psychological factors, such as depression, anger, sustained anxiety, and alexithymia, have been associated with increased carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA) and in HIV-infected patients.1,2 There are many psychological, social, and cultural factors that may be potentially important determinants or modifiers of the atherosclerosis pathway from subclinical to overt vascular disease. Health-damaging psychological factors, such as stress, negative emotions, and health-promoting factors such as social support, are important predictors of cardiovascular disease (CVD) and stroke and may play a similar or larger role in CVD and stroke relative to traditional risk factors, including hypertension.3 However, available evidence addressing psychological, social, and cultural variables in relation to CVD and stroke and its intermediate phenotypes, such as carotid intima-media thickness and plaque in the general population as well as in diverse raceethnic groups, is limited in the United States. In the Northern Manhattan Study (NOMAS), prestroke social isolation was a predictor of poststroke outcomes,4 suggesting that a lack of social support contributes to poorer outcomes because of poor compliance, depression, and stress. Limited research has addressed sociocultural processes, such as culturally driven beliefs, attitudes, and behaviors, that may help explain vascular risk in the general population and in individuals at increased risk for CVD and stroke. In addition, little is known about vulnerability factors, such as ethnic-specific stressors or resiliency factors such as family cohesion and social support, that have been suggested as possible mechanisms that may exacerbate or buffer vascular risk among diverse age, sex, and race-ethnic groups. In addition, little is known about the association between neighborhood environments, either physical (eg, food and recreational access) or social (eg, social cohesion), and risk of atherosclerosis and CVD.5
The exact mechanism by which these psychosocial and cultural factors affect development of atherosclerosis is not well-understood. Alterations in the autonomic nervous system as a result of chronic health-damaging stressors may be the common mechanism linking them to cardiovascular responses and to an increased risk of atherosclerosis. More research is needed to elucidate the health-damaging and health-promoting biological mechanisms of psychological, social, and cultural factors on atherosclerosis. Therefore, we agree with Santilli et al that psychological and sociocultural factors may have a major role in the development of subclinical and clinical CVD, and research in this area is critically needed for CVD health prevention and health promotion.
Disclosures None.
Tatjana Rundek, MD, PhD Susan H. Blanton, PhD Department of Neurology Miller School of Medicine University of Miami Miami, FL 1. Ohira T, Diez Roux AV, Polak JF, Homma S, Iso H, Wasserman BA. Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: the multi-ethnic study of atherosclerosis. Psychosom Med. 2012;74:517–525. 2. Parruti G, Vadini F, Sozio F, Mazzott E, Ursini T, Polill E, et al. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study. PLoS One. 2013;8:e54555. 3. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953–962. 4. Boden-Albala B, Litwak E, Elkind MS, Rundek T, Sacco RL. Social isolation and outcomes post stroke. Neurology. 2005;64:1888–1892. 5. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186:125–145.
(Stroke. 2013;44:e236.) © 2013 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.113.003653
Downloaded from http://stroke.ahajournals.org/ at NY UNIV MED CTR LIBR on May 31, 2015 e236
Response to Letter Regarding Article, ''Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness'' Tatjana Rundek and Susan H. Blanton Stroke. 2013;44:e236; originally published online November 5, 2013; doi: 10.1161/STROKEAHA.113.003653 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/44/12/e236
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Downloaded from http://stroke.ahajournals.org/ at NY UNIV MED CTR LIBR on May 31, 2015
Response to Letter Regarding Article, “Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness”
We thank Santilli et al for their interest in our article and for emphasizing the potential important contribution of psychological factors to the development of subclinical atherosclerosis. Psychological factors, such as depression, anger, sustained anxiety, and alexithymia, have been associated with increased carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA) and in HIV-infected patients.1,2 There are many psychological, social, and cultural factors that may be potentially important determinants or modifiers of the atherosclerosis pathway from subclinical to overt vascular disease. Health-damaging psychological factors, such as stress, negative emotions, and health-promoting factors such as social support, are important predictors of cardiovascular disease (CVD) and stroke and may play a similar or larger role in CVD and stroke relative to traditional risk factors, including hypertension.3 However, available evidence addressing psychological, social, and cultural variables in relation to CVD and stroke and its intermediate phenotypes, such as carotid intima-media thickness and plaque in the general population as well as in diverse raceethnic groups, is limited in the United States. In the Northern Manhattan Study (NOMAS), prestroke social isolation was a predictor of poststroke outcomes,4 suggesting that a lack of social support contributes to poorer outcomes because of poor compliance, depression, and stress. Limited research has addressed sociocultural processes, such as culturally driven beliefs, attitudes, and behaviors, that may help explain vascular risk in the general population and in individuals at increased risk for CVD and stroke. In addition, little is known about vulnerability factors, such as ethnic-specific stressors or resiliency factors such as family cohesion and social support, that have been suggested as possible mechanisms that may exacerbate or buffer vascular risk among diverse age, sex, and race-ethnic groups. In addition, little is known about the association between neighborhood environments, either physical (eg, food and recreational access) or social (eg, social cohesion), and risk of atherosclerosis and CVD.5
The exact mechanism by which these psychosocial and cultural factors affect development of atherosclerosis is not well-understood. Alterations in the autonomic nervous system as a result of chronic health-damaging stressors may be the common mechanism linking them to cardiovascular responses and to an increased risk of atherosclerosis. More research is needed to elucidate the health-damaging and health-promoting biological mechanisms of psychological, social, and cultural factors on atherosclerosis. Therefore, we agree with Santilli et al that psychological and sociocultural factors may have a major role in the development of subclinical and clinical CVD, and research in this area is critically needed for CVD health prevention and health promotion.
Disclosures None.
Tatjana Rundek, MD, PhD Susan H. Blanton, PhD Department of Neurology Miller School of Medicine University of Miami Miami, FL 1. Ohira T, Diez Roux AV, Polak JF, Homma S, Iso H, Wasserman BA. Associations of anger, anxiety, and depressive symptoms with carotid arterial wall thickness: the multi-ethnic study of atherosclerosis. Psychosom Med. 2012;74:517–525. 2. Parruti G, Vadini F, Sozio F, Mazzott E, Ursini T, Polill E, et al. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study. PLoS One. 2013;8:e54555. 3. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:953–962. 4. Boden-Albala B, Litwak E, Elkind MS, Rundek T, Sacco RL. Social isolation and outcomes post stroke. Neurology. 2005;64:1888–1892. 5. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186:125–145.
(Stroke. 2013;44:e236.) © 2013 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.113.003653
Downloaded from http://stroke.ahajournals.org/ at NY UNIV MED CTR LIBR on May 31, 2015 e236
Response to Letter Regarding Article, ''Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness'' Tatjana Rundek and Susan H. Blanton Stroke. 2013;44:e236; originally published online November 5, 2013; doi: 10.1161/STROKEAHA.113.003653 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/44/12/e236
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Downloaded from http://stroke.ahajournals.org/ at NY UNIV MED CTR LIBR on May 31, 2015
