Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome - Nested case-control study

被引:384
作者
Brunner, EJ
Hemingway, H
Walker, BR
Page, M
Clarke, P
Juneja, M
Shipley, MJ
Kumari, M
Andrew, R
Seckl, JR
Papadopoulos, A
Checkley, S
Rumley, A
Lowe, GDO
Stansfeld, SA
Marmot, MG
机构
[1] UCL, Dept Epidemiol & Publ Hlth, Int Ctr Hlth & Society, London, England
[2] Univ Edinburgh, Western Gen Hosp, Endocrinol Unit, Edinburgh EH8 9YL, Midlothian, Scotland
[3] Bethlem Royal & Maudsley Hosp, Inst Psychiat, London, England
[4] Univ Glasgow, Royal Infirm, Dept Med, Glasgow G12 8QQ, Lanark, Scotland
[5] Queen Mary Univ London, Dept Community Psychiat, London, England
基金
英国医学研究理事会;
关键词
norepinephrine; coronary disease; stress; metabolism; heart rate;
D O I
10.1161/01.CIR.0000038364.26310.BD
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The causes of metabolic syndrome (MS), which may be a precursor of coronary disease, are uncertain. We hypothesize that disturbances in neuroendocrine and cardiac autonomic activity (CAA) contribute to development of MS. We examine reversibility and the power of psychosocial and behavioral factors to explain the neuroendocrine adaptations that accompany MS. Methods and Results-This was a double-blind case-control study of working men aged 45 to 63 years drawn from the Whitehall II cohort. MS cases (n = 30) were compared with healthy controls (n = 153). Cortisol secretion, sensitivity, and 24-hour cortisol metabolite and catecholamine output were measured over 2 days. CAA was obtained from power spectral analysis of heart rate variability (HRV) recordings. Twenty-four-hour cortisol metabolite and normetanephrine (3-methoxynorepinephrine) outputs were higher among cases than controls (+0.49, +0.45 SD, respectively). HRV and total power were lower among cases (both -0.72 SD). Serum interleukin-6, plasma C-reactive protein, and viscosity were higher among cases (+0.89, +0.51, and +0.72 SD). Lower HRV was associated with higher normetanephrine output (r=-0.19; P=0.03). Among former cases (MS 5 years previously, n=23), cortisol output, heart rate, and interleukin-6 were at the level of controls. Psychosocial factors accounted for 37% of the link between MS and normetanephrine output, and 7% to 19% for CAA. Health-related behaviors accounted for 5% to 18% of neuroendocrine differences. Conclusions-Neuroendocrine stress axes are activated in MS. There is relative cardiac sympathetic predominance. The neuroendocrine changes may be reversible. This case-control study provides the first evidence that chronic stress may be a cause of MS. Confirmatory prospective studies are required.
引用
收藏
页码:2659 / 2665
页数:7
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