Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study.

Autor:	Tawakol A; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: atawakol@mgh.harvard.edu., Ishai A; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Takx RA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Figueroa AL; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Ali A; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Kaiser Y; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Truong QA; Radiology Department, Weil Cornell Medical College, New York, NY, USA., Solomon CJ; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Calcagno C; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Mani V; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Tang CY; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Mulder WJ; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Murrough JW; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Hoffmann U; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Nahrendorf M; Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA., Shin LM; Department of Psychology, Tufts University, Medford, MA, USA., Fayad ZA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Pitman RK; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Lancet (London, England) [Lancet] 2017 Feb 25; Vol. 389 (10071), pp. 834-845. Date of Electronic Publication: 2017 Jan 12.
DOI:	10.1016/S0140-6736(16)31714-7
Abstrakt:	Background: Emotional stress is associated with increased risk of cardiovascular disease. We imaged the amygdala, a brain region involved in stress, to determine whether its resting metabolic activity predicts risk of subsequent cardiovascular events. Methods: Individuals aged 30 years or older without known cardiovascular disease or active cancer disorders, who underwent 18 F-fluorodexoyglucose PET/CT at Massachusetts General Hospital (Boston, MA, USA) between Jan 1, 2005, and Dec 31, 2008, were studied longitudinally. Amygdalar activity, bone-marrow activity, and arterial inflammation were assessed with validated methods. In a separate cross-sectional study we analysed the relation between perceived stress, amygdalar activity, arterial inflammation, and C-reactive protein. Image analyses and cardiovascular disease event adjudication were done by mutually blinded researchers. Relations between amygdalar activity and cardiovascular disease events were assessed with Cox models, log-rank tests, and mediation (path) analyses. Findings: 293 patients (median age 55 years [IQR 45·0-65·5]) were included in the longitudinal study, 22 of whom had a cardiovascular disease event during median follow-up of 3·7 years (IQR 2·7-4·8). Amygdalar activity was associated with increased bone-marrow activity (r=0·47; p<0·0001), arterial inflammation (r=0·49; p<0·0001), and risk of cardiovascular disease events (standardised hazard ratio 1·59, 95% CI 1·27-1·98; p<0·0001), a finding that remained significant after multivariate adjustments. The association between amygdalar activity and cardiovascular disease events seemed to be mediated by increased bone-marrow activity and arterial inflammation in series. In the separate cross-sectional study of patients who underwent psychometric analysis (n=13), amygdalar activity was significantly associated with arterial inflammation (r=0·70; p=0·0083). Perceived stress was associated with amygdalar activity (r=0·56; p=0·0485), arterial inflammation (r=0·59; p=0·0345), and C-reactive protein (r=0·83; p=0·0210). Interpretation: In this first study to link regional brain activity to subsequent cardiovascular disease, amygdalar activity independently and robustly predicted cardiovascular disease events. Amygdalar activity is involved partly via a path that includes increased bone-marrow activity and arterial inflammation. These findings provide novel insights into the mechanism through which emotional stressors can lead to cardiovascular disease in human beings. Funding: None. (Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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