Delayed retinal vein recovery responses indicate both non-adaptation to stress as well as increased risk for stroke: the SABPA study
| Autor: | Nico T. Malan, Annemarie Wentzel, Roelof D. van Wyk, Walthard Vilser, Roland von Känel, Gavin W. Lambert, Carlien E Myburgh, Martin Magnusson, Wayne Smith, Markus P. Schlaich, H.S. Steyn, Leoné Malan, Konstantin Kotliar, Mark Hamer, Tjalf Ziemssen |
|---|---|
| Přispěvatelé: | University of Zurich |
| Rok vydání: | 2021 |
| Předmět: |
Hypothalamo-Hypophyseal System
medicine.medical_specialty Retinal Vein Hydrocortisone Provocation test Diastole Black People Pituitary-Adrenal System 610 Medicine & health 030204 cardiovascular system & hematology Norepinephrine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Adrenocorticotropic Hormone Internal medicine Humans Medicine Chronic stress Prospective Studies Creatinine business.industry Cardiovascular Topics Retinal General Medicine Odds ratio Middle Aged Stroke 10057 Klinik für Konsiliarpsychiatrie und Psychosomatik chemistry Reflex Cardiology Female Cardiology and Cardiovascular Medicine business Stress Psychological |
| Zdroj: | Cardiovasc J Afr |
| ISSN: | 1680-0745 1995-1892 |
| DOI: | 10.5830/cvja-2020-031 |
| Popis: | OBJECTIVES: Low or high sympatho–adrenal–medullary axis (SAM) and hypothalamic–pituitary–adrenal axis (HPA) dysregulation reflect chronic stress. Retinal vessel dynamics may relate to SAM, HPA activity and stroke risk. Our objectives were therefore to assess the relationships between retinal vessel, SAM and HPA responses, and to determine stroke risk. METHODS: A prospective bi-ethnic gender cohort (n = 275, 45 ± 9 years) was included. Urine/serum/saliva samples for SAM [norepinephrine:creatinine ratio (u-NE)] and HPA [adrenocorticotrophic hormone (ACTH), cortisol] were obtained at baseline, three-year follow up and upon flicker light-induced provocation. Diastolic ocular perfusion pressure was measured as a marker of hypo-perfusion. Retinal arterial narrowing and venous widening calibres were quantified from digital images in the mydriatic eye. A validated stress and stroke risk score was applied. RESULTS: An interaction term was fitted for venous dilation in u-NE tertiles (p ≤ 0.05) and not in u-NE median/quartiles/ quintiles. Independent of race or gender, tertile 1 (low u-NE) had a 112% increase in u-NE, decreases in cortisol, and no changes in ACTH over three years (positive feedback). Tertile 3 (high u-NE) contradictorily had decreases in u-NE and cortisol, and increases in ACTH (negative feedback). In tertile 1, reduced arterial dilation, and faster arterial vasoconstriction and narrowing were related to higher SAM activity and hypo-perfusion (p ≤ 0.05), whereas delayed venous dilation, recovery and widening were related to cortisol hypo-secretion (p ≤ 0.05). In tertile 1, delayed venous recovery responses predicted stress and stroke risk [odds ratio 4.8 (1.2–19.6); p = 0.03]. These associations were not found in u-NE tertiles 2 and 3. CONCLUSIONS: In response to low norepinephrine, a reflex increase in SAM activity occurred, enhancing arterial vasoconstriction and hypo-perfusion. Concomitant HPA dysregu- lation attenuated retinal vein vasoactivity and tone, reflecting delayed vein recovery responses and non-adaptation to stress. These constrained vein recovery responses are indicative of increased chronic stress and stroke risk. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|