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Psychosocial Factors and Inflammation in the Multi-Ethnic Study of Atherosclerosis
Nalini Ranjit, PhD;
Ana V. Diez-Roux, MD, PhD;
Steven Shea, MD;
Mary Cushman, MD, MSc;
Teresa Seeman, PhD;
Sharon A. Jackson, PhD;
Hanyu Ni, PhD, MPH
Arch Intern Med. 2007;167(2):174-181.
Background Psychosocial factors are associated with the development and progress of cardiovascular disease, but the pathological mechanisms remain unclear. We examined the associations of psychosocial risk factors for cardiovascular disease with concentrations of inflammatory markers among healthy adults and assessed the extent to which these associations are mediated by behaviors, body mass index (BMI), and diabetes mellitus.
Methods This cross-sectional study used data from the baseline examination of the Multi-Ethnic Study of Atherosclerosis, a multisite study of 6814 men and women aged 45 to 84 years. Regression analyses were used to estimate associations of cynical distrust, chronic stress, and depression with serum levels of C-reactive protein, IL-6, and fibrinogen before and after adjustment for socioeconomic position, behaviors, BMI, and diabetes.
Results Higher levels of cynical distrust were associated with higher levels of inflammatory markers. The percentage differences (95% confidence intervals [CIs]) comparing the 80th and 20th percentiles of the scale were 7% (3%-11%) for IL-6; 9% (2%-16%) for C-reactive protein; and 1.3% (0.1%-2.4%) for fibrinogen. Higher levels of chronic stress were associated with higher concentrations of IL-6 and C-reactive protein. The percentage differences (95% CIs) comparing 2 and 0 ongoing stressful circumstances were 4% (1%-8%) for IL-6 and 5% (1%-11%) for C-reactive protein. Depression was positively associated with the level of IL-6 (percentage difference [95% CI] comparing the Center for Epidemiologic Studies–Depression Scale scores of  21 vs <21 was 7% [1%-14%]). Associations of psychosocial factors with inflammatory markers were reduced by 20% to 55% after adjustment for behavioral factors and by 45% to 100% after adjustment for BMI and diabetes, mostly owing to the effect of BMI. No associations remained after controlling for socioeconomic position, behaviors, BMI, and diabetes.
Conclusions Psychosocial factors are associated with higher levels of inflammatory markers, most consistently for cynical distrust. Results are compatible with a mediating role of BMI, behaviors, and diabetes.
Author Affiliations: Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor (Drs Ranjit and Diez-Roux); Division of General Medicine, College of Physicians and Surgeons, and Division of Epidemiology, School of Public Health, Columbia University New York, NY (Dr Shea); Department of Medicine, University of Vermont, Burlington (Dr Cushman); Division of Geriatrics, School of Medicine, University of California–Los Angeles (Dr Seeman); and Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Ni). Dr Jackson is a contractor from Northrop Grumman Corporation, Atlanta, Ga, to the Division for Heart Disease and Stroke Prevention, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta.
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