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Title: Chronic defensiveness and neuroendocrine dysfunction reflect a novel cardiac troponin T cut point: The SABPA study.
Authors: Malan, Leone
Hamer, Mark
von Kanel, Roland
Lambert, Gavin W.
Delport, Rhena
Steyn, Hendrik Stefanus
Malan, Nico T.
Keywords: Defense
Depression
Heart-rate-variability
Catecholamine
Cardiac-Troponin T
Issue Date: 2017
Publisher: © Elsevier
Citation: MALAN, L. ...et al., 2017. Chronic defensiveness and neuroendocrine dysfunction reflect a novel cardiac troponin T cut point: The SABPA study. Psychoneuroendocrinology, 85, pp. 20-27.
Abstract: Background: Sympatho-adrenal responses are activated as an innate defense coping (DefS) mechanism during emotional stress. Whether these sympatho-adrenal responses drive cardiac troponin T (cTnT) increases are unknown. Therefore, associations between cTnT and sympatho-adrenal responses were assessed. Methods: A prospective bi-ethnic cohort, excluding atrial fibrillation, myocardial infarction and stroke cases, was followed for 3 years (N=342; 45.6±9.0 years). We obtained serum high-sensitive cTnT and outcome measures [Coping-Strategy-Indicator, depression/Patient-Health-Questionnarie-9, 24h BP, 24h heart-rate-variability (HRV) and 24h urinary catecholamines]. Results: cTnT levels of the cohort remained similar over 3 years but recovery to cTnT-negative levels was higher in Blacks. Blacks showed moderate depression (45% vs. 16%) and 24h hypertension (67% vs. 42%) prevalence compared to Whites. A receiver-operating-characteristics cTnT cut-point 4.2 ng/L predicting hypertension in Blacks was used as binary exposure measure in relation to outcome measures [AUC 0.68 (95% CI 0.60-0.76); sensitivity/specificity 63/70%; P≤0.001]. In cross-sectional analyses, elevated cTnT was related to DefS [OR 1.08 (95% CI 0.99-1.16); P=0.06]; 24h BP [OR 1.03-1.04 (95% CI 1.01-1.08); P≤0.02] and depressed HRV [OR 2.19 (95% CI 1.09-4.41); P=0.03] in Blacks, but not in Whites. At 3 year follow-up, elevated cTnT was related to attenuated urine norepinephrine:creatinine ratio in Blacks [OR 1.46 (95% CI 1.01-2.10); P=0.04]. In Whites, a cut point of 5.6 ng/L cTnT predicting hypertension was not associated with outcome measures. Conclusion: Central neural control systems exemplified a brain-heart stress pathway. Desensitization of sympatho-adrenal responses occurred with initial neural- (HRV) followed by neuroendocrine dysfunction (norepinephrine:creatinine) in relation to elevated cTnT. Chronic defensiveness may thus drive the desensitization or physiological depression, reflecting ischemic heart disease risk at a 4.2 ng/L cTnT cut-point in Blacks.
Description: This paper is in closed access until 28th July 2018.
Sponsor: Funding was obtained by the North-West University, Potchefstroom, South Africa; the National Research Foundation (NRF); the Department of Education, North-West Province, South Africa; ROCHE diagnostics; and the Metabolic Syndrome Institute, France.
Version: Accepted for publication
DOI: 10.1016/j.psyneuen.2017.07.492
URI: https://dspace.lboro.ac.uk/2134/26209
Publisher Link: http://dx.doi.org/10.1016/j.psyneuen.2017.07.492
ISSN: 0306-4530
Appears in Collections:Closed Access (Sport, Exercise and Health Sciences)

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