Perceived stress and smoking-related behaviors and symptomatology in male and female smokers.

INTRODUCTION: Stress has been found to be a significant risk factor for cigarette smoking. Stress affects males and females differently, as does the use of smoking for stress reduction. Few studies have examined gender differences with the interrelation of perceived stress and smoking behaviors and nicotine related symptomatology. Our study investigates this association, as well as the influence of sociodemographic variables. METHODS: This is a retrospective analysis of 62 smokers (41 males, 21 females) enrolled in a smoking cessation study. At the screening visit sociodemographic information, smoking behaviors and survey measures were completed. These included the Perceived Stress Scale (PSS), Minnesota Nicotine Withdrawal Scale (MNWS), and others. Analyses were conducted using multiple linear regression models. RESULTS: PSS score was found to have a negative association with number of cigarettes smoked in males (slope -0.29±0.08; p=0.0009) and females (slope -0.20±0.18; p=0.26) with no difference in effect between genders (p=0.64). Linear regression of MNWS on PSS revealed a positive association for both males (slope 0.41±0.068; p<0.0001) and females (slope 0.73±0.14; p<0.0001). There was a significant difference in effect between genders (p=0.04). CONCLUSIONS: A strong positive association was observed between perceived stress and nicotine withdrawal symptomatology in smokers of both sexes, with a larger effect seen in women. These findings emphasize the importance of stress reduction in smokers, which may lead to fewer withdrawal symptoms and more effective smoking cessation.

Vascular and cardiac functional and structural screening to identify risk of future morbid events: preliminary observations.

Risk factors have served to identify patients in need of antihypertensive and lipid-lowering therapy. Because of their limited sensitivity and specificity, we developed a screening program using noninvasive testing and a scoring system aimed at detecting functional and structural cardiovascular abnormalities in asymptomatic individuals. Ten cardiovascular tests were performed in 1 hour by a single technologist. Tests were scored as normal (0), borderline abnormal (1), or abnormal (2). Total disease score (DS) could range from 0 (all tests normal) to 20 (all tests abnormal). Scores of 0-2 were classified as normal, 3-5 as early disease, and 6+ as advanced disease. Morbid events during follow-up of 6 months to 8 years were determined from mailed questionnaires. Framingham risk scores (FRS) were calculated using published algorithms. Thirty-five morbid events (1 of 169 in the "normal" group, 8 of 214 in the "early disease" group, and 26 of 230 in the "advanced disease" group) occurred during the follow-up period among the 613 individuals who completed the questionnaire. Risk for morbid events was highly significantly different between the Kaplan-Meier curves based on disease detection (log rank 21.75, P ≤ .0001). FRS were significantly different but less discriminating, with five morbid events in the 227 subjects with FRS <10, eight in 162 with FRS 10-13, and 22 of 227 with FRS >13 (log rank 9.80, P = .0074). The area under receiver operating characteristic curve for DS (0.74) surpassed that of FRS (0.66) and was not improved when both were included in the model. Neither blood pressure levels nor low-density lipoprotein cholesterol levels provided adequate discrimination. Identifying early disease in asymptomatic individuals provides a better guide to the need for preventive therapy than traditional risk factor assessment.

Relation of heart rate parameters during exercise test to sudden death and all-cause mortality in asymptomatic men.

Heart rate (HR) profile during exercise predicts all-cause mortality. However, less is known about its relation to sudden (vs nonsudden) death in asymptomatic people. The relation of exercise HR parameters (HR at rest, target HR achievement, HR increase, and HR recovery) with sudden death, coronary heart disease (CHD) death, myocardial infarction, and all-cause mortality was assessed in 12,555 men who participated in MRFIT. Subjects were 35 to 57 years old without clinical CHD, but with higher than average Framingham risk. Trial follow-up was 7 years, and extended follow-up after the trial for all-cause mortality was 25 years. After adjusting for cardiac risk factors, having to stop exercise before achieving 85% of age-specific maximal HR was associated with increased risk of sudden death (hazard ratio 1.8, 95% confidence interval [CI] 1.3 to 2.5, p = 0.001), CHD death (hazard ratio 1.4, 95% CI 1.2 to 1.5, p <0.001), and all-cause mortality (hazard ratio 1.3, 95% CI 1.2 to 1.4, p <0.001). Increased HR at rest (p = 0.001), attenuated HR increase (p = 0.02), delayed HR recovery (p = 0.04), and exercise duration (p <0.0001) were independent predictors of all-cause death in the overall study population and also in the subgroup that achieved target HR. In conclusion, middle-aged men without clinical CHD who stopped exercise before reaching 85% of maximal HR had a higher risk of sudden death. Other exercise HR parameters and exercise duration predicted all-cause mortality.

Arterial elasticity as part of a comprehensive assessment of cardiovascular risk and drug treatment.

Early cardiovascular disease can be identified in asymptomatic individuals by noninvasive evaluation of functional and structural abnormalities of the vasculature and heart. These abnomalities are usually a consequence of endothelial dysfunction. A panel of 10 tests, including small and large artery elasticity, has been used as the basis for a screening system that provides a score of 0 to 20 as a guide to the severity of disease. Using that Rasmussen score allows for stratification of patients into low, intermediate, or high risk for progression to cardiovascular morbid events. This comprehensive screening can be performed efficiently in a single room with a single technician. The sensitivity and specificity of this screening system in predicting future cardiovascular events, its superiority to traditional risk factor assessment, and its potential to track the response to therapeutic interventions must be validated in long-term follow-up studies.