Editors' ChoiceCardiology

Fear as a Cardiovascular Risk Factor

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Science Translational Medicine  14 Jan 2015:
Vol. 7, Issue 270, pp. 270ec9
DOI: 10.1126/scitranslmed.aaa6252

As adults age, their resting heart rate tends to decline. However, individuals with a paradoxical rise in resting heart rate suffer an increased risk of cardiovascular events, such as myocardial infarction. Characterizing the underlying causes of this paradoxical increase in heart rate could provide opportunities for intervention. Shenhar-Tsarfaty et al. have now identified some factors associated with resting heart rate and its paradoxical rise in aging individuals.

The authors used a cohort of 17,380 healthy Israeli adults who were participating in the Tel Aviv Medical Center Inflammation Survey (TAMCIS), a longitudinal registry of healthy employees attending periodic health examinations. In this study, the researchers serially measured 325 variables, spanning physiological parameters such as sports activity, inflammatory biomarkers such as C-reactive protein, and psychological measures of anxiety, including perceived control over one’s life and fear of terror. This last parameter, fear of terror, affects a large number of Israeli residents. Fear of terror was quantified by graded responses to three patient-reported concerns: worry about personal safety, heightened tension in crowded places, and fear of a terror strike harming self or family.

A regression analysis of the 325 variables identified 27 components as prominent determinants of annual pulse increases. These variables fell into several major categories, including inflammatory markers, body mass index, physical activity, and psychological measures such as fear of terror. A model incorporating these variables predicted that 8.2% of the cohort would have paradoxical changes in heart rate, which was 81 to 85% accurate. Combining indicators of inflammation and fear of terror revealed an even greater impact on heart rate changes than either variable alone. Cholinergic activity has anti-inflammatory effects, and decreases in such signaling have been associated with cardiovascular mortality. Therefore, the authors measured cholinergic activity in a subset of patients (398 males and 214 females). As expected, they found cholinergic status to be an independent predictor of heart rate, but only in males.

This research offers strong evidence of association between heart rate and a variety of physiologic and psychological variables, including fear of terror. The cohort size is very large, increasing the validity of this study. However, association is not causation, and further research into the nature of these associations will be necessary to generate a more complete understanding of their role.

S. Shenhar-Tsarfaty et al., Fear and C-reactive protein cosynergize annual pulse increases in healthy adults. Proc.Natl. Acad. Sci. U.S.A. 10.1073/pnas.1418264112 (2014). [Full Text]

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