Psychological stress, insulin resistance, inflammation and the assessment of heart disease risk. Time for a paradigm shift?

Medical Hypotheses
William R Ware

Abstract

There is growing evidence that the present risk assessment protocol for coronary heart disease appears to underestimate the risk in general and the presence and progression of atherosclerosis in particular. Little or no correlation has been found between the 10-year risk based on the Framingham model and the extent or progression of coronary calcification. In addition, a number of studies find the protocol based on current guidelines leads to an under appreciation of the risk of symptomatic coronary heart disease or the associated fatal and non-fatal events, especially in younger asymptomatic individuals and women. Furthermore, the current guidelines give secondary importance to insulin resistance and inflammation and do not include psychosocial stress and depression, both of which are established and important risk factors for coronary heart disease. An alternative approach to risk assessment is proposed which emphasizes insulin resistance and psychological stress and depression and gives much greater recognition to inflammation as a root cause and target for intervention than is found in current guidelines. Consistent with this view, a revised assessment protocol is suggested which is still appropriate to the primary care set...Continue Reading

References

Jul 7, 2000·The New England Journal of Medicine·M J StampferW C Willett
Nov 4, 2000·The New England Journal of Medicine·P G O'MalleyA J Taylor
Feb 15, 2001·Archives of Internal Medicine·J JeppesenF Gyntelberg
May 23, 2001·JAMA : the Journal of the American Medical Association·UNKNOWN Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
Jan 22, 2002·Journal of Psychosomatic Research·Paul H Black, Lisa D Garbutt
May 31, 2002·QJM : Monthly Journal of the Association of Physicians·U Ravnskov
Jun 19, 2002·Trends in Cardiovascular Medicine·Burkhard LudewigHans Hengartner
Jan 24, 2003·International Journal of Epidemiology·Robert Beaglehole, Paul Magnus
Apr 16, 2003·Circulation·Christine M AlbertJoAnn E Manson
Jun 6, 2003·The Journal of Clinical Endocrinology and Metabolism·Gerald M Reaven
Aug 21, 2003·JAMA : the Journal of the American Medical Association·Umesh N KhotEric J Topol
Sep 6, 2003·Atherosclerosis·Henning Sloth PedersenDonald A Boudreau
Jun 1, 1961·Circulation·K S MATHURR D SHARMA
Dec 17, 2003·The American Journal of Cardiology·Stephan AchenbachThomas Killip
Dec 20, 2003·European Heart Journal·Hok-Hay S OeiJacqueline C M Witteman
Jan 22, 2004·JAMA : the Journal of the American Medical Association·Arnold M Weissler
Jan 30, 2004·Recent Progress in Hormone Research·Gerald ReavenTracey McLaughlin
Feb 28, 2004·Diabetes Care·Marian RewersUNKNOWN Insulin Resistance Atherosclerosis Study Investigators
Apr 15, 2004·International Journal of Epidemiology·Jonathan R EmbersonMary Walker
May 1, 2004·Clinical Chemistry·Meng H TanN Bradly Glazer
Jun 3, 2004·Circulation·James T Willerson, Paul M Ridker
Jan 26, 2005·Archives of Internal Medicine·Daniel J BrotmanRalph G O'Brien
Feb 3, 2005·International Journal of Cardiology·Matthew A Allison, C Michael Wright
Mar 5, 2005·Clinical Chemistry·Gerald M Reaven
May 25, 2005·Psychosomatic Medicine·Willem J KopAlan Rozanski
Jul 13, 2005·Circulation·Rozemarijn VliegenthartJacqueline C M Witteman
Aug 16, 2005·The American Journal of Cardiology·Neil J StoneSara Rosenbaum

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Citations

May 15, 2009·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·M MorcosP Nawroth
Dec 15, 2018·Stress : the International Journal on the Biology of Stress·Feres José Mocayar MarónWalter Manucha
Mar 23, 2017·Human Factors·Kimberly StowersEduardo Salas
Oct 30, 2020·International Journal of Environmental Research and Public Health·Carmen PheifferSumaiya Adam

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