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dc.contributor.authorMalan, Leoné
dc.contributor.authorSchutte, Christiaan E.
dc.contributor.authorMalan, Nicolaas T.
dc.contributor.authorAlkerwi, Ala'a
dc.contributor.authorStranges, Saverio
dc.date.accessioned2017-07-13T06:45:26Z
dc.date.available2017-07-13T06:45:26Z
dc.date.issued2017
dc.identifier.citationSchutte, L. et al. 2017. Hypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA study. Hypertension research, 40(6):590-597. [http://dx.doi.org/10.1038/hr.2017.5]en_US
dc.identifier.issn0916-9636
dc.identifier.issn1348-4214 (Online)
dc.identifier.urihttp://hdl.handle.net/10394/25149
dc.identifier.urihttp://dx.doi.org/10.1038/hr.2017.5
dc.description.abstractEmotional distress has been associated with a poorer prognosis in myocardial infarction patients. Elevated adrenocorticotrophic hormone (ACTH), lower cortisol, dehydroepiandrosterone sulfate (DHEAS) and cortisol:DHEAS, as measures of emotional distress, might correlate with silent myocardial ischemia (SMI) and workload. Thus, we assessed the relationship between emotional distress, SMI and double product (systolic blood pressure (SBP) × heart rate). Cross-sectional South African biethnic single-set cohorts (N=378), aged 44.7±9.52 years, were investigated. Depressive symptoms (Patient Health Questionnaire-9), anthropometric, fasting blood, 24-h double product and 24-h 2-lead electrocardiogram (ST-segment depression) values were obtained. Blacks, mostly men, had increased depressive symptoms, hyperglycemia, SMI, double product, SBP hypertension and ACTH but lower cortisol, DHEAS and cortisol:DHEAS than their White counterparts. Black men had the highest combined SBP hypertension and below-median cortisol prevalence, 38%, compared with 5.9–13.8% in the other groups. Their SMI was associated with ACTH and cortisol:DHEAS (adj. R2 0.29; β 0.27–0.31 (0.12–0.64); Pless than or equal to0.05), double product (adj. R2 0.29; β 0.38 (0.18–0.57); P=0.050) and SBP hypertension (area under the curve: 0.68 (95% CI: 0.56, 0.80); P=0.042; sensitivity/specificity 49/85%). Double product was positively associated with central obesity in all sex groups and with cortisol in the Black men (P<0.05). A dysregulated hypothalamic-pituitary-adrenal-axis (HPAA) showed signs of a hyporesponsive adrenal cortex, suggesting chronic emotional stress in the Black male cohort. In this cohort, HPAA dysregulation and compensatory increases in double product occur as a potential defense mechanism to alleviate perfusion deficits, thereby potentiating ischemic heart disease risken_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.subjectAfricansen_US
dc.subjectDouble producten_US
dc.subjectHypothalamic-pituitary-adrenal-axisen_US
dc.subjectMyocardial ischemiaen_US
dc.titleHypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA studyen_US
dc.typeArticleen_US
dc.contributor.researchID10056173 - Malan, Nicolaas Theodor
dc.contributor.researchID10060871 - Malan, Leoné
dc.contributor.researchID22369562 - Schutte, Christiaan Ernst


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