Stress is a well-known major contributing factor in cardiovascular disease. Dr. Robert Sapolsky, a renowned Stanford neuroendocrinologist who specializes in the psychobiological impact of stress, observes that a chronic out-of-kilter stress response can cause severe damage to arteries.1 In this scenario, a build-up in blood pressure exerts increasing force on critical junctures of the vascular system, scraping the protective inner lining. Excess glucose and fatty acids mobilized via the hormonal stress response soon appear at the damaged site, starting a clumping process with other metabolic waste products and voila--the insidious process of atherosclerosis begins. Chronic elevations of glucocorticoids--such as the adrenal stress hormone cortisol--make this atherosclerosis worse.

So powerful is this chronic vascular-hormonal stress response, that experimental studies show it can trigger plague formation even in animals on low-fat diets.

The interactive relationship between hormonal stress response and cardiovascular disease can start at an early age. Researchers from Duke University have found that the early loss of a parent, combined with poor quality family relationships, can make an individual more prone to both hypertension and increased cortisol response to stressful events later in life.2 Independent studies have revealed a vital connection between the oversecretion of stress hormones and fatigue, emotional distress, and increased blood pressure.3,4

This profile of a hypertensive, high-stress hormone responder reveals some other interesting patterns. One recent study examining the effects of stress and caffeine consumption found that men with hypertension produced greater amounts of corticosteroids such as cortisol and ACTH (the pituitary hormone that stimulates cortisol secretion) in their bodies in response to stress and caffeine than did normotensive men.5

Fortunately, preventative strategies aimed at reducing an unhealthy stress response can have an astounding impact on reversing the pathogenesis of hypertensive heart disease. Certain types of meditation, for example, are so potentially powerful in alleviating psychoneuroendocrine dysfunction (such as high cortisol) associated with high blood pressure that they have led researchers to contend that "hypertensive heart disease is avoidable, even in modern industrialized societies."6

The role of another adrenal hormone, DHEA, in heart disease has also received much recent scientific attention. DHEA plays an important role in balancing some of the "wear-and-tear" effects of cortisol during the stress response.

Experimental evidence suggests that DHEA inhibits the process of atherosclerosis, the progressive build-up of fat sludge inside the arteries, in animals fed a cholesterol-rich diet.7 The effects in humans seem less clear, but most studies on men associate low circulating levels of DHEA with an increased risk of heart disease.8 This would support certain metabolic relationships observed in relation to DHEA in men: Low DHEA levels have been linked to increased body fat, obesity, and hyperinsulinemia,9,10 well-known risk factors for cardiovascular disease. Lower levels of DHEA are also linked with increased incidence of blood vessel diseases in heart patients receiving cardiac allografts.11 Researchers caution, however, to be aware of possible confounding effects such as smoking, which can raise DHEA levels.12

Some researchers suggest that androgens such as DHEA and testosterone have contrary effects on cardiovascular health in men and women. Prospective studies on DHEA in women have generally found an increased or negligible incidence of heart disease associated with higher DHEA levels.13 Clearly, androgen excess in women is associated with apple-shaped obesity, dysglycemia, polycystic ovary syndrome and heart disease. This underscores the importance of testing to ensure that women have adequate, but not excessive, levels of DHEA.

Because circulating levels of cortisol increase and DHEA decrease as the body ages, adrenal imbalances may become even more pronounced in individuals as they age, and may play increasingly important roles in related cardiovascular disease processes.

The Adrenal Stress Profile is a noninvasive salivary analysis of bioavailable cortisol DHEA, including a DHEA/cortisol ratio, which provides important information about how a chronic maladaptation to stress (via adrenal dysfunction) may be contributing to cardiovascular disease, depression, insomnia, and other stress-related degenerative conditions.

References:
1 Sapolsky RM. Why zebras don't get ulcers. New York: Freeman and Co., 1994;37-58.
2 Luecken LJ. Childhood attachment and loss experiences affect adult cardiovascular and cortisol function. Psychosom Med 1998;60(6):765-72.
3 Raikkonen K, Hautanen A, Keltikangas-Jarvinen L. Feelings of exhaustion, emotional distress, and pituitary and adrenocortical hormones in borderline hypertension. J Hypertens 1996;14(6):713-8.
4 Earle TL, Linden W, Weinberg J. Differential effects of harassment on cardiovascular and salivary cortisol stress reactivity and recovery in women and men. J Psychosom Res 1999;46(2):125-41.
5 al'Absi M, Lovallo WR, McKey B, Sung BH, Whitsett TL, Wilson MF. Hypothalamic-pituitary-adrenocortical responses to psychological stress and caffeine in men at high and low risk for hypertension. Psychosom Med 1998;60(4):521-7.
6 Walton KG, Pugh ND, Gelderloos P, Macrae P. Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. J Altern Complement Med 1995;1(3):263-83.
7 Alexandersen P, Haarbo J, Byrjalsen I, Lawaetz H, Christiansen C. Natural androgens inhibit male atherosclerosis: a study in castrated, cholesterol-fed rabbits. Circ Res 199;84(7):813-9.
8 Alexandersen P, Haarbo J, Christiansen C. The relationship of natural androgens to coronary heart disease in males: a review. Atherosclerosis 1996;125(1):1-13.
9 Haffner SM, Valdez RA, Stern MP, Katz MS. Obesity, body fat distribution and sex hormones in men. Int J Obes Relat Metab Disord 1993;17(11):643-9.
10 Nestler JE, Clore JN, Blackard WG. Dehydroepiandrosterone: the "missing link"" between hyperinsulinemia and atherosclerosis?" FASEB J 1992;6(12):3073-5.
11 Herrington DM. Dehydroepiandrosterone and coronary atherosclerosis. Ann N Y Acad Sci 1995;774:271-80.
12 Khaw KT. Dehydroepiandrosterone, dehydroepiandrosterone sulphate and cardiovascular disease. J Endocrinol 1996;150 Supple:S149-53.
13 Johnannes CB, Stellato RK, Feldman HA, Longcope C, McKinlay JB. Relation of dehydroepiandrosterone and dehydroepiandrosterone sulfate with cardiovascular disease risk factors in women: longitudinal results from the Massachussetts Women's Health Study. J Clin Epidemiol 1999;52(2):95-103.

Call to set up a nutritional consultation so that tests can be performed and a comprehensive strategy of lifestyle, dietary modification and nutrient supplementation can be implemented to aid you in reversing this disorder.

For an appointment, call (818) 707-3126 or 800-956-7083 or go to lab tests and click on appropriate test for information.

Dr. Rispoli, Ph.D., L.Ac. has had a clinical practice for over 20 years. Her programs work because she is so thorough in testing and providing a nutritional approach. Remember that the body can heal itself if given the proper nutrients.

The information herein is not intended as diagnosis, treatment or a cure. Should you have a medical condition please seek the advice of your medical doctor.