Medicine /4. Therapy
Bastrikov O.Yu., Belov V.V., Grigoricheva E.A.,
Sumerkina V.A., Evdokimova E.V., Il'inyh E.I.,
Ozhigina E.V.
South Ural State Medical University (Chelyabinsk)
Gender features metabolism of lipoproteins in correlation with psychoemotional
factors in practically healthy individuals
Introduction. Currently, along with a certain influence has become "traditional", new risk
factors of cardio - vascular diseases
(CVD), the impact of which is still poorly understood and / or which are
not taken into account. Among them psychoemotional stress
and anxiety - depressive disorder may
have on human health more impact than
the already well-known,
acting either directly or through "traditional" risk
factors, enhancing the effect of the latter [1]. The psychosomatic approach
to the problem of physical illness as a result of emotional
stress involves the study of possible biochemical
mechanisms of stress-induced reactions: dyslipidemia, activation
of free radical oxidation, "pro-inflammatory" cytokine imbalance ergic processes, the
immune system with the development of inflammation [2]. In the literature, there
is a lot of evidence that acute and
especially chronic psycho-emotional stress causes the disorder of
lipid metabolism. According to P.D. Gorizontov "hypercholesterolemia - is an expression of metabolic stress" [3]. In turn, the
stress situation is an indicator of the
relationship between mental health and neuroendocrine regulation. According
to some reports,
this relationship is due to the
simultaneous effect of stress on lipid
profile, and on the development of physical illness. Therefore, dyslipidemia is
a prognostic factor for the development of
cardio - vascular diseases and other non-communicable diseases. It
is relevant to study the effects of the relationship of
blood lipid metabolism and psychobiology of
stress from a gender perspective.
Purpose: examine gender features metabolism of lipoproteins in correlation with
psychoemotional factors in practically healthy individuals.
Fence venous
blood lipid profile parameters for
the study was carried out on an empty stomach in
the morning, after a 12-hour fast. Determination of the
concentration of total cholesterol (C), triglycerides (TG), high
density lipoprotein cholesterol (HDL-C) in the blood serum was
carried out by an enzymatic colorimetric method using a
reagent kit by "Olvex Diagnosticum" (Russia)
at the biochemical analyzer Stat
Fax 3300 (USA) , the level of low density lipoprotein
cholesterol (LDL - C)
was determined by calculation on
the Friedewald formula: LDL-C = total cholesterol - HDL - HDL - TG / 2.2,
the calculation of the level of cholesterol very low density lipoproteins (LDL
- VLDL) using the formula VLDL = TG / 2,2, atherogenic index (AI) was
calculated according to the formula proposed by A.N. Klimov: AI = total cholesterol (mmol / l) - HDL-C(mmol / l) / HDL-C (mmol
/ l) [11]. Non-HDL cholesterol (Non-HDL-C) defined by
the formula = total cholesterol – HDL-C [12]. Determination
of apolipoprotein B 100 (apo B100) and apolipoprotein A1 (Apo A1) in serum was
performed immunoturbodimetricheskim method
using a reagent kit of the company «Human» on
automatic ELISA analyzer Bio Chem Analette EIA (HTI, USA). Statistical analysis
of the material was carried out using statistical software
package SPSS for Windows version 17.0. Evaluating
the differences variables for independent samples were
performed using t-test.
In the case of the
distribution of values different from the normal, using a
non-parametric Mann - Whitney U. Comparison of groups was
carried out by attributes using the crosstabs with
Pearson Chi-Square. To identify the relationships between
the studied parameters was performed correlation
analysis using Spearman's rank correlation
coefficient (r). In order to select the most significant variables
affecting the variability of quantitative variables studied, used
the method of multiple stepwise linear
regression. In all procedures of statistical analysis the
level of significance was taken as p<0.05.
Results and discussion. The analysis of the data showed that the vast majority
of average lipoprotein metabolism, responsible
for the atherogenic potential was
significantly higher in the group of males surveyed. When
comparing the mean value of Apo-A1 between-group differences were
found. The level of "good" cholesterol was
significantly higher in women (Table
1). Gender characteristics of lipid studied in
different populations,
including living in extreme
climatic conditions. So according to the epidemiological study
conducted in the indigenous population of the Republic of
Sakha (Yakutia), no statistically significant gender
differences in the content of total cholesterol, LDL
cholesterol and triglycerides. In women, the
concentration of HDL cholesterol was higher than that
of men. In men,
compared with women who had
higher values of atherogenic index [13].
Table 1
Average performance indicators
lipoprotein metabolism in the two groups,
M [95% CI]
|
The indicator unit. edited. |
Male group (n=30) |
Female group (n=41) |
|
C, mmol/l |
5.59 [5.06-6.12]* |
4.82 [4.31-5.34]* |
|
TG, mmol/l |
2.07 [1.30-2.84]* |
1.13 [0.96-1.31]* |
|
HDL-C, mmol/l |
1.19 [1.11-1.27]* |
1.37 [1.30-1.45]* |
|
LDL-C, mmol/l |
3.56 [2.98-4.14]* |
2.94 [2.43-3.45]* |
|
HDL - VLDL, mmol/l |
0.84 [0.64-1.05]* |
0.51 [0.43-0.59]* |
|
LDL-C & VLDL, mmol/l |
6.27 [5.28-7.26]* |
4.56 [4.02-5.10]* |
|
AI |
3.86 [3.33-4.39]* |
2.64 [2.16-3.13]* |
|
Apo-А1, g/l |
1.09 [1.03-1.16] |
1.11 [1.07-1.16] |
|
Apo-В100, g/l |
1.17 [1.08-1.26]* |
1.06 [1.00-1.12]* |
|
Apo-В100/Apo-А1 ratio |
1.09 [1.00-1.18]* |
0.95 [0.90-1.01]* |
|
Non-HDL-C,
mmol/l |
4.27 [3.79-4.75]* |
3.45 [2.91-3.98]* |
*hereinafter p<0.05
A
statistically significant gender differences in
the frequency of TG and increased content of apo-B100.
Currently, hypertriglyceridemia, and Apo-B are
considered as valid criteria for evaluating new cardiovascular
risk [14]. The most common types of atherogenic birefringence of the population
studied were elevated levels of Apo - B100, Non-HDL-C, Apo-V100/Apo-A1 ratio.
In men, except for the above, the share of isolated hypercholesterolemia and hypertriglyceridemia accounted for 40% (Table 2).
Table 2
Frequency dyslipoproteinemia among
healthy individuals, abs. h (%)
|
The indicator unit. edited. |
Male group (n=30) |
Female group (n=41) |
χ2 |
p |
|
hypercholesterolemia (atherogenic index of more than 4) |
12 (40%) |
8 (20%) |
0.06 |
|
|
hypertriglyceridemia |
12 (40%) |
7 (17%) |
0.03 |
* |
|
hypercholesterolemia & hypertriglyceridemia |
8 (27%) |
4 (10%) |
0.06 |
|
|
hypercholesterolemia, reduced level HDL-C |
4 (13%) |
6 (15%) |
0.88 |
|
|
hypertriglyceridemia, reduced level HDL-C |
6 (20%) |
7 (17%) |
0.75 |
|
|
reduced level HDL-C |
6 (20%) |
11 (27%) |
0.51 |
|
|
hypercholesterolemia & hypertriglyceridemia & reduced level HDL-C |
4 (13%) |
4 (10%) |
0.64 |
|
|
elevated Non-HDL-C |
22 (73%) |
15 (37%) |
0.38 |
|
|
elevated Apo B100 |
26 (87%) |
22 (54%) |
0.003 |
* |
|
elevated Apo-В100/Apo-А1 ratio |
19 (63%) |
14 (37%) |
0.83 |
|
The average parameters of psychological testing in healthy individuals by
gender are presented in Table 3. Identified the following gender-specific
psychological status. The assessment of visual - analogue scale health, stress,
resilience, level of social frustration and reactive anxiety intergroup
differences were found. Average performance level of depression, trait anxiety
and evaluation of accumulated stress on a scale of Holmes-Rahe were
significantly higher in the group of women. At the inter-group comparison of
psychological factors expressed in quantitative characteristics (absolute
and%), it was found that in the female group compared with men significantly
more frequent in persons with clinically significant level of personal anxiety
(respectively 46 (75%) and 22 (48%) and stress accumulated scale Holmes - Rahe
(respectively 22 (36%) and 6 (13%) (p < 0.05).
Table 2
The average parameters of psychological testing in
the two groups, M [95% CI]
|
The indicator, points |
Male group (n=46) |
Female group (n=61) |
|
health
self-assessment |
68,6 [61,9-75,4] |
62,1 [56,1-68,1] |
|
stress
self-assessment |
38,6 [29,5-47,7] |
45,5 [38,8-52,3] |
|
resilience
self-assessment |
64,3 [54,0-74,6] |
60,8 [54,0-67,6] |
|
level
of a social frustration |
2,0 [1,7-2,2] |
1,8 [1,6-2,1] |
|
depression
level |
11,3 [9,1-13,5]* |
14,9 [14,6-16,5]* |
|
level
of jet uneasiness |
33,6 [30,1-37,1] |
37,8 [34,5-41,1] |
|
level
of personal uneasiness |
38,1 [34,8-41,4]* |
43,7 [42,5-45,9]* |
|
level
of the saved-up stress |
111,8 [90,4-133,1]* |
156,4 [143,2-180,7]* |
Correlation
analysis in the group of men surveyed revealed an
inverse relationship of trait anxiety and the level of Apo-A1 (r = -0,52; p = 0,021), the
level of social frustration and Apo-B100/Apo-A1 ratio (r
= -0,72; p = 0,000), and the VAS (self-reported health), and Non-HDL cholesterol (r
= -0,46; p = 0,048). Moreover, found positive
associations with personal relations Apo-B100/Apo-A1 anxiety (r
= 0,56; p = 0,012) and depression (r = 0,50; p = 0,028). In
the group of women studied were found statistically
significant correlations between VAS (self-reported health) of cholesterol - LDL (r = -0,35; p = 0,034), atherogenic index (r
= -0,35; p = 0,035), as well as Non-HDL cholesterol (r = -0,37; p = 0,027). There was a negative relationship between the VAS (self-assessment of
stress) and the level of Apo-A1 (r = -0,40; p = 0,016).
Multiple regression analysis in men showed an independent effect of trait
anxiety on the rate of Apo-A1, the total contribution of this predictor was 17%
(p = 0.011). In addition, 15% of the variance of the variable
"Apo-B100" due to the influence of a predictor of the "level of
social frustration" (p = 0.018). The total contribution of the two
predictors (level of social frustration and depression) to the variance of the
variable "Apo-V100/Apo-A1 ratio" was 34% (p < 0.05). Also noted independent
effect of accumulated stress, as measured on a scale Holmes-Rahe level to Non-HDL
cholesterol (R2 = 0,15, β = 0,39, p = 0,004).
The
women noted the independent influence of the
accumulated stress scale Holmes - Ray on atherogenic index (R2 = 0,11, β = 0,34,
p = 0,014), the level of LDL-C and total
cholesterol equally (R2 = 0,18, β = 0,42, p = 0,002).
Numerous studies in recent years support the view of a single mechanism by
which acute psychological stress causes an increase in the concentrations of
total cholesterol and its sub-fractions. In addition, increased levels of
cholesterol can occur as a result of changes in the metabolism of lipoproteins
themselves.
According to research by L.E.
Panin in individuals with high levels of anxiety were all elevated lipid
parameters: total lipids, triglycerides, total cholesterol, LDL - cholesterol,
HDL - VLDL. Based on the experimental model of stress author found a
significant increase in cholesterol content organs and braditrof tissues
(aorta), which is a consequence of their fatty infiltration [15].
According to the data of N.P.
Garganeeva coronary disease patients with comorbid mood disorders and neurotic
character revealed metabolic changes of lipid profile was determined by the
phenomenology of mental disorders. In patients with affective disorders
observed the highest serum levels of total cholesterol, LDL - cholesterol,
atherogenic index, and the downward trend in HDL-C [16].
A. Kempinski, developing
ideas corticovisceral and Psychosomatic Medicine, wrote
that "every mental state has
its biochemical correlates. With
further improvement of research methods, we can soon
for each mental changes - not only pathological - to find organic correlate, if not morphological, at least, "biochemical" [17].
Conclusion. Established significant gender
differences on the studied parameters of lipid profile. The majority of
secondary indicators that determine the atherogenic potential, were significantly
higher in the group of males surveyed. Dyslipoproteinemia the highest
prevalence was found in the group of men, with no significant differences
reached a frequency of hypertriglyceridemia and increased levels of apo-B100. The frequency of personal anxiety and clinically
significant stress, measured on a scale of Holmes - Rahe, was significantly
higher in the group of women surveyed, were, respectively, 75% and 36%. Both
groups identified the association of psycho-emotional factors and lipid profile.
In this case, the men show an independent
relationship between levels of trait anxiety and social frustration with
apoproteins, as well as the accumulated stress from cholesterol,
non-high-density lipoproteins. The women identified the association of accumulated
stress scale Holmes - Rahe with total cholesterol, LDL cholesterol, atherogenic
index. These findings point to the need to find ways of creating a
comprehensive primary prevention of stress - induced damage metabolism of
lipoproteins with the psychoemotional factors and gender characteristics of
their influence.
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