Feelings of Hopelessness Linked to Stroke Risk in Healthy Women

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MINNEAPOLIS / ST. PAUL (Aug. 27, 2009) – Healthy middle-aged women with feelings of hopelessness appear to experience thickening of the neck arteries, which can be a precursor to stroke, according to new research out of the University of Minnesota Medical School.

The study, published online today in Stroke: Journal of the American Heart Association, found that hopelessness — negative thinking and feelings of uselessness — affects arteries independent of clinical depression and before women develop clinically relevant cardiovascular disease.

Researchers looked at 559 women (average age 50, 62 percent white, 38 percent African American) who were generally healthy and did not show signs of clinical cardiovascular disease.

They measured hopelessness with a two-item questionnaire assessing expectancies regarding future and personal goals. Depressive symptoms were measured with a 20-item Center for Epidemiologic Studies Depression Scale. Thickness of neck arteries was assessed using ultrasound.

The study found a consistent, progressive, and linear association between increasing neck artery thickness and rising levels of hopelessness. The overall difference in arterial thickening between women with higher versus lower hopelessness scores, about .02 millimeters (mm), was equal to about one year of thickening. Those with the highest hopelessness scores had an average .06 mm greater thickening than those in the lowest group — a clinically significant difference. This correlation remained after adjusting for any influence of age, race, income, cardiovascular risk factors, and depression.

“Previous studies have shown that hopelessness is associated with cardiovascular disease outcomes in men and also in women with documented heart disease. However, this is the first study to suggest that hopelessness may be related to subclinical cardiovascular disease in women without clinical symptoms of heart disease and who are generally healthy,” said Susan A. Everson-Rose, Ph.D., M.P.H., principal investigator of the study, associate director of the Program in Health Disparities Research, and associate professor of medicine.

“These findings suggest that women who experience feelings of hopelessness may have greater risk for future heart disease and stroke,” Everson-Rose said. “In fact, our data indicate that hopelessness may be uniquely related to cardiovascular disease risk. We did not see similar relations when looking at global depressive symptoms.”

Researchers used data from Chicago and Pittsburgh sites of the Study of Women’s Health Across the Nation (SWAN) to examine associations of hopelessness and depressive symptoms with carotid IMT, an early marker of atherosclerosis.

“The findings we observed are based on cross-sectional data — a snapshot in time — so we look forward to examining the longitudinal relations between hopelessness and heart disease risk in women,” Everson-Rose said.

The paper’s lead author, Mary O. Whipple, B.A., was a summer research intern during the study. Other co-authors are Tené T. Lewis, Ph.D.; Kim Sutton-Tyrrell, Dr. P.H.; Karen A. Matthews, Ph.D.; Emma Barinas-Mitchell, Ph.D. and Lynda H. Powell, Ph.D.

This study was partially funded by the National Institutes of Health.

Dedicated to excellence, diversity and service, the University of Minnesota Medical School educates the next generation of physicians, advances patient care, and discovers breakthroughs in biomedical research that enhance health in Minnesota and beyond. Its commitment to transform medical education, Rural Physician Associate Program, and success in training Native American physicians are well-known. More than 1,500 Medical School physicians and scientists provide world-class care and carry out nearly $200 million in research, which informs the treatments and care that patients receive. For more information, go to www.med.umn.edu.

Contacts:
Nick Hanson, Academic Health Center, (612) 624-2449, hans2853@umn.edu
Laura Stroup, Academic Health Center, (612) 624-5680, stro0481@umn.edu