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Lower socioeconomic status increases CV risk via elevated amygdalar activity
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Patients of lower socioeconomic status had increased amygdalar activity, one of the factors that independently predicted major adverse cardiac events, according to a study published in the Journal of the American College of Cardiology.
“The current findings identify a potentially modifiable biological pathway driving the increased burden of CVD that encumbers the socioeconomically disadvantaged,” Ahmed A. Tawakol, MD, co-director of the Cardiac MR PET CT program at Massachusetts General Hospital, and colleagues wrote. “These pathways originate in the brain, which provides a bridge between external factors and extra-neural diseases.”
PET/CT imaging
Researchers analyzed data from 509 patients (mean age, 55 years; 42% men) who did not have CVD, active cancer or acute or chronic inflammatory or autoimmune disease when they underwent 18F-fluorodeoxyglucose PET/CT imaging. Socioeconomic status was estimated, in addition to metabolic activity in the amygdala, arterial inflammation and bone marrow metabolic activity.
The outcome of interest was major adverse cardiac events within 5 years of imaging, defined as MI, cardiac death, cerebrovascular accident, unstable angina, HF or peripheral artery disease with revascularization.
During a median follow-up of 4 years, 40 patients had one or more major adverse cardiac events.
Neighborhood median income at baseline was inversely associated with arterial inflammation (beta = –0.098; 95% CI, –0.182 to –0.14) and amygdalar activity ( = –0.156; 95% CI, –0.267 to –0.042) after adjusting for CVD risk factors. This was also negatively associated with major adverse cardiac events (HR = 0.673; 95% CI, 0.472-0.959).
Mediation analysis was also performed to examine a pathway of decreased socioeconomic status to increased amygdalar activity to increased hematopoietic tissue activity to increased arterial inflammation to increased major adverse cardiac events. This path significantly mediated the link between socioeconomic status and major adverse cardiac events (log OR = –0.0137; 95% CI, –0.057 to –0.0003).
“By illuminating a multi-organ system linking [socioeconomic status] to CVD, this study sets the stage for testing new interventions that may forestall future heart attacks and strokes and reduce [socioeconomic status]-driven health disparities,” Tawakol and colleagues wrote.
Future research
“The results from Tawakol et al highlight the importance of the amygdala in connecting [socioeconomic status] with CVD,” Gregory E. Miller, PhD, professor of psychology and faculty fellow at Northwestern University’s Institute for Policy Research, and colleagues wrote in a related editorial. “In subsequent research, it will be important to ask which other brain regions are involved, and whether additional insights might be gleaned from a network-based approach. Of special interest here is the cortico-basal ganglia circuit, which supports reward-related brain functions and is implicated in CVD risk behaviors like smoking, consumption of calorically dense foods and obesity.” – by Darlene Dobkowski
Disclosures: Tawakol reports he received grants from Actelion and Genentech and personal fees from Actelion and Amgen. The authors of the editorial report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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