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1.  Associations of Anger, Anxiety and Depressive symptoms with Carotid Arterial Wall Thickness: the Multi-Ethnic Study of Atherosclerosis 
Psychosomatic medicine  2012;74(5):517-525.
Carotid arterial wall thickness, measured as intima-media thickness (IMT), is an early subclinical indicator of cardiovascular disease. Few studies have investigated the association of psychological factors with IMT across multiple ethnic groups and by gender.
We included 6,561 men and women (2,541 whites, 1,790 African Americans, 1,436 Hispanics, and 794 Chinese) aged 45 to 84 years who took part in the first examination of the Multi-Ethnic Study of Atherosclerosis. Associations of trait anger, trait anxiety, and depressive symptoms with mean values of common carotid artery (CCA) and internal carotid artery (ICA) IMTs were investigated using multivariable regression and logistic models.
In age, gender, race/ethnicity-adjusted analyses, the trait anger score was positively associated with CCA and ICA IMTs (mean differences per one SD increment of trait anger score were 0.014 (95% CI, 0.003–0.025, p=0.01) and 0.054 (0.017–0.090, p=0.004) for CCA and ICA IMTs respectively). Anger was also associated with the presence of carotid plaque (age, gender, and race/ethnicity-adjusted odds ratio per one SD increase in trait anger: 1.27 (95%CI, 1.06–1.52)). The associations of the trait anger score with thicker IMT was attenuated after adjustment for covariates, but remained statistically significant. Associations were stronger in men than in women and in whites than in other race/ethnic groups but heterogeneity was only marginally statistically significant by race/ethnicity. There was no association of depressive symptoms or trait anxiety with IMT.
Only one of the three measures examined was associated with IMT and the patterns appeared to be heterogeneous across race/ethnic groups.
PMCID: PMC4966673  PMID: 22511725
Anger; Anxiety; Carotid artery wall thickness; Depressive symptoms; Intima-media thickness; Race/Ethnicity
2.  Do socioeconomic gradients in subclinical atherosclerosis vary according to acculturation level? Analyses of Mexican-Americans in the Multi-Ethnic Study of Atherosclerosis 
Psychosomatic medicine  2009;71(7):756-762.
Although socioeconomic position (SEP) shows a consistent, inverse relationship with cardiovascular disease (CVD) risk in westernized non-Hispanic white populations, the relationship in ethnic minorities, including Hispanics, is often weak or even reversed (i.e., worse health with higher SEP). In the current study, we examined whether the association between SEP and subclinical atherosclerosis in Mexican Americans would be moderated by acculturation.
Participants were 801 Hispanics of Mexican origin (49.6% female; average age 60.47 years) from the Multi-Ethnic Study of Atherosclerosis cohort who underwent computed tomography of the chest for coronary artery calcium (CAC) and thoracic aortic calcium (TAC). SEP was represented by a composite of self-reported education and income. Acculturation was a composite score including language spoken at home, generation, and years of “exposure” to U.S. culture.
Small, but statistically significant SEP by acculturation interaction effects were identified in relation to prevalent CAC, prevalent TAC, and extent of TAC (all p < .05). Follow-up analyses revealed that the direction of the SEP gradient on detectable CAC changed as individuals progressed from low to high acculturation. Specifically, the association between SEP and calcification was positive at low levels of acculturation (i.e., a “reversed” gradient), and negative in circumstances of high acculturation (i.e., the expected, protective effect of higher SEP).
The findings support the utility of examining SEP and acculturation simultaneously, and of disaggregating large ethnic groupings (e.g., “Hispanic”) into meaningful subgroups to better understand health risks.
PMCID: PMC2761426  PMID: 19661194
Acculturation; calcification; coronary artery disease; Hispanics; socioeconomic status

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