Defensive active coping facilitates chronic hyperglycaemia and endothelial dysfunction in African men: the SABPA...

Area of Science:

• Cardiovascular Health
• Behavioral Science
• Ethnic Health Disparities

Background:

• Active coping (AC) shows a dissociation between behavioral control and physiological "loss of control" responses.
• This dissociation is linked to silent ischemia and structural wall abnormalities in African men.
• The relationship with structural alterations and endothelial dysfunction requires further investigation.

Purpose of the Study:

• To determine ethnic-gender specific receiver operating characteristic (ROC) cut points for carotid intima-media far wall (CIMTf).
• To associate CIMTf cut points with 24-hour blood pressure (BP), silent ischemia, and glycated hemoglobin (HbA1c).

Main Methods:

• Included 317 African and Caucasian participants (aged 45 ± 9 years) without prior stroke or atrial fibrillation.
• Measured AC using the Coping Strategy Indicator.
• Utilized ultrasound for CIMTf, ambulatory monitoring for BP, and blood samples for HbA1c and silent ischemia assessment.

Main Results:

• AC African men had higher diastolic BP (69-77%) and HbA1c levels compared to AC Caucasian men (44-48%).
• AC African women (41-60%) exhibited higher BP, silent ischemia, and HbA1c than Caucasian women (17-44%).
• Optimal CIMTf cut points for BP ranged from 0.57-0.65 mm, and for silent ischemia from 0.71-0.74 mm. HbA1c (>5.7%) predicted structural alterations (0.69 mm cut point) in AC African men (OR 4.5).

Conclusions:

• AC African women demonstrated behavioral resilience despite a high prevalence of cardiovascular risk markers.
• In AC African men, chronic hyperglycemia contributed to endothelial dysfunction, "loss of control," and stroke risk.