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Exaggerated Blood Pressure Responses During Mental Stress Are Prospectively Related to Enhanced Carotid Atherosclerosis in Middle-Aged Finnish Men
Abstract
Background— Hemodynamic reactions to mental stress may contribute to atherosclerosis. We previously observed cross-sectional relationships between blood pressure reactions to a standardized stress battery and carotid intima-media thickness (IMT) in the Kuopio Ischemic Heart Disease (KIHD) study. These are the first prospective results on this relationship. Methods and Results— Men from 4 age cohorts (42 to 60 years old at study onset) were challenged with a standardized mental stress battery, and heart rate and blood pressure reactions were assessed. Ultrasound measures of common carotid IMT were collected at this time and 7 years later as noninvasive markers of atherosclerosis. Data were collected from a sample of 756 men at both times. Systolic blood pressure reactions to mental stress at study onset were positively related to mean carotid IMT 7 years later (β=0.035, P =0.001, by blood pressure quartile, IMT=0.91, 0.93, 0.96, 1.00 mm) and to the progression of IMT (β=0.020, P =0.006, by blood pressure quartile, ΔIMT=0.08, 0.09, 0.11, 0.11 mm). Similar significant relations were shown for maximal IMT and plaque height. Diastolic blood pressure responses were less strongly related to carotid IMT than were systolic responses. Heart-rate responses were unrelated. Adjustment for standard risk factors did not substantially reduce the relation between systolic blood pressure reactivity and the progression of mean carotid IMT (standardized β=0.059, P =0.026), maximal carotid IMT (standardized β=0.084, P =0.006), or plaque height (standardized β=0.093, P =0.008). Conclusions— The degree of systolic blood pressure reactivity to mental challenge is prospectively related to carotid IMT in middle-aged and older men, independent of known risk factors.
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“Furthermore, recent prospective studies have shown that high reactors to acute stressors have more extensive arterial plaques and more aggressive plaque growth (3,20).”
From A high fat meal increases cardiovascular reactivity to psychological stress in healthy young adults (2007) · cites this paper as [3]
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“Several prospective studies have established exaggerated cardiovascular reactivity as an independent predictor of future hypertension (8,(14)(15)(16)(17)(18), in some cases, as much as 36 y later (3).”
From A high fat meal increases cardiovascular reactivity to psychological stress in healthy young adults (2007) · cites this paper as [3]
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“Specifically, the reactivity hypothesis states that exaggerated responses to stress cause a cascade of pathophysiologic events that can eventually lead to sustained increases in blood pressure (1,3,10-12).”
From A high fat meal increases cardiovascular reactivity to psychological stress in healthy young adults (2007) · cites this paper as [3]
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I Diretriz de Prevenção da Aterosclerose na Infância e na Adolescência
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Brain-heart interaction in perseverative cognition
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“, lipids, glucose, and insulin) whereas the association between DBP reactivity and IMT remained significant in some (15) but not all reports (27).”
BackgroundResultMultivariate Brain Prediction of Heart Rate and Skin Conductance Responses to Social Threat
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“19 Women were ineligible for the present study if they had any of the following: (1) history of cardiovascular or cerebrovascular disease (including hypertension, coronary artery disease, angina, transient ischemic attacks, blood clotting, a myocardial infarction, and congestive heart failure); (2) a previous stroke o…”
BackgroundSelf-citationEarly life predictors of the physiological stress response later in life
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InfluentialThe Impact of Mental Stress on Cardiovascular Health—Part II
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A high fat meal increases cardiovascular reactivity to psychological stress in healthy young adults
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“Thus, a diet high in fat may contribute to the development of atherosclerosis, instigating elevations in blood pressure, which in turn can lead to a further risk of other cardiovascular events (3,4).”
BackgroundInfluentialA large-scale study of stress, emotions, and blood pressure in daily life using a digital platform
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“In all analyses, we also tested whether associations with BP recovery were independent of BP reactivity because the latter is well established as an indicator of future CHD risk (27,28).”
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“The dorsal amygdala, encompassing the central nucleus, has reciprocal connections with corticolimbic, diencephalic, and mesencephalic areas involved in cardiovascular regulation (9-12,14,16).”
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Bower, J. E., Low, C. A., Moskowitz, J. T., Sepah, S., & Epel, E. S. (2007) · Social and Personality Psychology Compass · doi:10.1111/j.1751-9004.2007.00038.x · Cited by 93
“, 2001), and that individuals who show more pronounced and persistent physiological reactivity to stress are at greater risk for disease, particularly cardiovascular disease (e.g., Cole et al., 1999; Jennings et al., 2004).”
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BackgroundPsychophysiological risk markers of cardiovascular disease
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A Brain Phenotype for Stressor‐Evoked Blood Pressure Reactivity
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“SBP reactivity was selected because of evidence that it is the parameter of cardiovascular stress reactivity most strongly related to CVD risk.(7,34) Conventionally, the predictive model would be as follows: Yn91=Xn9mbm91+en91, where en91 is a random error of N (0, r(2)In91), Yn91 is the dependent variable (ΔSBP), and…”
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“Witvliet et al. (2001) conducted the first published experimental examination of forgiveness and cardiovascular reactivity (CVR) in response to stress provocation — which may be a marker for future development of atherosclerosis (Jennings et al., 2004) and hypertension (Tuomisto et al., 2005).”
BackgroundSpouses' Cardiovascular Reactivity to Their Partners' Suffering
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“…(see Bradley & Lang, 2007 and Levenson, 1992 for reviews), and there is evidence to suggest that heightened cardiovascular reactivity over time is associated with an increased risk for cardiovascular disease (Jennings et al., 2004 ; Manuck, Marsland, Kaplan, & Williams, 1995; Treiber et al., 2003).”
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“Moreover, there is evidence that an exaggerated blood pressure response during stress challenge is prospectively related to increased carotid atherosclerosis and cardiovascular mortality.(36,37) Other potential mechanisms that may also be involved in the stimulating effects of sympathetic overactivation on cardiovascu…”
BackgroundArterial stiffness and inflammatory response to psychophysiological stress
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Introductory paper: Cardiovascular reactivity at a crossroads: Where are we now?
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“…including atherosclerosis, myocardial infarction, increased left ventricular mass, and coronary heart disease mortality (Allen et al., 1997; Barnett et al., 1997; Everson et al., 1997; Georgiades et al., 1997; Jennings et al., 2004; Kamarck et al., 1997; Kapuku et al., 1999; ∗ Corresponding author.”
BackgroundHeightened Resting Neural Activity Predicts Exaggerated Stressor-Evoked Blood Pressure Reactivity
Gianaros, P. J., Sheu, L. K., Remo, A. M., Christie, I. C., Critchley, H., & Wang, J. (2009) · Hypertension · doi:10.1161/hypertensionaha.108.126227 · Cited by 45
“All were right-handed, and none had any of the following: (1) a history of cardiovascular disease (including hypertension, stroke, myocardial infarction, congestive heart failure, and atrial and ventricular arrhythmias); (2) previous cardiovascular surgery (including coronary bypass, carotid artery, or peripheral vasc…”
BackgroundNarcissism and Cardiovascular Reactivity to Rejection Imagery1
Sommer, K. L., Kirkland, K. L., Newman, S. R., Estrella, P., & Andreassi, J. L. (2009) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.2009.00473.x · Cited by 47
Morris, A. A., Masoudi, F. A., Abdullah, A. R., Banerjee, A., Brewer, L. C., Commodore-Mensah, Y. Y., Cram, P. M., Desilvey, S. C., Hines, A. L., Ibrahim, N. E., et al. (2024) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/hcq.0000000000000133 · Cited by 48
Loria, A., D’Angelo, G., Pollock, D., & Pollock, J. (2010) · American Journal of Physiology. Regulatory Integrative and Comparative Physiology · doi:10.1152/ajpregu.00333.2009 · Cited by 40
“Acute stressors induce many physiological responses, and greater reactivity to stress or delayed poststress recovery predicts future cardiovascular disease risk (7), such as stroke (14), hypertension (37), and preclinical atherosclerosis (23, 52).”
BackgroundThe impact of informal cancer caregiving: A literature review on psychophysiological studies
Teixeira, R. J., Remondes‐Costa, S., Graça Pereira, M., & Brandão, T. (2019) · European Journal of Cancer Care · doi:10.1111/ecc.13042 · Cited by 41
“…reactivity have been recognized as being associated with atherosclerosis, hypertension, and other cardiovascular and immune disorders (e.g., Cacioppo et al., 1995; Jennings et al., 2004; Kronholm, Hyyppa, Jla, & Toikka, 1996; Matthews, Salomon, Brady, & Allen, 2003; Powell et al., 2013).”
BackgroundTyra, A. T., Fergus, T. A., & Ginty, A. T. (2024) · Health Psychology Review · doi:10.1080/17437199.2023.2251559 · Cited by 39
“…to suppress during a highly stressful situation leads to increased blood pressure and/or total peripheral resistance (TPR), which over time, can increase the risk of pre-clinical and clinical CVD (e.g., Chida & Steptoe, 2010; Jennings et al., 2004; Matthews et al., 2006; Turner et al., 2020).”
BackgroundHalonen, J. I., Dehbi, H., Hansell, A., Gulliver, J., Fecht, D., Blangiardo, M., Kelly, F. J., Chaturvedi, N., Mika Kivimaki, B., & Tonne, C. C. (2016) · Environment International · doi:10.1016/j.envint.2016.09.023 · Cited by 40
James, J. E., Gregg, M. E. D., Matyas, T. A., Hughes, B. M., & Howard, S. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.02.021 · Cited by 42
Feldt, K., Räikkönen, K., Eriksson, J. G., Andersson, S., Osmond, C., Barker, D. J. P., Phillips, D. I. W., & Kajantie, E. (2007) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1002176 · Cited by 37
Stress-induced cardiovascular reactivity and atherogenesis in adolescents
Roemmich, J. N., Feda, D. M., Seelbinder, A. M., Lambiase, M. J., Kala, G. K., & Dorn, J. P. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2010.12.030 · Cited by 38
Happy but unhealthy: The relationship between social ties and health in an emerging network
Howell, J. L., Koudenburg, N., Loschelder, D. D., Weston, D., Fransen, K., Dominicis, S. D., Gallagher, S. M., & Haslam, S. A. (2014) · European Journal of Social Psychology · doi:10.1002/ejsp.2030 · Cited by 37
Ginty, A. T., Williams, S. E., Jones, A., Roseboom, T. J., Phillips, A. C., Painter, R. C., Carroll, D., & de Rooij, S. R. (2016) · Psychophysiology · doi:10.1111/psyp.12640 · Cited by 36
“Although there are studies reporting no relationship between diminished HR reactivity and markers of CVD (Jennings et al., 2004; Matthews et al., 1998), longitudinal relationships between diminished HR reactivity and both coronary artery calcification (Matthews, Zhu, Tucker, & Whooley, 2006) and…”
BackgroundInfluentialImpact of Aerobic Training on Cardiovascular Reactivity to and Recovery From Challenge
Sloan, R. P., Shapiro, P. A., DeMeersman, R. E., Bagiella, E., Brondolo, E. N., McKinley, P. S., Crowley, O. V., Zhao, Y., Schwartz, J. E., & Myers, M. M. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31820a1174 · Cited by 35
Smith, T. W., Uchino, B. N., MacKenzie, J. J., Hicks, A. M., Campo, R., Reblin, M., Grewen, K., Amico, J. A., & Light, K. C. (2012) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2012.04.006 · Cited by 35
“, 2004), atherosclerosis (Jennings et al., 2004; Matthews et al., 2006), and stroke (Everson et al.”
BackgroundResultRoemmich, J. N., Lambiase, M. J., Balantekin, K. N., Feda, D. M., & Dorn, J. P. (2014) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000027 · Cited by 39
Associations Between Objective Sleep and Ambulatory Blood Pressure in a Community Sample
Doyle, C. Y., Ruiz, J. M., Taylor, D. J., Smyth, J. W., Flores, M. A., Dietch, J. R., Ahn, C. W., Allison, M., Smith, T. W., & Uchino, B. N. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000711 · Cited by 35
“Psychological/ behavioral factors have consistently demonstrated moderation of BP (17) with prospective data documenting their impact on underlying disease (18).”
BackgroundWallin, B. G. (2007) · Acta Physiologica · doi:10.1111/j.1748-1716.2007.01730.x · Cited by 34
Daytime Sleep Accelerates Cardiovascular Recovery after Psychological Stress
Brindle, R. C., & Conklin, S. M. (2011) · International Journal of Behavioral Medicine · doi:10.1007/s12529-011-9150-0 · Cited by 34
“A separate literature implicates exaggerated cardiovascular reactivity to psychological stress in the laboratory [7] with increased risk for cardiovascular disease in adolescents [8] and adults [9].”
BackgroundMuscle sympathetic response to arousal predicts neurovascular reactivity during mental stress
Donadio, V. A., Liguori, R., Elam, M., Karlsson, T., Giannoccaro, M. P., Pegenius, G., Giambattistelli, F., & Wallin, B. G. (2012) · The Journal of Physiology · doi:10.1113/jphysiol.2012.228981 · Cited by 32
“There is also evidence suggesting that subjects with high blood pressure reactivity are at higher risk of developing hypertension (Matthews et al. 1993; Everson et al. 1996; Carroll et al. 2001; Flaa et al. 2008; Chida & Steptoe 2010) and/or atherosclerosis (Jennings et al. 2004) later in life.”
BackgroundCardiovascular reactivity to psychological stress and carotid intima‐media thickness in children
Roemmich, J. N., Lobarinas, C. L., Joseph, P. N., Lambiase, M. J., Archer, F. D., & Dorn, J. P. (2009) · Psychophysiology · doi:10.1111/j.1469-8986.2008.00776.x · Cited by 32
Taylor, A. H., & Katomeri, M. (2005) · Psychopharmacology · doi:10.1007/s00213-005-0275-1 · Cited by 32
“2004), and progression to carotid atherosclerosis (Barnett et al. 1997; Jennings et al. 2004; Kamarck et al. 1997).”
BackgroundCardiovascular reactivity patterns and pathways to hypertension: a multivariate cluster analysis
Brindle, R. C., Ginty, A. T., Jones, A., Phillips, A. C., Roseboom, T. J., Carroll, D., Painter, R. C., & de Rooij, S. R. (2016) · Journal of Human Hypertension · doi:10.1038/jhh.2016.35 · Cited by 28
Batubo, N. P., Moore, J. B., & Zulyniak, M. A. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003499 · Cited by 35
Look on the bright side: do the benefits of optimism depend on the social nature of the stressor?
Terrill, A. L., Ruiz, J. M., & Garofalo, J. P. (2010) · Journal of Behavioral Medicine · doi:10.1007/s10865-010-9268-6 · Cited by 28
“Research on non-human primates (Manuck et al. 1988), and humans (Barnett et al. 1997; Jennings et al. 2004; Matthews et al. 2006) supports an association between exaggerated cardiovascular reactivity and disease risk (Kamarck and Lovallo 2003; Kamarck et al. 1998; Lovallo and Gerin 2003; Smith and…”
BackgroundHolt‐Lunstad, J., & Clark, B. D. (2014) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2014.05.014 · Cited by 28
“Importantly, evidence suggests that exaggerated cardiovascular reactivity to stressful situations predicts hypertension, atherosclerosis, and stroke (Matthews et al., 2004, 2006; Jennings et al., 2004; Everson et al., 2001), and an association with risk of cardiovascular disease (see Chida and Steptoe, 2010, for meta-…”
BackgroundPsychophysiological Bases of Disease ☆
Steptoe, A., & Poole, L. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.05144-0 · Cited by 28
White-Coat Hypertension Is Hypertension
Spence, J. D. (2008) · Hypertension · doi:10.1161/hypertensionaha.107.109660 · Cited by 28
Tyra, A. T., Soto, S. M., Young, D. A., & Ginty, A. T. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.08.006 · Cited by 27
Sazonova, M. A., Sinyov, V. V., Ryzhkova, A. I., Sazonova, M. D., Kirichenko, T. V., Khotina, V. A., Khasanova, Z. B., Doroschuk, N. A., Karagodin, V. P., Orekhov, A. N., et al. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22020699 · Cited by 27
“Since the psychological conflicts of modern people do not involve physical manifestations, this contributes to the excessive accumulation of glucose, lipids, and other substances produced by the organism as a result of stress, which triggers atherogenesis [17,18].”
BackgroundRubinow, D. R., & Girdler, S. S. (2011) · Depression and Anxiety · doi:10.1002/da.20833 · Cited by 27
“[168–171] Longitudinal studies in normotensives show the following: that large magnitude blood pressure responses to acute stress predict blood pressure levels or incident hypertension up to 36 years later;[16,172–174] and that cardiovascular reactivity to stressors predicts cardiac events[175–177] and the development…”
Background2024 ACC/AHA Key Data Elements and Definitions for Social Determinants of Health in Cardiology
Morris, A. A., Masoudi, F. A., Abdullah, A. R., Banerjee, A., Brewer, L. C., Commodore-Mensah, Y. Y., Cram, P. M., Desilvey, S. C., Hines, A. L., Ibrahim, N. E., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.05.034 · Cited by 26
Ginty, A. T., Hurley, P. E., & Young, D. A. (2020) · Biological Psychology · doi:10.1016/j.biopsycho.2020.107933 · Cited by 24
Protective effect of interval exercise on psychophysiological stress reactivity in children
Roemmich, J. N., Lambiase, M. J., Salvy, S., & Horvath, P. J. (2009) · Psychophysiology · doi:10.1111/j.1469-8986.2009.00808.x · Cited by 25
Tabara, Y., Kohara, K., Nakagawa, S., HANDA, J., Hayashi, M., Hamada, C., MIYAGUCHI, M., Shigemi, Y., Miki, T., & Konishi, M. (2008) · Hypertension Research · doi:10.1291/hypres.31.1219 · Cited by 25
Kamarck, T. W., Li, X., Wright, A. G. C., Muldoon, M. F., & Manuck, S. B. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000627 · Cited by 24
“Heart rate readings were not included here, because we have not previously found heart rate reactivity to be a consistent predictor of carotid artery atherosclerosis (27,28).”
Self-citationBenini, R., de Oliveira, L. L., Gomes‐de‐Souza, L., Rodrigues, B., & Crestani, C. C. (2020) · Journal of Experimental Biology · doi:10.1242/jeb.219501 · Cited by 24
“In fact, studies have documented that exaggerated stress-evoked blood pressure increase is related to enhanced cardiovascular disease risk (Jennings et al., 2004; Steptoe et al., 1996).”
BackgroundImproving cardiovascular recovery from stress with brief poststress exercise.
Chafin, S., Christenfeld, N. J. S., & Gerin, W. (2008) · Health Psychology · doi:10.1037/0278-6133.27.1(suppl.).s64 · Cited by 24
“…pressure and heart rate responses to stress are associated with damage to the cardiovascular system (Barnett, Spence, Manuck, & Jennings, 1997; Jennings et al., 2004; Kamarck et al., 1997; Matthews et al., 2004; Matthews, Woodall, & Allen, 1993; see Light, Sherwood, & Turner, 1992, for a review).”
Background
Metadata
- Authors
- Jennings, J. R., Kamarck, T. W., Everson-Rose, S. A., Kaplan, G. A., Manuck, S. B., & Salonen, J. T.
- Affiliations
- Rush University Medical Center (US)
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, Pa (J.R.J., T.W.K., S.B.M.); the Department of Preventive Medicine and Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Ill (S.A.E.-R.); the Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor (G.A.K.); and the Research Institute of Public Health and Department of Community Health and General Practice, University of Kuopio, Finland,...
- Venue
- Circulation
- Published
- 2004-10-12
- Volume
- 110
- Issue
- 15
- Pages
- 2198-2203
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2160202245
- Cited by
- 229
- References
- 35
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 7 · 2020: 11 · 2019: 6 · 2018: 22 · 2017: 6 · 2016: 11 · 2015: 5 · 2014: 10 · 2013: 11 · 2012: 16
- FWCI
- 8.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Academy of Finland
- National Heart, Lung, and Blood Institute (HL-44199, R01HL044199)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD047861)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- psychological stress, blood pressure reactivity, carotid intima-media thickness, carotid atherosclerosis, carotid plaque, systolic blood pressure, heart rate, middle-aged men, cardiovascular risk factors
- MeSH terms
- Adult, Blood Pressure, Carotid Artery Diseases, Cross-Sectional Studies, Disease Susceptibility, Finland, Follow-Up Studies, Heart Rate, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Stress, Psychological, Ultrasonography, Cohort Studies, Tunica Intima, Tunica Media
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