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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1996;16:275-280.)
© 1996 American Heart Association, Inc.

Articles

Vital Exhaustion, Anger Expression, and Pituitary and Adrenocortical Hormones

Implications for the Insulin Resistance Syndrome

Liisa Keltikangas-Järvinen; Katri Räikkönen; Aarno Hautanen; Herman Adlercreutz

From the Departments of Psychology (L.K.-J., K.R.) and Clinical Chemistry (A.H., H.A.), University of Helsinki, Helsinki, Finland.

Correspondence to Professor Liisa Keltikangas-Järvinen, Department of Psychology, University of Helsinki, PO Box 4, FIN-00014 University of Helsinki, Finland.

Abstract This study was undertaken to examine whether there are psychological factors that can incline an individual toward coronary heart disease and that can in turn identify a pattern of pituitary and adrenocortical responses that is associated with the Insulin Resistance Syndrome (IRS). The study was performed with 69 normotensive and 21 unmedicated borderline hypertensive men (age range, 30 to 55 years). Type A behavior, hostility (defined as cynicism, pessimism, and paranoia), vital exhaustion, and anger expressions were the behavioral variables studied. Among these, only the vital exhaustion–anger-out factor identified the neuroendocrine pattern that predicted the IRS. This neuroendocrine pattern consisted primarily of an adrenal responsiveness to ACTH and secondarily of a high mean basal cortisol–to–mean basal ACTH ratio. The contribution of this last variable was, however, slightly questionable. Instead of the traditional coronary-prone factors, ie, type A behavior and hostility, the findings emphasize the significance of vital exhaustion and emotional distress. The findings have been discussed in terms of defeat reaction, hypocortisolemia, and visceral obesity.

Key Words: vital exhaustion • ACTH • cortisol • insulin resistance

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