Abstract

Background

Individuals engage in a range of behaviors to maintain close relationships. One behavior is self-silencing or inhibiting self-expression to avoid relationship conflict or loss. Self-silencing is related to poor mental health and self-reported physical health in women but has not been examined in relation to cardiovascular health, particularly using direct measures of the vasculature.

Purpose

To test associations between self-silencing and carotid atherosclerosis in midlife women; secondary analyses examined moderation by race/ethnicity.

Methods

Women (N = 290, ages 40–60) reported on self-silencing in intimate relationships and underwent physical measurements, blood draw, and ultrasound assessment of carotid intima–media thickness (IMT) and plaque. Associations between self-silencing and mean IMT and plaque index (0, 1, ≥2) were tested in linear regression and multinomial logistic regression models, respectively, followed by interaction terms between self-silencing and race, adjusted for demographic factors, CVD risk factors, partner status, depression, physical activity, and diet.

Results

Forty-seven percent of women demonstrated carotid plaque. Greater self-silencing was related to increased odds of plaque index ≥2 (e.g., for each additional point, odds ratio [95% confidence interval] = 1.16 [1.03–1.31], p = .012), relative to no plaque). Moderation analyses indicated that self-silencing was related to odds of plaque index ≥2 in non-white women (1.15 [1.05–1.26], p = .004), but there was no significant relationship in white women (1.01 [0.97–1.06], p = .550). No associations emerged for IMT.

Conclusions

Among midlife women, self-silencing was associated with carotid plaque, independent of CVD risk factors, depression, and health behaviors. Emotional expression in relationships may be important for women’s cardiovascular health.

中文翻译：

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沉默的心血管成本：中年女性自我沉默与颈动脉粥样硬化之间的关系

摘要

背景

个人从事一系列行为以维持密切的关系。一种行为是自我沉默或抑制自我表达，以避免关系冲突或损失。自我沉默与女性较差的心理健康和自我报告的身体健康有关，但尚未对心血管健康进行检查，特别是使用脉管系统的直接测量。

目的

测试中年女性自我沉默与颈动脉粥样硬化之间的关联；次要分析检查了种族/民族的适度性。

方法

女性（N = 290，40-60 岁）报告了亲密关系中的自我沉默，并接受了身体测量、抽血和颈动脉内膜中层厚度 (IMT) 和斑块的超声评估。自我沉默与平均 IMT 和斑块指数 (0, 1, ≥2) 之间的关联分别在线性回归和多项逻辑回归模型中进行了测试，然后是自我沉默与种族之间的交互项，并根据人口因素、CVD 风险进行了调整因素、伴侣状态、抑郁、体力活动和饮食。

结果

47% 的女性表现出颈动脉斑块。更大的自我沉默与斑块指数≥2 的几率增加有关（例如，相对于没有斑块，对于每个额外的点，优势比 [95% 置信区间] = 1.16 [1.03–1.31]，p = .012）。适度分析表明，自我沉默与非白人女性斑块指数≥2的几率有关（1.15 [1.05-1.26]，p = .004），但在白人女​​性中没有显着相关性（1.01 [0.97-1.06] ]，p = .550)。IMT 没有出现任何关联。

结论

在中年女性中，自我沉默与颈动脉斑块相关，与 CVD 危险因素、抑郁和健康行为无关。人际关系中的情感表达可能对女性的心血管健康很重要。