Association Between Chronic Caregiving Stress and Impaired Endothelial Function in the Elderly

Objectives We examined the relationship between chronic caregiving stress and endothelial function. Background Evidence suggests that caregiving stress is associated with pathophysiologic processes related to atherosclerosis. Endothelial dysfunction is a possible underlying mechanism explaining the relationship between caregiving stress and cardiovascular morbidity. We investigated the relationship between chronic caregiving stress and endothelial dysfunction assessed by reactive hyperemia-induced flow-mediated dilation (FMD). Methods Seventy-eight elderly individuals participated in the study. Fifty-five were providing in-home care to a spouse with Alzheimer's disease, and 23 were married and living with a healthy, nondemented spouse. Analysis of covariance was used to examine the relationships between advancing dementia severity (Clinical Dementia Rating scores) and FMD and nitroglycerin-induced vasodilation of the brachial artery. Multiple linear regression was used to examine the relationship between years of caregiving and FMD. Results Clinical Dementia Rating scale scores were significantly related to FMD (p = 0.033), with participants caring for a spouse with moderate to severe dementia showing significantly worse FMD than those caring for a spouse with mild dementia (p = 0.028) and noncaregivers (p = 0.032). Within the caregiver sample, the number of years of caregiving was significantly related to FMD (r = -0.465, p < 0.001). Conclusions These results suggest that the chronic stress of caregiving is associated with impaired endothelial function, which may be a potential mechanistic link to the observed increased risk of cardiovascular disease in elderly caregivers. (J Am Coll Cardiol 2010;55:2599-606) (C) 2010 by the American College of Cardiology Foundation