Hypertension affects 1 in 3 Australian adults and is a major contributor to stroke and myocardial infarction. Despite the availability of various medications, over 50

Stress initiates alterations in electrophysiological brain activity that are correlated with increases in muscle sympathetic nerve activity (MSNA), heart rate (HR), and blood pressure (BP). However, we do not know if changes in brain activity occur solely in regions comprising the central autonomic network, or if other large-scale brain networks are involved in the stress-induced pressor response. To answer this question, this study measured connectivity between different brain regions at rest and during acute stress, using magnetoencephalography in 29 healthy individuals. Whole head and regions of interest analyses were performed using phase-lag indices as a connectivity metric. Regions of interest were confined to the central autonomic, sensorimotor, salience, default, and central executive networks. Functional connectivity was calculated on magnetoencephalography recordings that were filtered into delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), low gamma (30-80 Hz), and high gamma (80-120 Hz) bands. Substantial reductions in connectivity were observed during cognitive stress. These were largely characterized by reduced parahippocampal-sensorimotor connectivity in beta and high gamma bands. Moreover, reduced connectivity within the central autonomic, sensorimotor, and default mode networks was noted, specifically as a reduction in the alpha band between the precuneus and hippocampus. We observed a salience-directed switching between the default and executive networks, driven by reduced right anterior cingulate-right insula connectivity. Furthermore, we observed reduced right medial prefrontal cortex-brainstem connectivity in beta band. Our results indicate that stress influences the functional connectivity of several key brain regions that interact with multiple large-scale brain networks linked to mental and physical states.NEW & NOTEWORTHY This study reveals significant reductions in functional connectivity among several large-scale brain networks during stress. Reduced connectivity was observed within central autonomic, sensorimotor, default, salience, and executive networks in alpha (8-13 Hz), beta (13-30 Hz), and high gamma (80-120) bands, including reduced connectivity between the right medial prefrontal cortex and the brainstem.

Cardiovascular and metabolic dysfunction plays a significant role in the onset and progression of inflammation and cerebrovascular diseases, often leading to cognitive impairment. Although growing evidence highlights the link between activity in key brain regions and cardiovascular disease events, the relationship between brain dynamics and cardiovascular or metabolic profiles in healthy individuals remains largely unexplored. We performed magnetoencephalography in 29 healthy participants (12 males and 17 females; aged 19-72 yr). Brain activity, calculated as neural activity index (NAI), was determined in 15 regions of interest in each participant. Brachial and central blood pressure (BP), arterial stiffness, and metabolic profile were assessed. Brachial diastolic BP correlated positively with NAI in the right parahippocampal gyrus, insula, and amygdala (across several frequency bands), whereas both central systolic and diastolic BP correlated positively with NAI in the left orbitofrontal cortex (θ and α bands). Arterial stiffness measured via augmentation index correlated negatively with NAI in the left and right medial prefrontal cortex (δ and high-γ bands), whereas pulse wave velocity correlated positively with the left caudate (θ and α bands). NAI in several brain regions showed associations with metabolic parameters (lipid levels, kidney function, and liver proteins), including the middle frontal gyrus, anterior cingulate gyrus, lateral occipital cortex, precuneus, insula, parahippocampal gyrus, hippocampus, amygdala, putamen, and thalamus (across several frequency bands). We have shown that activity in key brain regions correlated with cardiovascular and metabolic profiles in healthy individuals, suggesting that regions involved in cognitive and emotional processing may be influenced by or contribute to cardiovascular and metabolic health.NEW & NOTEWORTHY Using magnetoencephalography, we have shown for the first time, a non-task-related association of resting-state brain dynamics with cardiovascular and metabolic profiles in a group of healthy individuals. These findings are important in understanding that even in healthy individuals, early associations between brain function and cardiovascular-metabolic health can be detected before the development of any disease states.

Exaggerated blood pressure and vasoconstriction responses during acute mental stress are prospectively associated with an increased risk of hypertension, arrhythmia, and vascular dysfunction. This study assessed electrophysiological brain power and cardiovascular response to acute psychological stress during concurrent recordings of magnetoencephalography, muscle sympathetic nerve activity, and blood pressure in 29 healthy participants. Brain power was filtered through delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), low gamma (30-80 Hz), and high gamma (80-120 Hz) bands. Stress induced significant increases in systolic blood pressure (SBP), 5.2 ± 5.6 mmHg, heart rate, 4.1 ± 4.8 beats/min, and sympathetic nerve activity, 4.0 ± 8.0 bursts per minute (means ± SD, P < 5). Whole head and region of interest analyses showed stress induced significant increases in delta power in the right medial frontal cortex, anterior cingulate, and amygdala. Alternatively, there were significant decreases in alpha power in the left and right precuneus, posterior cingulate, hippocampus, and in the right thalamus and insula. Correlation analyses revealed that reduced alpha power in the right insula was correlated with SBP (r = 0.446). Moreover, reduced alpha power in the left amygdala was correlated with SBP (r = 0.392), anxiety, and depression inventory scores, P < 0.01. The reduced alpha power in the insula and amygdala was pronounced in participants displaying heightened sympathetic nerve reactivity to stress. Similarly, participants who displayed higher mean SBP reactivity (of 19 mmHg) to stress showed reduced alpha power in the precuneus, hippocampus, and amygdala. Our results suggest that regionalized and frequency-specific brain power is involved in neurogenic blood pressure regulation in normotensive individuals.NEW & NOTEWORTHY This study illustrates a correlation between electrophysiological brain power, sympathetic nerve activity, and blood pressure in response to stress. Notable mental stress-induced changes were observed, including an increase in delta power in the frontal regions and a decrease in alpha power in the temporal and parietal regions. The diminished alpha power in the insula, amygdala, precuneus, and hippocampus was particularly significant among individuals exhibiting greater vasoconstrictor activity and a higher increase in systolic blood pressure.

OBJECTIVE:This study aimed to investigate whether transcutaneous vagus nerve stimulation (tVNS) at different frequencies affects phase-amplitude coupling among regions of the brain linked to mood and memory disorders using simultaneous magnetoencephalography (MEG) in healthy participants. MATERIALS AND METHODS:Phase-amplitude coupling was measured among brain areas in response to different stimulation frequencies of tVNS using concurrent MEG and tVNS in 17 healthy participants. The 4 protocols were: 24 Hz cymba concha, 1 Hz cymba concha, PFM cymba concha, and 24 Hz ear lobe. A driven autoregressive method was used to estimate the coupling among brain areas in different physiological frequency bands in response to these protocols. RESULTS:Different tVNS stimulation protocols led to alterations in phase-amplitude coupling among multiple brain regions linked to mood and memory, notably the prefrontal cortex, hippocampus, and temporal pole. Stimulation delivered at 24 Hz was observed to decrease delta-gamma coupling within the temporal pole and cingulate cortex when contrasted with 24-Hz sham stimulation. Increased alpha-gamma coupling was observed between the hippocampus and prefrontal cortex when contrasting 24 Hz with pulse-frequency-modulated stimulation. Finally, a comparison of 24-Hz with low-frequency 1-Hz stimulation showed an increase in theta-gamma coupling within the prefrontal cortex. SIGNIFICANCE:To our knowledge, this study represents the first attempt to quantify phase-amplitude coupling in response to tVNS and suggests that different stimulation frequencies can modulate coupling between different areas of the brain. Abnormal phase-amplitude coupling has been linked to multiple mood and memory disorders. Further investigations using different stimulation frequencies of tVNS to alter phase-amplitude coupling may lead to the development of tVNS as a therapeutic option for different medical conditions.

PURPOSE:Increased adiposity is associated with the development of cardiometabolic disturbances, with sympathetic dysregulation playing a crucial role in the early phase. Both adiposity and chronic sympathetic activation may impair cerebral function, increasing the risk of neurodegenerative diseases. However, whether adiposity and sympathetic activity are associated with brain dynamics in the healthy state is not fully understood. METHODS:We performed magnetoencephalography in 29 healthy participants (12 males and 17 females; age 19-72 years; body fat percentage 7-45.3%) to record brain dynamics as neural activity index and functional connectivity. Adiposity was assessed using body fat percentage and microneurography was used to assess muscle sympathetic nerve activity. RESULTS:Individuals with higher fat percentage had higher muscle sympathetic nerve activity. Group comparison showed lower activity in the left posterior cingulate gyrus (delta and theta bands) and left precuneus (delta band) in individuals with higher fat percentage. Stronger connectivity between the right superior frontal gyrus and left temporal pole (delta band) was also seen in this group. Neural activity index in the right caudate (theta and low-gamma bands) correlated positively with muscle sympathetic nerve activity while correlating negatively with body fat percentage. CONCLUSION:We have shown that resting-state brain activity and functional connectivity are associated with adiposity and sympathetic activity even in healthy individuals with no manifest cardiometabolic diseases. Thus, the findings highlight that understanding central pathways associated with the healthy state may help to uncover the pathophysiology of obesity and associated metabolic disorders.

Background: Renal denervation (RDN) has been consistently shown in recent sham-controlled clinical trials to reduce blood pressure (BP). Salt sensitivity is a critical factor in hypertension pathogenesis, but cumbersome to assess by gold-standard methodology. Twenty-four-hour average heart rate (HR) and mean arterial pressure (MAP) dipping, taken by ambulatory blood pressure monitoring (ABPM), stratifies patients into high, moderate, and low salt sensitivity index (SSI) risk categories. Objectives: We aimed to assess whether ABPM-derived SSI risk could predict the systolic blood pressure reduction at long-term follow-up in a real-world RDN patient cohort. Methods: Sixty participants had repeat ABPM as part of a renal denervation long-term follow-up. Average time since RDN was 8.9 ± 1.2 years. Based on baseline ABPM, participants were stratified into low (HR < 70 bpm and MAP dipping > 10%), moderate (HR ≥70 bpm or MAP dipping ≤ 10%), and high (HR ≥ 70 bpm and MAP dipping ≤ 10%) SSI risk groups, respectively. Results: One-way ANOVA indicated a significant treatment effect ( P = 0.03) between low ( n = 15), moderate ( n = 35), and high ( n = 10) SSI risk with systolic BP reduction of 9.6 ± 3.7 mmHg, 8.4 ± 3.5 mmHg, and 28.2 ± 9.6 mmHg, respectively. Baseline BP was not significantly different between SSI Risk groups ( P = 0.18). High SSI risk independently correlated with systolic BP reduction ( P = 0.02). Conclusions: Our investigation indicates that SSI risk may be a simple and accessible measure for predicting the BP response to RDN. However, the influence of pharmacological therapy on these participants is an important extraneous variable requiring testing in prospective or drug naive RDN cohorts.

The sympathetic nervous system is involved in cardiovascular regulation and metabolic function. When weight gain occurs, excess adiposity impacts neural and humoral functions. Increased bioactive mediators, including cytokines, adipokines, and free fatty acids released from fat, in conjunction with regionally specific changes in sympathetic nervous activity and abnormal sympathetic regulation, have profound effects on many metabolic regulatory processes and target organ function, favoring the development of insulin resistance, dyslipidemia, high blood pressure, renal disease, inflammation, and atherosclerosis. Through these multiple pathways, excess weight is accompanied by an increased prevalence of comorbidities and is associated with significant morbidity and early mortality. Changes in sympathetic tone associated with weight loss play an integral part in improving many of the metabolic and cardiovascular risk factors associated with obesity.

Purpose Mental stress is of essential consideration when assessing cardiovascular pathophysiology in all patient populations. Substantial evidence indicates associations among stress, cardiovascular disease and aberrant brain–body communication. However, our understanding of the flow of stress information in humans, is limited, despite the crucial insights this area may offer into future therapeutic targets for clinical intervention. Methods Key terms including mental stress, cardiovascular disease and central control, were searched in PubMed, ScienceDirect and Scopus databases. Articles indicative of heart rate and blood pressure regulation, or central control of cardiovascular disease through direct neural innervation of the cardiac, splanchnic and vascular regions were included. Focus on human neuroimaging research and the flow of stress information is described, before brain–body connectivity, via pre-motor brainstem intermediates is discussed. Lastly, we review current understandings of pathophysiological stress and cardiovascular disease aetiology. Results Structural and functional changes to corticolimbic circuitry encode stress information, integrated by the hypothalamus and amygdala. Pre-autonomic brain–body relays to brainstem and spinal cord nuclei establish dysautonomia and lead to alterations in baroreflex functioning, firing of the sympathetic fibres, cellular reuptake of norepinephrine and withdrawal of the parasympathetic reflex. The combined result is profoundly adrenergic and increases the likelihood of cardiac myopathy, arrhythmogenesis, coronary ischaemia, hypertension and the overall risk of future sudden stress-induced heart failure. Conclusions There is undeniable support that mental stress contributes to the development of cardiovascular disease. The emerging accumulation of large-scale multimodal neuroimaging data analytics to assess this relationship promises exciting novel therapeutic targets for future cardiovascular disease detection and prevention.

Abstract Loneliness is recognised as a risk factor for cardiovascular disease development. However, it is unclear whether loneliness itself or other closely related mental health symptoms, such as depression and social anxiety, are associated with the development of cardiovascular disease. In the present study, we examined the relationship between loneliness and several early cardiovascular disease markers in young adults, after controlling for depression and social anxiety. Sixty-six young adults (18–35 years old, M age = 22.70; 75.8% females) completed psychological questionnaires and took part in several physiological tests assessing cardiovascular health (e.g., vascular function). Results revealed higher loneliness was significantly associated with shorter pulse transit time (β = − 0.70, p = 0.002; shorter pulse transit time is a subclinical marker for arterial stiffness). Additionally, results show that while loneliness and depression were both related to vascular dysfunction in young adults, the underlining physiological mechanisms through which they affect vascular function may be different. Specifically, higher loneliness was associated with increased arterial stiffness, whereas depression was associated with increased endothelial dysfunction (β = − 0.43, p = 0.04). Our findings indicate that presence of loneliness and depression in young adults may be accompanied by early indicators of poor cardiovascular health, such as arterial stiffness and endothelial dysfunction. Results from the study further support the link between loneliness and cardiovascular disease development.

BACKGROUND:Renal denervation is a recognized adjunct therapy for hypertension with clinically significant blood pressure (BP)-lowering effects. Long-term follow-up data are critical to ascertain durability of the effect and safety. Aside from the 36-month follow-up data available from randomized control trials, recent cohort analyses extended follow-up out to 10 years. We sought to analyze study-level data and quantify the ambulatory BP reduction of renal denervation across contemporary randomized sham-controlled trials and available long-term follow-up data up to 10 years from observational studies. METHODS:A systematic review was performed with data from 4 observational studies with follow-up out to 10 years and 2 randomized controlled trials meeting search and inclusion criteria with follow-up data out to 36 months. Study-level data were extracted and compared statistically. RESULTS:In 2 contemporary randomized controlled trials with 36-month follow-up, an average sham-adjusted ambulatory systolic BP reduction of -12.7±4.5 mm Hg from baseline was observed (P=0.05). Likewise, a -14.8±3.4 mm Hg ambulatory systolic BP reduction was found across observational studies with a mean long-term follow-up of 7.7±2.8 years (range, 3.5-9.4 years; P=0.0051). The observed reduction in estimated glomerular filtration rate across the long-term follow-up was in line with the predicted age-related decline. Antihypertensive drug burden was similar at baseline and follow-up. CONCLUSIONS:Renal denervation is associated with a significant and clinically meaningful reduction in ambulatory systolic BP in both contemporary randomized sham-controlled trials up to 36 months and observational cohort studies up to 10 years without adverse consequences on renal function.

Background: Recent sham-controlled randomized clinical trials have confirmed the safety and efficacy of catheter-based renal denervation (RDN). Long-term safety and efficacy data beyond 3 years are scarce. Here, we report on outcomes after RDN in a cohort of patients with resistant hypertension with an average of ≈9-year follow-up (FU). Methods: We recruited patients with resistant hypertension who were previously enrolled in various RDN trials applying radiofrequency energy for blood pressure (BP) lowering. All participants had baseline assessments before RDN and repeat assessment at long-term FU including medical history, automated office and ambulatory BP measurement, and routine blood and urine tests. We analyzed changes between baseline and long-term FU. Results: A total of 66 participants (mean±SD, 70.0±10.3 years; 76.3% men) completed long-term FU investigations with a mean of 8.8±1.2 years post-procedure. Compared with baseline, ambulatory systolic BP was reduced by −12.1±21.6 (from 145.2 to 133.1) mm Hg ( P <0.0001) and diastolic BP by −8.8±12.8 (from 81.2 to 72.7) mm Hg ( P <0.0001). Mean heart rate remained unchanged. At long-term FU, participants were on one less antihypertensive medication compared with baseline ( P =0.0052). Renal function assessed by estimated glomerular filtration rate fell within the expected age-associated rate of decline from 71.1 to 61.2 mL/min per 1.73 m 2 . Time above target was reduced significantly from 75.0±25.9% at baseline to 47.3±30.3% at long-term FU ( P <0.0001). Conclusions: RDN results in a significant and robust reduction in both office and ambulatory systolic and diastolic BP at ≈9-year FU after catheter-based RDN on less medication and without evidence of adverse consequences on renal function.

Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive method of brain stimulation that has been investigated for its use in the clinical treatment of a number of different conditions. There has been little investigation into the stimulation current that is delivered and the effect on individual variability in response to tVNS.Seventeen participants underwent tVNS, and stimulation current was determined based on individual pain threshold. To investigate individual variability, brain dynamics were measured concurrently using magnetoencephalography (MEG) in response to two different stimulation protocols of tVNS. The first protocol consisted of a sequence of equally spaced short (1ms) stimulation pulses applied 24 times per second (24 Hz), and the second consisted of a sequence of 24 pulses per second spaced according to a 6 Hz pulse frequency modulation (PFM). Both stimulation sequences were delivered to the cymba concha in the left ear.The difference in brain responses to the two sequences was initially calculated using a one-sample t-test at the group level, based on z-scoring of the data at the individual level, and no statistically significant differences were observed. Further investigation of individual variability suggested that participants fell into two groups; one that responded more strongly to 24 Hz and one that responded more strongly to the irregular spacing of pulses in the PFM protocol.We tested whether the stimulation current that the participant received could predict how they would respond to the stimulation, but we did not observe any correlation. This supports the literature that suggests that selecting stimulation current based on individual pain threshold is a suitable procedure for tVNS, and higher stimulation intensities does not correspond to stronger brain response. Further investigation into individual variability in response to different frequencies and pulse spacing of tVNS should also be investigated further and may lead to the development of personalised stimulation protocols.Clinical relevance— The stimulation current at which tVNS is delivered does not appear to influence brain response to stimulation, and the value of stimulation current should be selected based on individual participant comfort.

Objective.The percentages of cardiac and sympathetic baroreflex patterns detected via baroreflex sequence (SEQ) technique from spontaneous variability of heart period (HP) and systolic arterial pressure (SAP) and of muscle nerve sympathetic activity (MSNA) burst rate and diastolic arterial pressure (DAP) are utilized to assess the level of the baroreflex engagement. The cardiac baroreflex patterns can be distinguished in those featuring both HP and SAP increases (cSEQ++) and decreases (cSEQ--), while the sympathetic baroreflex patterns in those featuring a MSNA burst rate decrease and a DAP increase (sSEQ+-) and vice versa (sSEQ-+). The present study aims to assess the modifications of the involvement of the cardiac and sympathetic arms of the baroreflex with age and postural stimulus intensity.Approach.We monitored the percentages of cSEQ++ (%cSEQ++) and cSEQ-- (%cSEQ--) in 100 healthy subjects (age: 21-70 years, 54 males, 46 females), divided into five sex-balanced groups consisting of 20 subjects in each decade at rest in supine position and during active standing (STAND). We evaluated %cSEQ++, %cSEQ--, and the percentages of sSEQ+- (%sSEQ+-) and sSEQ-+ (%sSEQ-+) in 12 young healthy subjects (age 23 ± 2 years, 3 females, 9 males) undergoing incremental head-up tilt.Main results.We found that: (i) %cSEQ++ and %cSEQ-- decreased with age and increased with STAND and postural stimulus intensity; (ii) %sSEQ+- and %sSEQ-+ augmented with postural challenge magnitude; (iii) the level of cardiac and sympathetic baroreflex engagement did not depend on either the absolute value of arterial pressure or the direction of its changes.Significance.This study stresses the limited ability of the cardiac and sympathetic arms of the baroreflex in controlling absolute arterial pressure values and the equivalent ability of both positive and negative arterial pressure changes in soliciting them.

Cardiovascular and metabolic complications associated with excess adiposity are linked to chronic activation of the sympathetic nervous system, resulting in a high risk of mortality among obese individuals. Obesity-related positive energy balance underlies the progression of hypertension, end-organ damage, and insulin resistance, driven by increased sympathetic tone throughout the body. It is, therefore, important to understand the central network that drives and maintains sustained activation of the sympathetic nervous system in the obese state. Experimental and clinical studies have identified structural changes and altered dynamics in both grey and white matter regions in obesity. Aberrant activation in certain brain regions has been associated with altered reward circuitry and metabolic pathways including leptin and insulin signaling along with adiposity-driven systemic and central inflammation. The impact of these pathways on the brain via overactivity of the sympathetic nervous system has gained interest in the past decade. Primarily, the brainstem, hypothalamus, amygdala, hippocampus, and cortical structures including the insular, orbitofrontal, temporal, cingulate, and prefrontal cortices have been identified in this context. Although the central network involving these structures is much more intricate, this review highlights recent evidence identifying these regions in sympathetic overactivity in obesity.

Patients with psychogenic non-epileptic seizures (PNES) may exhibit similar clinical features to patients with epileptic seizures (ES). Misdiagnosis of PNES and ES can lead to inappropriate treatment and significant morbidity. This study investigates the use of machine learning techniques for classification of PNES and ES based on electroencephalography (EEG) and electrocardiography (ECG) data. Video-EEG-ECG of 150 ES events from 16 patients and 96 PNES from 10 patients were analysed. Four preictal periods (time before event onset) in EEG and ECG data were selected for each PNES and ES event (60-45 min, 45-30 min, 30-15 min, 15-0 min). Time-domain features were extracted from each preictal data segment in 17 EEG channels and 1 ECG channel. The classification performance using k-nearest neighbour, decision tree, random forest, naive Bayes, and support vector machine classifiers were evaluated. The results showed the highest classification accuracy was 87.83% using the random forest on 15-0 min preictal period of EEG and ECG data. The performance was significantly higher using 15-0 min preictal period data than 30-15 min, 45-30 min, and 60-45 min preictal periods ( [Formula: see text]). The classification accuracy was improved from 86.37% to 87.83% by combining ECG data with EEG data ( [Formula: see text]). The study provided an automated classification algorithm for PNES and ES events using machine learning techniques on preictal EEG and ECG data.

It was on 6 June, 2007 that catheter-based renal denervation was first used experimentally to treat a patient with hypertension. The introduction of renal denervation into the routine clinical care of hypertension has had a long gestation, but a tipping point has now been reached, justified by the clinical trial evidence. The theoretical basis for this device therapy remains strong, the antihypertensive effect of renal denervation in animal models of hypertension, and the existence of activation of the renal sympathetic outflow in essential hypertension. Notably, renal sympathetic activation is present in obesity-hypertension, despite the cardiac sympathetic outflow being normal. Selecting those patients with hypertension who will benefit most from renal denervation is now the key issue. Choosing primarily patients with neurogenic essential hypertension will not be feasible, as the testing required to do this accurately is too complicated. Most likely the target hypertension population for RDN will be those patients with treated but uncontrolled hypertension. This will be because of the evident clinical need, but also because of something additional and counter-intuitive. Patients with uncontrolled hypertension are commonly nonadherent with their antihypertensive prescription. Testing has shown that many would prefer device over drug therapy for their hypertension. Selectively treating this patient group with RDN thus becomes congruent with patient-centred therapy. Pharmacological treatment of hypertension commonly fails to lower blood pressure to target, for multiple reasons, but importantly due to patient nonadherence to the antihypertensive prescription. Faced with this therapeutic failure, devices which treat hypertension are increasingly being evaluated. Of these, catheter-based renal denervation has the strongest evidence base.

Purpose Stress produces many physiological changes, some of which may contribute to the development of cardiovascular disease (CVD). Individuals with intellectual disability (ID) are exposed to multiple and stressful challenges everyday which may put them at increased cardiovascular risk. This current study aimed to establish whether adults with ID experience higher levels of subjective stress and encounter different stressors (including social isolation) than the general population, and whether there is a relationship between stress and cardiometabolic profile in this population. Methods Adults with ID (n = 35) aged 18-45 years completed the Subjective Stress Survey, and underwent a physiological assessment to measure blood pressure, metabolic profile and subclinical CVD risk factors, and were compared to a control group (n = 29). Multiple regression was used to investigate whether cardiometabolic parameters were predicative of SSS scores. Results Findings showed adults with ID have higher perceived stress levels (total score ID: 21.3 +/- 11.4 vs control: 13.9 +/- 9.0, p = 0.006), which is elicited by unique stressors, when compared to people without ID. Stress was strongly associated with increased social isolation (r = -0.38, p = 0.002) and with obesity in females with mild ID (r = 0.72). Regression showed that arterial stiffness was predictive of total SSS score (p = 0.038). Conclusions Adults with ID aged 18-45 years report higher levels of perceived stress when compared to people without ID.

ObjectivesIn current study, we aim to extend previous research by investigating the unique impact of loneliness on health literacy and health-related factors of young adults, after controlling for social isolation, depressive symptomology, and social anxiety, as well as evaluate how social isolation and loneliness differ in their impact on health literacy, and health-related factors among young adults, after accounting for abovementioned concomitant variables.MethodsUsing a cross-sectional study design, 521 young adults completed an online survey in 2020, where they self-reported their loneliness, social isolation, health-related factors, and health literacy data.ResultsIncreased loneliness was associated with decrease in several health literacy domains (e.g., poorer social support for health, lower appraisal of health information, among others) and increase in some health-related factors (e.g., higher perceived stress, higher negative affect), among young adults, even after controlling for social anxiety, depressive symptomology, and social isolation. Contrastingly, increase in social isolation was associated with changes in some health-related factors - more somatic health complaints, higher alcohol use, poorer cognitive and physical functioning, and lower scores for only one health literacy domain (i.e., social support for health) among young adults, after adjusting for the influence of social anxiety, depressive symptomology, and loneliness.ConclusionEven after accounting for the influence of several co-occurring social and mental health symptoms, higher loneliness was associated poorer health literacy and health-related factors in young adults. We also found loneliness and social isolation may differ in the mechanisms through which they impact health literacy and health-related factors in young adults.