ESTRÉS PSICOLÓGICO

4.1 ESTRATO SOCIOECONÓMICO 

Las condiciones de vida afectan considerablemente la fisiología del organismo. Bajos estratos económicos están relacionados con mayor incidencia de enfermedad coronaria  (99), aterosclerosis carotidea y calcificación aortica y coronaria  (100,101). También se asocia con factores de riesgo como fumar, tomar alcohol en exceso, sedentarismo, HDL bajo, y LDL muy superiores al normal, obesidad central e intolerancia a la glucosa  (102,103).

Aunque se conoce la relación entre estrés y el estrato socioeconómico, aún no se comprenden del todo los mecanismos desencadenantes, sin embargo algunos estudios ya dejan ilustrarlos mejor  (104). 

4.2 DIFERENCIAS SEGÚN EL SEXO 

Existen diferencias significativas en el eje hipotálamo-pituitario-adrenal según el sexo, también es considerable las diferencias que se dan en la percepción del estrés y en los hábitos de vida.

A nivel adrenal, las mujeres son mucho más sensibles al ACTH que los hombres (105). En muchos estudios independientes, se muestra que los hombres jóvenes muestran apreciables mayores respuestas del eje hipotálamo-pituitario-adrenal que las mujeres (106,107). La diferencia en la respuesta se debe principalmente a las hormonas esteroideas gonadales (108).El estradiol posee efectos moduladores sobre los receptores de corticoides y glucocorticoides. Más aún, el estradiol puede incrementar la trascripción del gen para CRF en el hipotálamo (109). La testosterona ejerce un efecto similar al ser metabolizada a estrógenos por aromatización en el cerebro y tejidos perifericos (110). Aunque la mujer parece ser más sensitiva a los niveles pituitarios y adrenales, los altos niveles de testosterona y estradiol en hombres jóvenes explica el incremento de niveles de ACTH y Cortisol después de estimulación suprapituitaria (108). 

4.3 EFECTOS PERJUDICIALES DE LA RESPUESTA 

La alostasis es indispensable para la supervivencia. El precio que la supervivencia tiene sobre el organismo se denomina carga alostásica, que se asocia con la cronicidad en la presencia de hormonas del estrés. La ausencia al estrés repetido del mismo tipo, o la incapacidad para evitar respuestas alostásicas exageradas cuando ya ha finalizado el estrés, y respuestas inadecuadas de los sistemas alostásicos; el consumo de alcohol, cigarrillo, dieta y ejercicio también están relacionados con la carga alostásica. Una dieta rica en grasas saturadas acelera la aterosclerosis y progreso de la diabetes mellitus tipo II, incrementando secreción de cortisol y produciendo deposición de grasa y resistencia a la insulina. La medición de la carga alostásica se efectúa mediante la cuantificación de variables fisiológicas como presión arterial sistólica, cortisol urinario nocturno, excreción de catecolaminas, medidas de cintura y cadera, valor de la hemoglobina glicosilada, porcentaje de LDL, concentración sérica de dehidroepiandrosterona-sulfato y concentración de HDL sérica. La mayor carga alostásica está muy asocia con el riesgo de una centena de enfermedades (104).

Estudios reportan que el estrés psicológico repetido se traduce en una menor liberación de catecolaminas y habituación a su acción (105). El estrés psicológico repetido produce una disociación de las respuestas del eje hipotálamo-pituitario-adrenal y el SAM  (Simpathetic-adrenal-medullary) (112). Un incremento en la carga alostásica debida al HPA y al SAM ante estrés repetido puede hacer al individuo vulnerable a múltiples patologías. 

El significado clínico del estudio del estrés se focaliza sobre cuatro sistemas: cardiovascular  (falla cardiaca e hipertensión), inmunitario  (autoinmunidad, cáncer y alergias), metabólicos  (obesidad) y nervioso  (depresión, ansiedad). Para estos sistemas, el estrés es un factor de riesgo (113). La interacción inseparable entre los sistemas alóstasicos hace que el estudio de estos mecanismos sean la esperanza para encontrar tratamientos farmacológicos asociados a la carga alostásica (114).

Las investigaciones más actuales se dirigen a determinar el efecto del estrés psicológico sobre el material genético. El estrés psicológico puede afectar a la célula a través de tres rutas: función celular inmune, estrés oxidativo o actividad de la telomerasa (115). EL estrés crónico podría inducir estrés oxidativo por activación crónica de las respuestas neuroendocrinas y autonómicas. GCs aumentan daño neuronal por estrés oxidativo, en parte debido al incremento de glutamato y Ca2+ y decrecimiento de enzimas antioxidantes (116,117). Este efecto, con daño oxidativo del DNA es notable en mujeres (118), el estrés oxidativo corta los telómeros in vivo (119); este efecto ya ha sido demostrado in vivo, estrés psicológico alarga los telómeros, sin embargo, se desconoce la tasa a la cual sucede este incremento (115). 

CONCLUSIÓN 

El estrés psicológico está presente en el diario vivir. Las nuevas investigaciones han arrojado resultados que visualizan los mecanismos alóstasicos en respuesta al estrés y permiten relacionarlos con estados patológicos que aún no están del todo claros. Las redes inmunoneuroendocrinas dirigen estas respuestas e implican el cuerpo como un conjunto inseparable.

Así mismo, importantes relaciones socioeconómicas y medio ambientales como determinantes en la percepción y factores de riesgo de desarrollar alteraciones funcionales como resultado de la carga alostásica. El estrés psicológico e sin duda, de indispensable comprensión para el manejo de los estados fisiológicos del organismo. 

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