Mental Stress Worsens Outcomes in Women with CHD
Young women with stable coronary heart disease (CHD) are susceptible to mental stress-induced myocardial ischemia (MSIMI), according to a new study.
“We wanted to address the question of whether psychological stress affects the heart circulation of young women with heart disease differently than men of the same age,” said lead study author Viola Vaccarino, MD, PhD, of the department of epidemiology at Emory University in Atlanta. “We were interested in this question because previous studies have found that psychological factors like depression and stressful events affect cardiovascular risk in young women more markedly than in men—increasing the risk of premature heart disease in women more than in men.”
The researchers studied 686 patients (191 women) with stable CHD. Patients underwent 99mTc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. They compared quantitative and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier.
Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤ 50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. They found no significant sex differences in inducible ischemia with conventional stress.
“The extent of the difference at young age between men and women was somewhat surprising,” Dr Vaccarino said. “We were expecting to see differences, but perhaps not of this magnitude.”
Future research will look at mechanisms underlying these gender differences that they observed, and the researchers plan to follow the patients to link their findings with patients’ outcomes, she said.
“It is important that this potential vulnerability for women is recognized,” Dr Vaccarino said. “Clinicians should inquire about stress and emotional difficulties in this patient population and possibly recommend ways to ameliorate these factors. Systems of care and reimbursement policies should be more amenable towards addressing the psychosocial aspects of patients’ health status.”
—Mike Bederka
Reference:
Vaccarino V, Wilmot K, Al Mheid I, et al. Sex differences in mental stress-induced myocardial ischemia in patients with coronary heart disease [published online Aug. 24, 2016]. J Am Heart Assoc. doi: 10.1161/JAHA.116.003630.