Sex Differences in Mental Stress-Induced Myocardial Ischemia in Young Survivors of an Acute Myocardial Infarction

• Type of Material: Article
• Authors: Laura Vaccarino, Emory University; Amit J. Shah, Emory University; Cherie Rooks, Emory University; Ijeoma Ibeanu, Emory University; Jonathon A Nye, Emory University; Pratik Pimple, Emory University; Amy Salerno, Emory University; Luis D'Marco, Emory University; Cristina Karohl, Emory University; J. Douglas Bremner, Emory University; Paolo Raggi, Emory University
• Language: English
• Date: 2014-04-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2014 by the American Psychosomatic Society.
• Final Published Version (URL): http://dx.doi.org/10.1097/PSY.0000000000000045
• Title of Journal or Parent Work: Psychosomatic Medicine
• ISSN: 0033-3174
• Volume: 76
• Issue: 3
• Start Page: 171
• End Page: 180
• Grant/Funding Information: This work was supported by the National Institutes of Health (R21HL093665; R21HL093665-01A1S1; R01 HL109413; K24HL077506; and K24 MH076955).
• Keywords: Psychology, Multidisciplinary; DYSFUNCTION; Psychology; EXERCISE; CHEST-PAIN; MORTALITY; CORONARY-ARTERY-DISEASE; stress; Social Sciences; cardiovascular diseases; EMISSION COMPUTED-TOMOGRAPHY; PROGNOSTIC VALUE; Psychiatry; RISK-FACTORS; ischemia; WOMEN; HEART-DISEASE; Life Sciences & Biomedicine; sex; Science & Technology
• Research Categories: Health Sciences, Epidemiology; Psychology, Clinical; Health Sciences, Medicine and Surgery

Abstract

OBJECTIVES: Emotional stress may disproportionally affect young women with ischemic heart disease. We sought to examine whether mental stress-induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than in men. METHODS: We studied 98 post-MI patients (49 women and 49 men) aged 38 to 60 years. Women and men were matched for age, MI type, and months since MI. Patients underwent technetium-99m sestamibi perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Perfusion defect scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions. RESULTS: Women 50 years or younger, but not older women, showed a more adverse psychosocial profile than did age-matched men but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease. Compared with age-matched men, women 50 years or younger exhibited a higher SDS with mental stress (3.1 versus 1.5, p = .029) and had twice the rate of MSIMI (SDS ≥3 52% versus 25%), whereas ischemia with physical stress did not differ (36% versus 25%). In older patients, there were no sex differences in MSIMI. The higher prevalence of MSIMI in young women persisted when adjusting for sociodemographic and life-style factors, coronary artery disease severity, and depression. CONCLUSIONS: MSIMI post-MI is more common in women 50 years or younger compared with age-matched men. These sex differences are not observed in post-MI patients who are older than 50 years.