Chest Pain and Mental Stress-Induced Myocardial Ischemia: Sex Differences

• Type of Material: Article
• Authors: Pratik Pimple, Emory University; Muhammad Hammadah, Emory University; Kobina Wilmot, Emory University; Ronnie Ramadan, Emory University; Ibhar Al Mheid, Emory University; Oleksiy Levantsevych, Emory University; Samaah Sullivan, Emory University; Ernest V Garcia, Emory University; Jonathon Nye, Emory University; Amit J. Shah, Emory University; Laura Ward, Emory University; Puja Mehta, Emory University; Paolo Raggi, Emory University; J. Douglas Bremner, Emory University; Arshed Ali Quyyumi, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjmed.2017.11.026
• Title of Journal or Parent Work: American Journal of Medicine
• ISSN: 0002-9343
• Volume: 131
• Issue: 5
• Start Page: 540
• End Page: +
• Grant/Funding Information: This work was supported by the National Institutes of Health (P01 HL101398, R01HL109413, R01HL109413-02S1, K24HL077506, K24 MH076955, UL1TR000454, KL2TR000455, and THL130025A).
• Keywords: DAILY-LIFE; Ischemia; HIGHLY PREVALENT; MICROVASCULAR DYSFUNCTION; Sex differences; CORONARY-ARTERY-DISEASE; EXERCISE; SEATTLE ANGINA QUESTIONNAIRE; Life Sciences & Biomedicine; Cardiovascular disease; General & Internal Medicine; Medicine, General & Internal; Science & Technology; DEPRESSION; PECTORIS; METAANALYSIS; ASSOCIATION; Angina
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Mental Health

Abstract

Background: Mental stress–induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease. Women with coronary artery disease tend to have more mental stress–induced myocardial ischemia and more chest pain/anginal symptoms than men, but whether the association between mental stress–induced myocardial ischemia and angina burden differs in women and men is unknown. Methods: This was a cross-sectional study with experimental manipulation of 950 individuals with stable coronary artery disease. Chest pain/angina frequency in the previous 4 weeks was assessed with the Seattle Angina Questionnaire's angina-frequency subscale. Mental stress–induced myocardial ischemia was assessed with myocardial perfusion imaging during mental stress (standardized public speaking task). Presence of mental stress–induced myocardial ischemia was based on expert readers and established criteria. A conventional (exercise or pharmacologic) stress test was used as a control condition. Results: Overall, 338 individuals (37%) reported angina; 112 (12%) developed mental stress–induced myocardial ischemia, and 256 (29%) developed conventional stress ischemia. Women who reported angina had almost double the probability to develop mental stress–induced myocardial ischemia (19% vs 10%, adjusted prevalence rate ratio, 1.90; 95% confidence interval, 1.04-3.46), whereas there was no such difference in men (11% vs 11%, adjusted prevalence rate ratio, 1.09; 95% confidence interval, 0.66-1.82). No association was found between angina symptoms and conventional stress ischemia for women or men. Results for ischemia as a continuous variable were similar. Conclusions: In women, but not in men, anginal symptoms may be a marker of vulnerability toward ischemia induced by psychologic stress. These results highlight the psychosocial origins of angina in women and may have important implications for the management and prognosis of women with angina.