Coronary Artery Spasm, Coronary Reactivity, and Their Psychological Context

• Type of Material: Article
• Authors: Puja Mehta, Emory University; Aneesha Thobani, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2019-04-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 by the American Psychosomatic Society.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/PSY.0000000000000682
• Title of Journal or Parent Work: PSYCHOSOMATIC MEDICINE
• Volume: 81
• Issue: 3
• Start Page: 233
• End Page: 236
• Grant/Funding Information: National Institutes of Health grants K23HL105787, R01 HL109413, R01 HL125246, R01 HL136205, and P01 HL101398.
• Keywords: depression; coronary artery spasm; women; DEPRESSION; Psychiatry; CHEST-PAIN; coronary artery disease; Psychology; Psychology, Multidisciplinary; Life Sciences & Biomedicine; Science & Technology; Social Sciences; INDUCED-MYOCARDIAL-ISCHEMIA; anxiety; DISEASE; SEX-DIFFERENCES
• Research Categories: Psychology, Behavioral; Gender Studies; Psychology, Clinical

Abstract

Symptomatic individuals suspected of having myocardial ischemia often have no obstructive atherosclerotic narrowing of epicardial coronary arteries. Abnormal coronary vascular reactivity and, in particular, coronary artery vasospasm (CAS) may be an explanation in a subset of these patients. Psychological factors play an important role in ischemic heart disease, but their role in CAS is not clear; autonomic dysfunction and increased inflammation are two prevailing pathophysiological mechanisms implicated in abnormal coronary reactivity resulting from mental health conditions. Interrelationships between psychological factors, abnormal coronary reactivity, and sex/gender differences are poorly defined in the etiology of CAS. In this issue of Psychosomatic Medicine (2019;81:237-245), Hung et al. report a frequency of less than 0.1% of new-onset CAS in the Taiwanese population, with higher occurrence in women and younger individuals. Patients with CAS had a higher prevalence of previous anxiety and depression compared with those with coronary artery disease and controls, with no sex differences. In this editorial comment, we discuss the potential reasons for underreporting of CAS and the challenges regarding the use of administrative health records for psychosomatic research. In this editorial, a model is presented to explain the association between emotional stressors and mental health factors with CAS, including the role of sympathetic nervous system activation, inflammation, oxidative stress, endothelial dysfunction, and smooth muscle cell dysregulation.