Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction: Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study

• Type of Material: Article
• Authors: Puja Mehta, Emory University; Melody Hermel, Cedars Sinai Heart Institute; Michael D. Nelson, Cedars Sinai Heart Institute; Galen Cook-Wiens, Cedars Sinai Medical Center; Elizabeth A. Martin, Cedars Sinai Heart Institute; Ayman A. Alkhoder, Emory University; Janet Wei, Cedars Sinai Heart Institute; Margo Minissian, Cedars Sinai Heart Institute; Chrisandra Shufelt, Cedars Sinai Heart Institute; Sailaja Marpuri, Cedars Sinai Heart Institute; David Hermel, Cedars Sinai Heart Institute; Amit Shah, Emory University; Michael R. Irwin, University of California Los Angeles; David S. Krantz, Uniformed Services University of the Health Sciences; Amir Lerman, Mayo Clinic; C. Noel Bairey Merz, Cedars Sinai Heart Institute
• Language: English
• Date: 2018-01-15
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijcard.2017.10.061
• Title of Journal or Parent Work: International Journal of Cardiology
• ISSN: 0167-5273
• Volume: 251
• Start Page: 8
• End Page: 13
• Grant/Funding Information: This work was supported by contracts from the National Heart, Lung and Blood Institute K23HL105787, K23HL127251, R01 HL090957, T32HL69751, N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, U0164829, U01 HL649141, U01 HL649241, 1R03AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources, the National Center for Advancing Translational Sciences (NCATS) grant UL1TR000124, and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc., Laurence Harbor, NJ, Society for Women’s Health Research (SWHR), Washington, D.C., the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, the Barbra Streisand Women’s Cardiovascular Research and Education Program, the Linda Joy Pollin Women’s Heart Health Program, and the Erika Glazer Women’s Heart Research Initiative and the Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, CA.
• Keywords: Cardiovascular System & Cardiology; Microvascular dysfunction; ENDOTHELIAL FUNCTION; Science & Technology; APICAL BALLOONING SYNDROME; SEX-DIFFERENCES; DAILY-LIFE; HEART-RATE-VARIABILITY; ISCHEMIA SYNDROME EVALUATION; Cardiac & Cardiovascular Systems; Women heart disease; Mental stress; SILENT-MYOCARDIAL-ISCHEMIA; PSYCHOPHYSIOLOGICAL INVESTIGATIONS; Vascular reactivity; ARTERY-DISEASE; MICROVASCULAR DYSFUNCTION; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. Methods 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. Results Mean age of CVaD and control groups was 58 ± 9 and 55 ± 10 years (p = 0.73). Baseline RHI correlated with coronary endothelial function (r = 0.36, p = 0.03) and inversely with RHI change post-MST (r = − 0.51, p < 0.001). During MST, 10% of controls reported chest pain vs. 41% of CVaD subjects (p = 0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p = 0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r = − 3.4, p = 0.03), frustration (r = − 0.37, p = 0.02), and feeling challenged (r = − 0.37, p = 0.02) in CVaD but not controls. Conclusions Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.