Psychological stress, cardiac symptoms, and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease

• Type of Material: Article
• Authors: Mayra A. Gomez, Palo Alto University; Noel B. Merz, Cedars Sinai Smidt Heart Institute; Jo-Ann Eastwood, University of California Los Angeles; Carl J. Pepine, University of Florida; Eileen M. Handberg, University of Florida; Vera Bittner, University of Alabama Birmingham; Puja Mehta, Emory University; David S. Krantz, Uniformed Services University of the Health Sciences; Laura Vaccarino, Emory University; Wafia Eteiba, University of Pittsburgh; Thomas Rutledge, VA San Diego Healthcare System
• Language: English
• Date: 2020-02-07
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 John Wiley & Sons, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1002/smi.2928
• Title of Journal or Parent Work: Stress and Health
• Volume: 36
• Issue: 3
• Start Page: 264
• End Page: 273
• Grant/Funding Information: 1R03 AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources, the National Center for Advancing Translational Sciences Grant UL1TR000124 and UL1TR000064, and the Edythe L. Broad Women’s Heart Research Fellowship; This work was supported by contracts from the National Heart, Lung and Blood Institutes, N01-HV-68161, N01-HV-68162, N01-HV-68163, and N01-HV-68164, grants U01 64829, U01 HL649141, U01 HL649241, T32 HL69751, K23HL105787, K23HL127262, K23HL125941; 1R03 AG032631, K23HL105787, K23HL125941, K23HL127262,T32 HL69751, U01 64829, U01 HL649141, U01 HL649241; National Center for Advancing Translational Sciences, Grant/Award Numbers: UL1TR000064, UL1TR000124; National Center for Research Resources, Grant/Award Number:; MO1-RR00425; National Heart, Lung, and Blood Institute, Grant/Award Numbers: N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164; National Institute on Aging, Grant/Award Numbers:; Constance Austin Women’s Heart Health Fellowship, both at Cedars-Sinai Medical Center, Los Angeles, California, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, the Linda Joy Pollin Women’s Heart Health Program, and the Erika Glazer Women’s Heart Health Project.; Dr Pepine was also supported by the National Institute of Health grants HL33610, HL56921; UM1 HL087366; the Gatorade Trust and the McJunkin Family Foundation through funds distributed by the University of Florida, Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and PCORnet-OneFlorida Clinical Research Consortium CDRN-1501-26692.
• Keywords: Financial strain; 52 countries; Science & Technology; Life Sciences & Biomedicine; Association; psychological stress; Social Sciences; Heart disease; Events; Mental health; heart disease; depression; cardiovascular disease; Psychology, Applied; prospective; Syndrome evaluation; Myocardial infarction; Psychiatry; Artery disease; Mortality; women; Psychology
• Research Categories: Health Sciences, Epidemiology; Psychology, Clinical; Health Sciences, Nursing; Psychology, Cognitive

Abstract

This paper evaluated cross-sectional relationships between psychological stress and coronary artery disease (CAD) risk among women with suspected ischaemia and no obstructive coronary artery disease (INOCA). Between 1996 and 2000, 551 women with INOCA were enrolled in the Women's Ischemia Syndrome Evaluation (WISE) cohort from four U.S. institutions. Between 2009 and 2012, 376 women with INOCA were recruited from two U.S. institutions for an independent cohort study titled WISE-Coronary Vascular Dysfunction (WISE-CVD). Participants underwent coronary angiography and testing for CAD symptoms and risk factors at baseline. Psychological stress was assessed in the form of home/work stress in WISE and home/work stress and financial stress in WISE-CVD. Results showed that home/work stress predicted greater depression, functional impairment, CAD symptoms, and lower self-rated health in WISE but was inconsistent as a predictor in WISE-CVD. In contrast, >60% of WISE-CVD women reported moderate or severe financial stress. Financial stress levels predicted more CAD risk factors and cardiac symptoms, poorer self-rated health, and greater depression and functional impairment. Among women with INOCA, psychological stress was associated with CAD symptoms and CAD risk factors. The prevalence and predictive value of psychological stress in this population supports the inclusion of stress measures in future CAD research.