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Myocardial ischemia common in young women with CHD under mental stress

CHICAGO — Women aged 55 years and younger with stable CHD under mental stress are more likely to develop myocardial ischemia than men of the same age.

“Myocardial ischemia with mental stress is more common in young and middle-aged women with CHD than men of the same age. It is not explained by sociodemographics, disease severity, CHD risk factors or depression,” Viola Vaccarino, MD, PhD, chairwoman of cardiovascular research and epidemiology at Emory University’s Rollins School of Public Health and Cardiology Today Editorial Board member, said during a press conference.

Viola Vaccarino, MD, PhD

Viola Vaccarino

Vaccarino and colleagues investigated the link between myocardial ischemia and stress in 534 patients (151 women) aged 38 to 79 years with a documented history of stable CHD.

Each participant was administered a standardized mental stress test and a physical stress test, consisting of an exercise treadmill test or pharmacological stress test. For the mental stress test, participants were asked to imagine a stressful life situation and deliver a speech in front of a small audience. The researchers used myocardial perfusion imaging at rest and during the stress tests to examine differences by sex and age.

Overall, women had greater ischemic perfusion deficit during the mental stress test compared with men. The total ischemic perfusion deficit was 139.1 in women vs. 39.8 in men aged ≤55 years (P<.0001), 100.8 in women vs. 55.6 in men aged 56 to 64 years (P=.03) and 69.5 in women vs. 60.8 in men aged ≥65 years (P=.5). Women aged ≤55 years exhibited a higher ischemic perfusion deficit with mental stress than any of the other groups.

This trend persisted after the researchers adjusted for sociodemographic and CHD risk factors, psychosocial factors and medications.

In contrast, the researchers observed no differences in myocardial ischemia with physical stress between men and women. The total ischemic perfusion deficit was 123.4 in women vs. 84.2 in men aged ≤55 years (P=.22); 134.9 in women vs. 133.9 in men aged 56 to 64 years (P=.98); and 148.9 in women vs. 148.7 in men aged ≥65 years (P=.99).

“We concluded that young and middle-aged women with heart disease, but not older women, had more myocardial ischemia with psychological stress than men of the same age. This is not explained by disease severity, heart disease risk factors or even depression,” Vaccarino said. “In contrast, there are no sex differences in ischemia with standard physical stress tests in any age group.”

Vaccarino encouraged health care providers to be aware of vulnerability to stress in young and middle-aged women, and “ask the questions about psychological stress that don’t often get asked.” – by Katie Kalvaitis and Adam Taliercio

For more information:

Vaccarino V. Abstract #14860. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.

Disclosure: The study was funded by the National Heart, Lung and Blood Institute. Vaccarino reports no relevant financial disclosures.

Nieca Goldberg, MD

Nieca Goldberg

  • [The study stresses] the importance of evaluating, particularly women younger than 55 years, for psychosocial issues, because it appears that psychosocial factors are associated with a higher risk for ischemic events in this younger population of women. This is a well-done study because they looked at women at different stages of their life cycle — women who are younger than 55, women who are postmenopausal and older than 55 years — and they also looked at comparisons between men and women. The thing that is missing, which this study didn’t set out to address, is what the mechanism is for this increase in ischemic events.

    A curiosity, as a cardiologist and someone who takes care of patients, is whether this helps us to understand that there may be a different physiologic basis for ischemia in those women. We know there is a higher preponderance of microvascular ischemia in the younger age group, as well as coronary artery vasospasm. Future studies should address whether or not there are different physiologic changes that occur with psychological stress that may help identify the right mechanism of ischemia.

    • Nieca Goldberg, MD
    • Medical Director
      Joan H. Tisch Center for Women’s Health
      NYU Langone Medical Center
      Clinical Associate Professor of Medicine
      NYU School of Medicine
  • Disclosures: Goldberg reports no relevant financial disclosures.

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