Angina and mental stress-induced myocardial ischemia

Pimple, Pratik; Shah, Amit; Rooks, Cherie; Bremner, J. Douglas; Nye, Jonathon A.; Ibeanu, Ijeoma; Raggi, Paolo; Vaccarino, Viola

doi:10.1016/j.jpsychores.2015.02.007

Cited by 34 publications

(27 citation statements)

References 35 publications

(42 reference statements)

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“…Given that MSIMI is associated with higher mortality in patients with CHD, it could represent an important mechanism of risk and a novel prognostic indicator for young women with CHD. Because MSIMI correlates with myocardial ischemia and angina in daily life, it may contribute to the triggering of acute coronary syndromes in young women and may play a role in their higher mortality post‐MI compared to men …”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Given that MSIMI is associated with higher mortality in patients with CHD, 16 it could represent an important mechanism of risk and a novel prognostic indicator for young women with CHD. Because MSIMI correlates with myocardial ischemia and angina in daily life, 15,48 it may contribute to the triggering of acute coronary syndromes in young women and may play a role in their higher mortality post-MI compared to men. 1 A limitation of our study is the relatively small number of young women, especially those below age 50 years; yet, this remains the largest investigation ever conducted of MSIMI in women.…”

Section: Discussionmentioning

confidence: 99%

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Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Vaccarino

Wilmot

Mheid

et al. 2016

JAHA

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BackgroundEmerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress‐induced myocardial ischemia (MSIMI).Methods and ResultsWe studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent 99mTc‐sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more‐adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4‐fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress.ConclusionsYoung women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Vaccarino

Wilmot

Mheid

et al. 2016

JAHA

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“…Z jakostjo angine pektoris se okrepita tako anksioznost kot depresivnost. Zato se poslabša kakovost ži-vljenja in zmanjša telesna zmogljivost pri bolnikih, ki so preboleli miokardni infarkt ali imajo stabilno koronarno bolezen (15)(16)(17). Ena od hipotez o nastanku angine pektoris v vsakdanjem življenju je koronarna mikrovaskularna disfunkcija, na katero naj bi vplivali različni psihosocialni in nevrobiološki mehanizmi, med drugim tudi subjektivno doživlja-nje stresa in fiziološke spremembe v nevroendokrinem in žilnem okolju (14,17).…”

Section: Anksioznost In Prsna Bolečinaunclassified

Anksioznost in koronarna bolezen srca

Kokalj

Šarotar

2018

SlovMedJour

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IzvlečekSimptomi anksioznosti se pri bolnikih s koronarno boleznijo pogosto spregledajo, saj se lahko zelo prekrivajo s simptomi telesne bolezni. Anksioznost je pogosta v splošni populaciji kot tudi pri bolnikih s koronarno boleznijo. Patofiziologija povezave še ni povsem pojasnjena, zanesljivo pa anksioznost pomeni višje tveganje za obolevnost in smrtnost zaradi koronarne bolezni ter znižuje kakovost življenja. AbstractIn patients with coronary heart disease anxiety is often overlooked. Symptoms of anxiety are often similar to coronary heart disease symptoms. The prevalence of anxiety in general population and coronary heart disease patients is very high. While the underlying pathophysiology of the connection remains unclear, anxiety lowers the quality of life and is a factor for a higher risk of morbidity and mortality due to coronary heart disease. UvodVedno več je zanimanja za raziskovanje povezav med psihopatološkimi pojavi in koronarno boleznijo srca. Pri bolnikih s koronarno boleznijo je negativni psihološki stres pogost in dolgotrajen, zato je povezan s slabšim izidom bolezni, vključno z zmanjšanim funkcioniranjem, ponavljajočimi se srčnimi dogodki in smrtnostjo (1). Depresivnost in anksioznost sta simptoma, ki sta pri bolnikih s koronarno boleznijo zelo pogosti (2). Povezani sta z visoko obolevnostjo in smrtnostjo zaradi koronarne bolezni (1,2). Medtem ko je vpliv depresivnosti znano in zelo raziskovano področje, pa je vpliv anksioznosti še vedno slabo raziskan. Pri bolnikih z akutnim koronarnim dogodkom je depresija povezana z 2-do 2,7-krat večjim tveganjem za smrt. Ameriško združenje kardiologov je tako opredelilo depresivnost kot dejavnik tveganja za slabši izid po akutnem miokardnem infarktu, zato je priporoči-lo rutinsko testiranje za depresivnost pri bolnikih s koronarno boleznijo (1-4).Letna prevalenca anksioznosti v splošni populaciji je 10,6 % in doživljenj-ska 16,6 %, s čimer spadajo anksiozne motnje med najpogostejše psihiatrične motnje (5,6). Anksiozne motnje prizadenejo do 20 % bolnikov v različnih fazah koronarne bolezni, kar je potrdila tudi metaanaliza iz leta 2014, ki je pokazala prevalenco 16 % (4,7,8). Najpogostejša anksiozna motnja pri bolnikih s koronarno boleznijo je generalizirana anksiozna motnja s prevalenco približno 8 %, sledi ji panična motnja in socialna fobi-

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“…8 Additionally, in younger CAD patients, MSIMI is significantly associated with angina frequency. 9 MSIMI is associated with a more than doubling of risk for major adverse cardiovascular events, including mortality. 4,7…”

Section: Physiology Of Mental Stress In Cadmentioning

confidence: 99%

Mental Stress and Myocardial Ischemia: Young Women at Risk

Wokhlu

Pepine

2016

JAHA

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W omen with obstructive coronary artery disease (CAD) have poor outcomes relative to otherwise comparable men. More women than men die after a first myocardial infarction.1 Younger women (<55 years) have a particularly unfavorable prognosis after myocardial infarction relative to male counterparts. 2 Mechanisms for these differential outcomes are unclear, but since younger women have worse preevent health status versus men, including lower overall and mental health qualities of life, 3 it is likely that the adverse condition begins long before the acute event.Attention has increasingly focused on psychosocial or mental stressors as potential nontraditional CAD risk conditions. In the Psychophysiological Investigations of Myocardial Ischemia Study, we found that mental stressinduced ischemia predicted increased risk for all-cause mortality in patients with obstructive CAD and exerciseinduced ischemia. 4 In a cohort of women with symptoms and signs of ischemic heart disease (mean age 58 years) from the Women's Ischemia Syndrome Evaluation, mostly without obstructive CAD, we found associations between psychosocial factors and premature mortality. 5 Over 9.3 years, the Spielberger Trait Anxiety Index and Beck Depression Inventory scores (hazard ratio 1.09, 95% CI 1.02-1.15, and hazard ratio 0.86, CI 0.78-0.93, respectively) and very good self-rated health (versus poor self-rated health, hazard ratio 0.33, CI 0.12-0.96) each independently predicted mortality risk. These results extend prior knowledge in female ischemic heart disease /CAD populations. Clearly, psychosocial factors link with adverse outcomes among women with ischemic heart disease, but how mental stress uniquely modulates the course of younger women remains unclear.

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Angina and mental stress-induced myocardial ischemia

Cited by 34 publications

References 35 publications

Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease

Anksioznost in koronarna bolezen srca

Mental Stress and Myocardial Ischemia: Young Women at Risk

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