Do Men and Women Differ on Measures of Mental Stress-Induced Ischemia?

York, Kaki M.; Hassan, Mustafa; Li, Qin; Li, Haihong; Fillingim, Roger B.; Lucey, Dorian G.; Bestland, Melinda; Sheps, David S.

doi:10.1097/psy.0b013e31815a9245

Cited by 13 publications

(15 citation statements)

References 25 publications

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“…This finding was not due to more pronounced hemodynamic responses to stress in female patients, as hemodynamic data were similar in women and men, consistent with previous studies (30). A possible mechanism is a higher burden of psychosocial risk factors in women.…”

Section: Discussionsupporting

confidence: 92%

“…In a study of 58 IHD patients (6 women), women showed a larger -but only borderline significant- ejection fraction reduction with mental stress than men, an effect not seen among normal controls (38). Another study of stable, broadly defined cardiac patients found no significant sex differences in myocardial perfusion abnormalities in response to mental stress (30). However, only about 1/4 of the patients had a previous MI, and the age ranged from 39 to 83 years.…”

Section: Discussionmentioning

confidence: 99%

“…For exercise/pharmacological stress, presence of ischemia was defined as a SDS ≥4 (29). A SDS ≥3 is typically used as evidence of MSIMI (16,30). However, the analyses were repeated with the same cut point (SDS≥4) as for physical stress.…”

Section: Methodsmentioning

confidence: 99%

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Sex Differences in Mental Stress–Induced Myocardial Ischemia in Young Survivors of an Acute Myocardial Infarction

Vaccarino

Shah

Rooks

et al. 2014

Psychosomatic Medicine

103

102

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Objectives Emotional stress may disproportionally affect young women with ischemic heart disease. We sought to examine whether mental stress-induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than men. Methods We studied 98 post-MI patients (49 women and 49 men) aged 38-60 years. Women and men were matched for age, MI type, and months since MI. Patients underwent [99mTc]sestamibi perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Perfusion defect scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions. Results Women aged 50 or younger, but not older women, showed a more adverse psychosocial profile than age-matched men, but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease (CAD). Compared with age-matched men, women aged 50 or younger exhibited a higher SDS with mental stress (3.1 vs. 1.5, p=0.029) and had twice the rate of MSIMI (SDS ≥3), 52% vs. 25%, while ischemia with physical stress did not differ (36% vs 25%). In older patients there were no sex differences in MSIMI. The higher prevalence of MSIMI in young women persisted when adjusting for sociodemographic and lifestyle factors, CAD severity and depression. Conclusions MSIMI post-MI is more common in women aged 50 or younger compared to age-matched men. These sex differences are not observed in post-MI patients who are older than 50 years.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Sex Differences in Mental Stress–Induced Myocardial Ischemia in Young Survivors of an Acute Myocardial Infarction

Vaccarino

Shah

Rooks

et al. 2014

Psychosomatic Medicine

103

102

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“…A previous study by York et al (40), which examined a comparable cohort of females, failed to show a significant difference in the rate of MSIMI between men and women. However, their study employed myocardial perfusion imaging techniques (40), whereas our study utilized real-time stress echocardiography as a means of detecting MSIMI. Differences in our findings may speak to the underlying pathophysiological basis of MSIMI.…”

Section: Discussionmentioning

confidence: 74%

Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients With Stable Ischemic Heart Disease

Samad

Boyle

Ersbøll

et al. 2014

Journal of the American College of Cardiology

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BACKGROUND Although emotional stress is associated with ischemic heart disease (IHD) and related clinical events, sex-specific differences in the psychobiological response to mental stress have not been clearly identified. OBJECTIVES We aimed to study the differential psychological and cardiovascular responses to mental stress between male and female patients with stable IHD. METHODS Patients with stable IHD enrolled in the REMIT (Responses of Mental Stress–Induced Myocardial Ischemia to Escitalopram) study underwent psychometric assessments, transthoracic echocardiography, and platelet aggregation studies at baseline and after 3 mental stress tasks. Mental stress–induced myocardial ischemia (MSIMI) was defined as the development or worsening of regional wall motion abnormality, reduction of left ventricular ejection fraction (LVEF) ≥8% by transthoracic echocardiography, and/or ischemic ST-segment change on electrocardiogram during 1 or more of the 3 mental stress tasks. RESULTS In the 310 participants with known IHD (18% women, 82% men), most baseline characteristics were similar between women and men (including heart rate, blood pressure, and LVEF), although women were more likely to be nonwhite, living alone (p < 0.001), and unmarried (p < 0.001); they also had higher baseline depression and anxiety (p < 0.05). At rest, women had heightened platelet aggregation responses to serotonin (p = 0.007) and epinephrine (p = 0.004) compared with men. Following mental stress, women had more MSIMI (57% vs. 41%, p < 0.04), expressed more negative (p = 0.02) and less positive emotion (p < 0.001), and demonstrated higher collagen-stimulated platelet aggregation responses (p = 0.04) than men. Men were more likely than women to show changes in traditional physiological measures, such as blood pressure (p < 0.05) and double product. CONCLUSIONS In this exploratory analysis, we identified clear, measurable, and differential responses to mental stress in women and men. Further studies should test the association of sex differences in cardiovascular and platelet reactivity in response to mental stress and long-term outcomes. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847)

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“…Samad et al 41 recently reported a significantly higher prevalence of MSIMI among women compared with men using wall motion abnormalities and LVEF reductions on echocardiography. Surprisingly, York et al 42 failed to reproduce these findings in a comparable cohort of females using myocardial perfusion imaging techniques. Samad et al argue that perfusion abnormalities identify obstructive coronary disease, whereas wall motion abnormalities are considered a downstream effect of myocardial ischaemia.…”

Section: Assessment Of Msimimentioning

confidence: 98%

Mental stress-induced myocardial ischaemia

Arri

Ryan

Redwood

et al. 2016

Heart

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Do Men and Women Differ on Measures of Mental Stress-Induced Ischemia?

Abstract: Results of this study showed no significant differences between men and women on measures of hemodynamic functioning or cardiac perfusion.

Cited by 13 publications

References 25 publications

Sex Differences in Mental Stress–Induced Myocardial Ischemia in Young Survivors of an Acute Myocardial Infarction

Sex Differences in Mental Stress–Induced Myocardial Ischemia in Young Survivors of an Acute Myocardial Infarction

Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients With Stable Ischemic Heart Disease

Mental stress-induced myocardial ischaemia

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