The Role of Mental Stress in Ischaemia with No Obstructive Coronary Artery Disease and Coronary Vasomotor Disorders

Abstract

Ischaemic heart disease has been estimated to affect 126.5 million people globally. Approximately 70% of patients with angina and suspected myocardial ischaemia show no signs of obstructed coronary arteries after coronary angiography, but may still demonstrate ischaemia. Ischaemia with no obstructive coronary artery disease (INOCA) is increasingly acknowledged as a serious condition because of its association with poor quality of life and elevated risk for cardiovascular events. The negative effects of psychological stress on INOCA are gaining more attention. Psychological stress is associated with adverse cardiovascular outcomes such as mental stress-induced myocardial ischaemia. Psychological stress includes anxiety, depression, anger and personality disturbances. Coronary microvascular dysfunction and coronary arterial spasm are phenotypes of coronary vasomotor disorders that are triggered by psychological distress and depression, thereby increasing cardiovascular disease risk. Coronary vasomotor disorders are often co-existent in INOCA patients and might be considered as a contributing factor to mental stress-associated adverse cardiovascular outcomes. Additionally, psychological stress induces endothelial dysfunction more often in (young) women with INOCA than in men. Overall, many studies demonstrate an association between mental stress, coronary microvascular dysfunction and coronary vasospasm in patients with INOCA – especially women. Future research on stress-reducing therapies that target coronary vasomotor disorders in patients with INOCA is needed. This is particularly the case in young adolescents, in whom this type of ischaemic heart disease is increasing.

Ischemia with no obstructive coronary artery disease (INOCA): A patient self-report quality of life survey from INOCA international

“…[12] Psychological stress can induce endothelial dysfunction and be an underlying cause of INOCA, particularly coronary microvascular dysfunction and vasospasm. [18][19][20] The social health of patients was adversely impacted in those living with INOCA symptoms, with at least 4 of every 5 respondents reporting that their symptoms adversely affected their home life and social life. Sexual activity may often decrease after a myocardial infarction due to fears of inducing another myocardial infarction or anginal symptoms, as was demonstrated in a study of myocardial infarction survivors, where 47% of patient abstained or reduced their sexual activity after their myocardial infarction.…”

Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022

“…Os exercícios aeróbicos parecem promover melhor benefício. [55][56][57][58][59] Em relação aos DSS, a diversidade de raça e etnicidade, nível de escolaridade, educação, racismo e discriminação, inacessibilidade aos sistemas assistenciais de saúde, ausência de suporte social, instabilidade econômica, orientação e violência sexual são fatores que conduzem às disparidades, atingem a mulher e geram desfechos negativos, que somados aos FRCV clássicos e específicos do sexo/gênero, promovem inflamação vascular e disfunção endotelial culminando em DCV (Figura 3.1). 26,[59][60][61][62][63] Estudo transversal para calcular o risco cardiovascular, utilizando dados laboratoriais de uma subamostra da PNS com 3.584 mulheres, encontrou 58,4% com baixo risco cardiovascular, 32,9% com risco médio e 8,7% com risco alto.…”

“…45 Estudos demonstram associação entre estresse mental, disfunção microvascular e vasoespasmo coronarianos em pacientes com INOCA,58 principalmente nas mulheres.…”

Clinical and psychological characteristics of patients with ischemia and non-obstructive coronary arteries (INOCA) and obstructive coronary artery disease

“…A subgroup of the patients additionally received an index of microcirculatory resistance (IMR) measurement to detect CMD [5] , however acetylcholine testing for coronary vasospasm could not be performed. INOCA is related to adverse cardiac outcomes [6] , [7] , recurrent angina symptoms, impaired quality of life (QoL), repeated hospitalizations [8] , and psychological distress (e.g., depression, anxiety, stress) [9] .…”

“…Psychological distress (e.g., depressive symptoms, anxiety, stress, and Type D personality) negatively affect the onset and prognosis of ischemic heart diseases and may be related to the etiology of INOCA [9] , [10] , [11] . It is unclear how psychological distress differs between patients with INOCA and patients with obstructive coronary artery disease (CAD).…”