Mental stress triggered significantly more myocardial ischemia in younger women with stable coronary heart disease than in younger men with CHD, according to a study presented at the American Heart Association’s Scientific Sessions.
However, physical stress generated little or no difference in blood flow to the heart between women and men with stable coronary heart disease (CHD).
Courtesy Emory University
Dr. Viola Vaccarino
“Women who develop heart disease at a younger age make up a special high-risk group, because they are disproportionally vulnerable to emotional stress,” said Dr. Viola Vaccarino, chair of cardiovascular research and epidemiology at the Rollins School of Public Health at Emory University, Atlanta, and her colleagues in a statement.
In a population-based study, Dr. Vaccarino and her associates analyzed 534 patients (including 151 women) aged 38-79 years. All patients had CHD, which was verified by their medical records, and were divided into three age-based groups: 55 years or younger, 56-64 years, and 65 years or older.
Men and women in each age group underwent two stress tests, one mental and one physical, along with a third test while at rest. The mental test consisted of giving a public address about a real-life stressful scenario, while the physical test was a treadmill exercise conducted in accordance with the Bruce protocol. Patients who were unable to achieve the target heart rate in the physical test underwent pharmacological stress with regadenoson.
During each test, patients’ heart rates and blood pressures were monitored, from which total severity scores were derived by quantifying myocardial perfusion deficit (size and severity) across 17 myocardial segments. Total ischemic perfusion deficits (IPD) were calculated by taking the difference between a patient’s severity score at rest and severity score during mental/physical stress.
Overall, women had greater IPD with mental stress than men did, and younger age exacerbated the difference.
Women aged 55 years or younger experiencing 3.5 times the mean IPD as did men in the same age group (139 vs. 40; P < .0001). Mean IPD was 1.8 times greater in women aged 56-64 years than in men (101 vs. 56; P = .03), while mean IPD in women 65 years or older was almost identical to that of their male counterparts (69 vs. 61; P = 0.5).
Conversely, physical stress yielded no significant difference between men and women across all three age groups. Those aged 55 years or younger showed the largest, albeit nonsignificant, differences – with women having 1.5 times more IPD under physical stress than similarly aged men (123 vs. 84; P = .22). In the other two age groups, however, differences between women and men were minimal and nonsignificant.
“Health care providers should be aware of young and middle-age women’s special vulnerability to stress, and ask the questions about psychological stress that often don’t get asked,” the authors advised. “If they note that their patient is under psychological stress or is depressed, they should advise the woman to get relevant help or support from mental health providers, stress-reduction programs, or other means.”
The National Heart, Lung, and Blood Institute funded the study. Dr. Vaccarino had no relevant disclosures.