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Responses to mental stress differ between men, women with ischemic heart disease
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Male and female patients with stable ischemic heart disease exhibited different CV and psychological responses to mental stress in a recent study.
Researchers evaluated 310 patients with stable ischemic heart disease who underwent stress testing for mental stress-induced myocardial ischemia (MSIMI) before enrollment in the REMIT study. Participants underwent 2 days of evaluation, including psychiatric and psychometric assessment on the first day, and mental and exercise stress testing on the second day. Symptoms of depression and levels of hostility, anxiety and perceived social stress also were measured.
Patients performed three mental stress-inducing tasks: mental arithmetic, mirror trace and anger recall, each followed by a 6-minute rest period, then underwent treadmill exercise testing. Psychometric evaluation, transthoracic ECG and platelet aggregation assessment were conducted at baseline and after performing the tasks and exercise test.
The cohort was 82% male. Most observed characteristics were similar at baseline between males and females, with the exception of a greater number of women who were nonwhite, unmarried and living alone (P<.001), increased prevalence of a history of depression and higher scores indicating depression, stress and anxiety (P<.05) compared with men.
While participants were at rest, researchers observed increased platelet aggregation responses to epinephrine (P=.004) and serotonin (P=.007) among women compared with men. After undergoing mental stress, women more frequently exhibited mental stress-induced myocardial ischemia (57% vs. 41% of men; P<.04), whereas exercise stress-induced myocardial ischemia occurred at similar rates between sexes. Women also demonstrated more negative (P=.02) and less positive emotion (P<.001) compared with men, as well as higher collagen-stimulated platelet aggregation responses (P=.04).
The researchers said men were significantly more likely to experience changes to physiological characteristics, such as BP and double product, compared with women.
Similar results were observed after adjustment for race, CABG history and clopidogrel use. Further adjustment for depression as indicated by Beck Depression Inventory scores attenuated the link between sex and MSIMI.
“This study revealed that mental stress affects the CV health of men and women differently,” Zainab Samad, MD, MHS, assistant professor of medicine at Duke University Medical Center, said in a press release. “We need to recognize this difference when evaluating and treating patients for CVD. … At this point, further studies are needed to test the association of sex differences in the heart’s responses to mental stress and long-term outcomes.”
In a related editorial, Ibhar Al Mheid, MD, and Arshed A. Quyyumi, MD, of the Emory Clinical Cardiovascular Research Institute in Atlanta, wrote that the data should be interpreted with caution due to a relatively small sample size and the increased prevalence of depression symptoms among women at baseline. However, they wrote, “the provocative findings of Samad et al certainly provide impetus for further research in understanding the influence of sex on mental stress-mediated CV responses, including myocardial ischemia.”
For more information:
Al Mheid I. J Am Coll Cardiol. 2014;64:1679-1680.
Samad Z. J Am Coll Cardiol. 2014;1669-1678.
Disclosure: See the full study for a list of relevant financial disclosures.