Vascular response to stress after MI may differ among men, women
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Among young and middle-aged survivors of MI, peripheral microvascular dysfunction with mental stress is associated with major adverse CV events among women but not among men, researchers reported.
The findings were reported at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023 and simultaneously published in Arteriosclerosis, Thrombosis, and Vascular Biology.
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“Emerging research has suggested that vascular function — an important determinant in the regulation of coronary blood flow — may play an important role in ischemic heart disease among women,” Samaah Sullivan, PhD, assistant professor of epidemiology, human genetics and environmental sciences at the Dallas campus of the University of Texas Health Science Center, and colleagues wrote in the simultaneous publication. “Coronary microvascular dysfunction consists of dysregulation of small coronary arteriole through endothelium-dependent and endothelium-independent mechanisms. These alterations can lead to a higher microvascular resistance with reduced coronary blood flow that is associated with ischemia and adverse cardiovascular events. Microvascular coronary disease may be a more important factor in the pathogenesis of myocardial ischemia than plaque burden in women compared with men.”
Sullivan and colleagues analyzed data from 263 participants in the Myocardial Infarction and Mental Stress 2 study who were hospitalized for MI during the past 8 months and prospectively followed for 5 years. The mean age of participants was 51 years; 48% were women and 65% were Black. Researchers defined major adverse CV events as a composite index of CV death and first/recurring events for nonfatal MI and HF hospitalization. Researchers assessed microvascular function via the reactive hyperemia index and endothelial function via flow-mediated dilation, before and then 30 minutes after a public speaking mental stress task. Researchers used survival models for recurrent events to examine the association between vascular response to stress, defined as the difference between post-stress and resting values, and major adverse CV events.
During a median follow-up of 4.3 years, 64 patients had 141 adverse CV events (first and repeated). Worse microvascular response to stress, defined as each standard deviation (SD) decrease in the reactive hyperemia index, was associated with a 50% greater risk for major adverse CV events (HR = 1.5; 95% CI, 1.05-2.13; P = .03) with the relationship persisting among women only (P for sex interaction = .03).
Worse transient endothelial dysfunction in response to stress, defined as each SD decrease in flow-mediated dilation, was associated with a 35% greater risk for major adverse CV events (HR = 1.35; 95% CI, 1.07-1.71; P = .01), with a similar relationship for both sexes, according to researchers.
“These findings support the importance of psychological stress as a risk factor for women with coronary heart disease and suggest that a microvascular phenomenon may underlie this effect,” the researchers wrote. “Future studies should explore the mechanistic links underlying these results, including, for example, cardiovascular physiology/reactivity, sympathetic activation, inflammation and neuroendocrine pathways.”
Reference:
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Sullivan S, et al. Abstract P407. Presented at: Epidemiology, Prevention, Lifestyle & Cardiometabolic Scientific Sessions; Feb. 28-March 3, 2023; Boston.
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