Women More Vulnerable to Mental Stress-Induced Ischemia

Megan Brooks

December 27, 2017

ATLANTA, GA — Men and women have distinct cardiovascular reactions to mental stress-induced myocardial ischemia (MSIMI), hint new data from the Mental Stress Ischemia Mechanisms and Prognosis Study (MIPS)[1].

The study suggests that women show greater peripheral vasoconstriction during mental stress, while men have greater hemodynamic responses.

"These differences are in agreement with a known propensity of women with coronary heart disease towards microvascular dysfunction," senior author Dr Viola Vaccarino (Emory University, Atlanta, GA) told theheart.org | Medscape Cardiology.

"Sympathetic nervous system activation due to stress tends to constrict microvessels throughout the body," Vaccarino explained. "Our data show that women, but not men, who have a more profound microvascular constriction during stress are more likely to become ischemic. In men, instead, ischemia with mental stress is primarily due to a standard supply-demand mismatch secondary to the stress-induced rise in hemodynamic workload in the presence of epicardial stenosis."

The study was published online December 21, 2017 in Arteriosclerosis, Thrombosis and Vascular Biology.  

Vaccarino and colleagues investigated sex-specific patterns of cardiovascular reactivity, including hemodynamic response and peripheral vasoconstriction in relation to MSIMI in 492 men and 186 women (mean age 63 years) with coronary artery disease who underwent myocardial perfusion imaging before and during a public speaking stressor.

Men (but not women) with MSIMI had a higher rate-pressure product response (calculated as the difference between the maximum value during the speech minus the minimum value during rest) than men without MSIMI (6500 vs 4800 mm Hg bpm).

Women with MSIMI had a significantly lower peripheral arterial tonometry (PAT) ratio (denoting greater vasoconstriction) than women without MSIMI (0.5 vs 0.8) and men with MSIMI (0.5 vs 0.7). There were no significant differences in PAT ratio for men by MSIMI status (0.7 vs 0.7).

Peripheral vasoconstriction by PAT was calculated as the ratio of pulse wave amplitude during the speech over the resting baseline; ratios <1 indicate a vasoconstrictive response.

These findings suggest clear gender differences in hemodynamic and microvascular mechanisms of myocardial ischemia induced by mental stress, the investigators say.

"These data do not yet translate directly into changes in clinical practice, but they highlight the profound effect of the microcirculation on women's vulnerability to ischemia during psychological stress," Vaccarino told theheart.org | Medscape Cardiology.

"They also highlight the fact that cardiovascular physiology, and ischemic heart disease pathophysiology, differ in women and men, and are consistent with current recommendations emphasizing the inclusion of women in cardiovascular research and the examination of data separately in women and men," she said.

"The psychosocial sphere doesn't receive a lot of attention during current clinical practice, but it is very important to advise both women and men with heart disease about interventions to reduce stress, and to refer them to other professionals if they need help with depression or anxiety," Vaccarino added in a news release.

The study was supported by the National Institutes of Health. One author receives royalties from the sale of the Emory Cardiac Toolbox, used for some analyses in the study. No other disclosures were reported.

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