Abstract 12232: Gender Differences in Microvascular Vasomotor Response to Mental Stress in Patients With Stable Coronary Artery Disease
Introduction: Evidence supports gender-specific pathophysiological differences in the presentation and risk profile of cardiovascular disease, and microvascular disease has been proposed as a mechanism. Mental stress-induced myocardial ischemia (MSI) is a poor prognostic indicator in patients with CAD, which is mediated partly by vasomotor changes induced by mental stress. We sought to examine gender differences in peripheral vascular reactivity in CAD patients and its relationship with MSI.
Methods: Patients with stable CAD (n= 481; 26% female) underwent a standardized mental stress test using a public speaking task. Myocardial perfusion imaging with 99m-Tc-sestamibi was used to assess myocardial ischemia. Peripheral arterial tonometry (PAT, Itamar Inc.) was used to assess the digital microvascular tone during mental stress as a ratio of pulse wave amplitude during speech compared to resting baseline with a PAT ratio of ≤1 signifying a vasoconstrictor response.
Results: The average age was 64±9 years in men and 64±8 years in women (P= 0.84). Men and women had a similar risk factor profile, except for a higher rate of smoking in men (P≤0.001). The prevalence of MSI was not significantly different between men (18%) and women (23%), P= 0.24. Hemodynamic measures increased in response to mental stress (ΔSBP= +42±19 mmHg, ΔDBP= +26±11 mmHg, ΔHR= +18±11 bpm; P≤0.001 for all) in a similar fashion in men and women. However, during mental stress, men had a significantly higher rate of vasoconstrictor response than women (84% vs. 68%; P≤0.001), and had a significantly lower PAT ratio than women (0.70±0.43 vs. 0.92±0.64; P= 0.001). Male gender remained independently associated with a greater degree of peripheral vasoconstriction after adjusting for age, traditional cardiac risk factors, medications (beta-blockers, calcium channel blockers, and ACE inhibitors), CAD severity, and MSI status (P= 0.001).
Conclusions: Women with stable CAD have lower peripheral vasoconstrictor response to mental stress despite similar hemodynamic response, risk factor profile, and prevalence of MSI. Our findings suggest the presence of gender-based differences in vasomotor tone provoked by psychological stress.
- © 2013 by American Heart Association, Inc.