Abstract 15445: Young Women Have a Higher Rate of Myocardial Ischemia Induced by Emotional Stress Than Age-Matched Men After Myocardial Infarction
Objectives: Young women exhibit higher mortality and complication rates after an acute myocardial infarction (MI) compared with men of similar age, a difference not seen in older patients. The pathophysiology of these findings is unexplained. We hypothesized that emotional stress disproportionally affects ischemic heart disease in young women. To address this issue, we examined whether mental stress-induced myocardial ischemia, but not exercise-induced ischemia, is more common in young female than male subjects post-MI.
Methods: We studied 98 patients (48 women and 48 men) 18 to 59 years old with documented MI in past 6 months. Women and men were matched by age, MI type, and months since the MI. Patients underwent SPECT [99mTc]sestamibi myocardial perfusion imaging (MPI) at rest, after mental stress, and after exercise/pharmacological stress. MPI perfusion defect scores were obtained with an observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions. A SDS ≥3 was used as indication of clinically significant mental stress-induced ischemia.
Results: Women age 50 years or younger, but not older women, showed a more adverse psychosocial risk profile than age-matched men, but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease (CAD) than men. Compared with age-matched men, young women exhibited a higher SDS with mental stress (3.1 vs. 1.5, p=0.03) and had twice the rate of mental stress-induced ischemia, (52% vs. 25%, p=0.05), while ischemia with physical stress did not differ between groups. In older patients there were no sex differences in mental stress-induced ischemia, while men had more ischemia induced by exercise/pharmacological stress. The disadvantage of young women with mental stress persisted after adjusting for sociodemographic and lifestyle factors, CAD severity and depression.
Conclusions: Myocardial ischemia induced by emotional stress is more common in young women post-MI than in age-matched men, and could play a role in the prognosis and perhaps also as a trigger of MI in young women.
- © 2013 by American Heart Association, Inc.