Abstract 17965: Sex Differences in Platelet Reactivity, Cardiovascular and Psychological Response to Mental Stress in Patients With Known Coronary Artery Disease: Data From the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment Study

Abstract

Background: Although emotional stress is known to be associated with ischemic heart disease (IHD) and related clinical events, sex-specific differences in the psychobiologic response to mental stress have not been clearly identified. We aimed to study the differential psychological and cardiovascular response to mental stress between women and men in patients with stable IHD.

Methods: Patients with stable IHD enrolled in the REMIT study underwent psychometric assessments, transthoracic echocardiography (TTE), and platelet aggregation studies at baseline and after three mental stress tasks. Mental stress-induced myocardial ischemia (MSIMI) was defined as the development or worsening of regional wall motion abnormality, reduction of LVEF ≥ 8% by TTE, and/or ischemic ST-segment change by ECG, during one or more of the three mental stress tasks.

Results: Of the 310 participants with known IHD (18% women, 82% men) most baseline characteristics were similar between women and men (including heart rate, blood pressure, and LVEF), though women were more likely to be non-white, living alone (p<0.001), and unmarried (p<0.001); they also had higher baseline depression and anxiety (p < 0.05). At rest, women compared with men had a heightened platelet aggregation response to serotonin (p=0.007) and epinephrine (p=0.004). Following mental stress, women had more induced MSIMI (57% vs. 41%, p<0.04), expressed more negative emotion (p=0.02) and less positive emotion (p<0.001), and demonstrated a higher platelet aggregation response to collagen (p=0.04), whereas men were more likely to show changes in traditional physiologic measures such as blood pressure (p<0.05) and double product. (Table).

Conclusions: We identified clear, measurable, and differential responses to mental stress in women and men. This dichotomy in cardiovascular and platelet reactivity in response to mental stress may contribute to long-term outcomes and requires further study.