Abstract 14860: Young Women with Stable CHD are More Likely to Develop Myocardial Ischemia with Mental Stress Than Men of Similar Age
Introduction: Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of emotional stress. We assessed myocardial ischemia induced by a standardized mental stress protocol to address this question.
Hypothesis: Young women (≤55 years) with stable CHD are more likely than men of similar age to develop ischemia with a mental stress test, but not ischemia with a standard exercise or pharmacological stress test.
Methods: We studied 534 patients with stable CHD who underwent 99mTc[[Unable to Display Character: ‐]]sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and physical (exercise or pharmacological) stress testing. A summed total severity score was computed to quantify hypoperfusion size and severity at rest and under both stress conditions with observer-independent software. The difference between stress and rest provided a quantitative measure of total ischemic perfusion deficit (IPD). Sex differences in IPD were calculated according to 3 age groups: ≤55, 56-64, and ≥65 years.
Results: Women had a more adverse psychosocial profile than men while there were few sex differences in medical history and CHD risk factors. Overall, women had more IPD with mental stress than men (91 vs. 55, p<0.001), but not with physical stress (140 vs. 131, p=0.63). For mental stress there was a significant sex by age interaction (p=0.001). Women ≤55 years had more than threefold IPD with mental stress than men of similar age; the sex difference declined in the older age groups (Table). There were no sex differences in IPD with physical stress. These results persisted when adjusting for sociodemographic and CHD risk factors, psychosocial factors, and medications. Women ≤55 years exhibited a higher IPD with mental stress than any of the other groups.
Conclusions: Young women with stable CHD are uniquely susceptible to ischemia with mental stress, which could play a role in the prognosis of CHD in this group.
Author Disclosures: V. Vaccarino: None. P.M. Pimple: None. E.V. Garcia: Other; Significant; Royalties. J. Nye: None. I. Al Mheid: None. K. Wilmot: None. R. Ramadan: None. A.J. Shah: None. P. Raggi: None. F. Esteves: None. M. Kutner: None. Q. Long: None. J.D. Bremner: None. A.A. Quyyumi: None.
- © 2014 by American Heart Association, Inc.