Abstract 17005: In Women, but Not in Men, Angina is a Stronger Correlate of Myocardial Ischemia Induced by Psychological Than by Exercise/Pharmacological Stress
Introduction: Mental stress-induced myocardial ischemia (MSIMI) is a common phenomenon in patients with coronary heart disease (CHD) and an emerging prognostic factor. Women with CHD tend to have more MSIMI and more anginal symptoms than men, but whether MSIMI is associated with angina burden in everyday life, and whether this association differs in women and men, is unknown.
Methods: We assessed angina frequency (past month) in 690 patients (191 women) with stable CHD using the Seattle Angina Questionnaire. All patients underwent 99mTc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. Inducible ischemia was assessed blindly and defined as new or worsening perfusion defect, and expressed as percent of ischemic myocardium.
Results: Women reported angina in past month more often than men (41% vs 24%), but otherwise had similar age (mean 63 years, SD 9 for both) and a similar or more favorable risk profile than men. In the entire sample, angina in past month was associated with myocardial ischemia with both mental stress (RR=1.6, p=0.008) and conventional stress (RR=1.3, p=0.04). However, compared to women with no reported angina, women who reported angina had twice the occurrence of ischemia with mental stress (RR=2.4, p=0.02) but not with conventional stress (RR=1.3, p=0.22). In men, angina was similarly related to ischemia with mental stress (RR=1.5, p=0.07) and conventional stress (RR=1.3, p=0.04). After adjusting for CHD risk factors, sociodemographic and psychosocial factors, medications, and presence of conventional stress ischemia, the % of ischemic myocardium with mental stress was twice in women with angina than men with angina, while there was no sex difference in absence of angina (p=0.01 for interaction). No sex differences were found with conventional stress ischemia, irrespective of angina.
Conclusions: In women, anginal symptoms are more closely related to myocardial perfusion abnormalities induced by psychological than conventional stress. In contrast, angina in men is associated with both types of ischemia. Ischemia induced by psychophysiological mechanisms could be a more important contributing factor for angina in women than in men.
Author Disclosures: V. Vaccarino: None. I. Al Mheid: None. K. Wilmot: None. R. Ramadan: None. M. Hammadah: None. N. Abdelhadi: None. M. Obideen: None. P. Pimple: None. O. Levantsevych: None. A. Shah: None. E. Garcia: Ownership Interest; Significant; Emory Cardiac Tool Box. J. Nye: None. M. Kutner: None. L. Ward: None. J.D. Bremner: None. P. Raggi: None. D. Sheps: None. A. Quyyumi: None.
- © 2016 by American Heart Association, Inc.