title: Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction.
abstract: OBJECTIVE
  Emotional stress may disproportionally affect young women with ischemic heart disease. We sought to examine whether mental stress-induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than in men.
  
  
  METHODS
  We studied 98 post-MI patients (49 women and 49 men) aged 38 to 60 years. Women and men were matched for age, MI type, and months since MI. Patients underwent technetium-99m sestamibi perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Perfusion defect scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions.
  
  
  RESULTS
  Women 50 years or younger, but not older women, showed a more adverse psychosocial profile than did age-matched men but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease. Compared with age-matched men, women 50 years or younger exhibited a higher SDS with mental stress (3.1 versus 1.5, p = .029) and had twice the rate of MSIMI (SDS ≥ 3; 52% versus 25%), whereas ischemia with physical stress did not differ (36% versus 25%). In older patients, there were no sex differences in MSIMI. The higher prevalence of MSIMI in young women persisted when adjusting for sociodemographic and life-style factors, coronary artery disease severity, and depression.
  
  
  CONCLUSIONS
  MSIMI post-MI is more common in women 50 years or younger compared with age-matched men. These sex differences are not observed in post-MI patients who are older than 50 years.
authors.affiliation: From the Department of Epidemiology (V.V., A.J.S., C.R., I.I., P.P., P.R.), Rollins School of Public Health, Emory University, Atlanta, Georgia; Departments of Medicine (V.V., A.J.S., A.S., L.D'M., C.K.), Radiology (J.A.N., P.R.), and Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, Georgia; Department of Internal Medicine (A.S.), Tuba City Regional Healthcare Corporation, Tuba City, Arizona; Division of Nephrology (L.D'M.), Hospital Universitario Ruiz y Páez, Universidad de Oriente, Bolívar, Venezuela; Division of Nephrology (C.K.), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; and Mazankowski Alberta Heart Institute (P.R.), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Amit J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Cherie
authors.initials: C
authors.lastname: Rooks
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Ibeanu
authors.forename: Jonathon A
authors.initials: JA
authors.lastname: Nye
authors.forename: Pratik
authors.initials: P
authors.lastname: Pimple
authors.forename: Amy
authors.initials: A
authors.lastname: Salerno
authors.forename: Luis
authors.initials: L
authors.lastname: D'Marco
authors.forename: Cristina
authors.initials: C
authors.lastname: Karohl
authors.forename: James Douglas
authors.initials: JD
authors.lastname: Bremner
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015444:Exercise; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000523:psychology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000706:statistics & numerical data; D012146:Rest / Q000502:physiology; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*; D017741:Survivors / Q000706:statistics & numerical data*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D055815:Young Adult