title: Sex differences in platelet reactivity and cardiovascular and psychological response to mental stress in patients with stable ischemic heart disease: insights from the REMIT study.
abstract: BACKGROUND
  Although emotional stress is associated with ischemic heart disease (IHD) and related clinical events, sex-specific differences in the psychobiological response to mental stress have not been clearly identified.
  
  
  OBJECTIVE
  We aimed to study the differential psychological and cardiovascular responses to mental stress between male and female patients with stable IHD.
  
  
  METHODS
  Patients with stable IHD enrolled in the REMIT (Responses of Mental Stress-Induced Myocardial Ischemia to Escitalopram) study underwent psychometric assessments, transthoracic echocardiography, and platelet aggregation studies at baseline and after 3 mental stress tasks. Mental stress-induced myocardial ischemia (MSIMI) was defined as the development or worsening of regional wall motion abnormality, reduction of left ventricular ejection fraction (LVEF) ≥8% by transthoracic echocardiography, and/or ischemic ST-segment change on electrocardiogram during 1 or more of the 3 mental stress tasks.
  
  
  RESULTS
  In 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), although women were more likely to be nonwhite, living alone (p < 0.001), and unmarried (p < 0.001); they also had higher baseline depression and anxiety (p < 0.05). At rest, women had heightened platelet aggregation responses to serotonin (p = 0.007) and epinephrine (p = 0.004) compared with men. Following mental stress, women had more MSIMI (57% vs. 41%; p < 0.04), expressed more negative (p = 0.02) and less positive emotion (p < 0.001), and demonstrated higher collagen-stimulated platelet aggregation responses (p = 0.04) than men. Men were more likely than women to show changes in traditional physiological measures, such as blood pressure (p < 0.05) and double product.
  
  
  CONCLUSIONS
  In this exploratory analysis, we identified clear, measurable, and differential responses to mental stress in women and men. Further studies should test the association of sex differences in cardiovascular and platelet reactivity in response to mental stress and long-term outcomes. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: zainab.samad@dm.duke.edu.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
authors.forename: Stephen
authors.initials: S
authors.lastname: Boyle
authors.affiliation: Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Ersboll
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Amit N
authors.initials: AN
authors.lastname: Vora
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
authors.forename: Redford
authors.initials: R
authors.lastname: Williams
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kuhn
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism*; D015283:Citalopram / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000188:drug therapy / Q000523:psychology; D015539:Platelet Activation / Q000187:drug effects / Q000502:physiology*; D012727:Sex Characteristics; D013315:Stress, Psychological / Q000097:blood* / Q000188:drug therapy / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram
keywords: mental stress; myocardial ischemia; women