title: Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease.
abstract: Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress-induced myocardial ischemia (MSIMI).
  
  
  
  We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent (99m)Tc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more-adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress.
  
  
  
  Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA viola.vaccarino@emory.edu.
authors: Viola
authors: V
authors: Vaccarino
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Kobina
authors: K
authors: Wilmot
authors: Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Ibhar
authors: I
authors: Al Mheid
authors: Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Ronnie
authors: R
authors: Ramadan
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Pratik
authors: P
authors: Pimple
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Amit J
authors: AJ
authors: Shah
authors: Department of Radiology, Emory University School of Medicine, Atlanta, GA.
authors: Ernest V
authors: EV
authors: Garcia
authors: Department of Radiology, Emory University School of Medicine, Atlanta, GA.
authors: Jonathon
authors: J
authors: Nye
authors: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Laura
authors: L
authors: Ward
authors: Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Muhammad
authors: M
authors: Hammadah
authors: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Michael
authors: M
authors: Kutner
authors: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Qi
authors: Q
authors: Long
authors: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
authors: J Douglas
authors: JD
authors: Bremner
authors: Department of Radiology, Emory University School of Medicine, Atlanta, GA.
authors: Fabio
authors: F
authors: Esteves
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA Department of Radiology, Emory University School of Medicine, Atlanta, GA Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors: Paolo
authors: P
authors: Raggi
authors: Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors: Arshed A
authors: AA
authors: Quyyumi
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000523:psychology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D055414:Myocardial Perfusion Imaging; D019275:Radiopharmaceuticals; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: ischemia; ischemic heart disease; sex differences; stress; women