ORIGINAL RESEARCH
Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease Viola Vaccarino, MD, PhD, FAHA; Kobina Wilmot, MD; Ibhar Al Mheid, MD; Ronnie Ramadan, MD; Pratik Pimple, MBBS, MPH; Amit J. Shah, MD, MSCR; Ernest V. Garcia, PhD; Jonathon Nye, PhD; Laura Ward, MPH; Muhammad Hammadah, MD; Michael Kutner, PhD; Qi Long, PhD; J. Douglas Bremner, MD; Fabio Esteves, MD; Paolo Raggi, MD, FAHA, FACC; Arshed A. Quyyumi, MD, FACC
Background-—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). Methods and Results-—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
Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease Viola Vaccarino, MD, PhD, FAHA; Kobina Wilmot, MD; Ibhar Al Mheid, MD; Ronnie Ramadan, MD; Pratik Pimple, MBBS, MPH; Amit J. Shah, MD, MSCR; Ernest V. Garcia, PhD; Jonathon Nye, PhD; Laura Ward, MPH; Muhammad Hammadah, MD; Michael Kutner, PhD; Qi Long, PhD; J. Douglas Bremner, MD; Fabio Esteves, MD; Paolo Raggi, MD, FAHA, FACC; Arshed A. Quyyumi, MD, FACC
Background-—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). Methods and Results-—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
