Women more susceptible to stress-induced ischemia after MI

Young women who’ve experienced a previous instance of heart attack are more susceptible to the development of mental stress–induced-myocardial ischemia (MSIMI) as compared to men with similar history, suggests a study published in the journal Circulation.

The study was conducted by Hawkins Gay, a third-year resident at Northwestern University Medical Center, Chicago, Illinois, and colleagues, to identify the mechanisms governing elevated rates of MSIMI in women having a previous instance of myocardial infarction (MI).

Mental stress-induced myocardial ischemia (MSIMI) has been thought to represent a dysregulated response to emotional, rather than physical stress, and the current study sought to confirm these suspicions and detail the mechanisms of disease.

For carrying out the research, the investigators studied 306 patients with an average age of 61 who were hospitalized for MI in the previous eight months, and compared them to an age- and sex-matched control group. Cardiovascular benchmarks such as microvascular reactivity and digital vasomotor response were measured before, during and after a stress event, in which participants were asked to imagine a real-life stressful situation and were given just two minutes to prepare a statement that was subsequently given on camera.

After analyzing the results, investigators found 22 percent of women developed MSIMI, compared to just 11 percent of men. The main reason for the difference was enhanced microvascular dysfunction in women during stress, suggesting the role of microvasculature — the smallest blood vessels in the body, in vulnerability to MSIMI.

Women with a history of heart attack have poorer cardiovascular outcomes when compared to men, a well-known phenomenon, according to the study. However, the full underlying explanation for their higher levels of morbidity and mortality remains unknown.

“Our ability to medically treat microvascular dysfunction is currently very limited,” Gay said. “I think we need to focus our therapeutic efforts on the well-established treatments for disorders such as depression and PTSD — this is best accomplished in multidisciplinary teams with regular patient follow-up, similar to diet and exercise.”

The study looked at rates of depression and anxiety; a different set of risk factors compared to the typical markers, such as cholesterol or high blood pressure. Previous studies identified the perceived stress rate — disproportionately high in young women after a heart attack — as a powerful predictor of cardiovascular risk, separate from those typical risk factors.

Based on the study the authors concluded that unmeasured psychosocial risk factors like depression or anxiety may undermine preventive cardiovascular care efforts for women, which have historically concentrated on traditional risk factors such as obesity or smoking. Overall heart disease mortality rates are declining more slowly in women as compared to men, which, the authors note, presents an urgent need to improve risk assessment and prevention.

“Consideration of socioeconomic and emotional risk factors is extremely important, similar to evaluating lifestyle factors such as diet and exercise, but difficult with limited time,” Gay said. “Having patients return to clinic for a full assessment of these factors, either as a separate clinician visit or with another advanced practice provider, would be very helpful for identifying those at increased cardiovascular risk.”

For further details click on the link: https://doi.org/10.1161/CIRCULATIONAHA.117.030849