Ischemia differs in men, women under mental stress

At the heart of things, men and women do react differently to stress. According to a study published in the Oct. 21 issue of the Journal of the American College of Cardiology, the physical impact of mental and emotional stress on the heart and its function differs between men and women.

This finding comes from a second look at heart disease patients enrolled in the REMIT (Responses of Myocardial Ischemia to Escitalopram Treatment) study. REMIT enrolled patients with stable coronary disease and mental stress-induced ischemia with the intent to find differences between Escitalopram (Lexapro, Forest Laboratories) on stress against a control.

Zainab Samad, MD, MHS, of the Department of Medicine at Duke University Medical Center in Durham, N.C., and colleagues, assessed data on 56 women and 254 men enrolled in the larger study. However, instead of looking at drug control, Samad et al sought the differences between men and women and their stress responses. Over a two-day period, patients underwent psychiatric assessment, psychometric testing and the mental and exercise stress testing protocols. Mental stress testing involved three mental stress tasks: arithmetic, mirror trace and anger recall.

At baseline and toward the end of each stress period, patients underwent echocardiography to determine ischemia in real time. Blood pressure was measured throughout along with electrocardiogram recordings. Samad et al collected blood samples at rest and at the end of mental stress testing.

They found women had more mental stress-induced MI and had higher collagen-stimulated platelet aggregation than men. Women also showed decreased blood flow to the heart. Men, on the other hand, were more likely to show changes in blood pressure and heart rate as a result to mental stress.

Women also showed a greater increase in negative and decrease in positive emotions compared with men during the stress test.

In a press release, Samad said, "This study also underscores the inadequacy of available risk prediction tools, which currently fail to measure an entire facet of risk, i.e. the impact of negative physiological responses to psychological stress in both sexes, and especially so among women."

Samad et al stressed that further studies were needed to explore the association of sex in differences to mental stress, heart response and long-term outcomes.