Mental stress associated with repeat heart attacks, death from heart disease

The presence of mental stress is a key predictor of when MI patients may have a repeat MI or die from heart disease, according to new research highlighted by the American College of Cardiology.

The study, originally planned to be presented during ACC.20/WCC before the conference was moved to an online-only format, explored how myocardial ischemia associated with mental stress—not physical stress—is associated with poor patient outcomes. Researchers tracked 306 adult participants 61 years old or younger who had been hospitalized in the last eight months due to an MI.

Each participant was exposed to two kinds of testing, a mental stress test loaded with “emotional content” and a more traditional stress test. They were then followed for either a median of three years, with the researchers focused on repeat MIs and cardiovascular deaths.

Overall, mental stress-induced ischemia was found in 16% of study participants and “conventional” ischemia was found in 35%. After the three-year follow-up point, 10% of patients suffered a repeat MI and two patients total died of heart-related complications. Importantly, repeat MIs and cardiovascular deaths were much more common among patients with mental stress-induced ischemia (20%) than conventional ischemia (8%).

“These data point to the important effect that psychological stress can have on the heart and on the prognosis of patients with heart disease,” principal investigator Viola Vaccarino, MD, PhD, of Emory University in Atlanta, said in a prepared statement. “It gives us tangible proof of how psychological stress, which is not specifically addressed in current clinical guidelines, can actually affect outcomes.”

The team also found that mental stress and conventional stress likely occur through completely different pathways and are not related to one another.

“This points to the fact that stress provoked by emotions has a distinct mechanism of risk for heart disease and its complications compared with physical stress,” Vaccarino said.