Mental stress-induced myocardial ischemia may increase the risk of cardiovascular (CV) events in patients with coronary heart disease (CHD), according to new data published in JAMA.
The analysis included data from 918 patients from a university-based hospital network in Atlanta. All patients were enrolled from June 2011 to March 2016, and the most recent follow-up was in February 2020. Sixty-six percent of patients were men, and the mean patient age was 60 years old.
Mental stress was prompted by a standardized public speaking task followed by a conventional exercise or pharmacological stress test. While 16% of patients had mental stress-induced ischemia, 31% had conventional stress ischemia, and 10% had both.
The study's primary endpoint was a composite of CV death or nonfatal MI, and its secondary endpoint added hospitalizations for heart failure to the mix.
According to the authors, over a five-year median follow-up period, the primary endpoint was observed in 156 patients. The secondary endpoint, meanwhile, occurred in 319 patients.
Patients with mental stress-induced ischemia alone or mental stress-induced ischemia and conventional stress-induced ischemia had an increased risk of having a CV event. However, patients with conventional stress ischemia alone did not have a significantly increased risk.
“These findings are consistent with a role of psychological stress in the outcome of patients with CHD,” wrote lead author Viola Vaccarino, MD, PhD with the department of epidemiology at Rollins School of Public Health at Emory University in Atlanta. “Additional studies have linked stress-related changes in microvascular tone, brachial endothelial function and brain activity to outcomes in patients with CHD. As a whole, this evidence suggests that the value of stress and mental health factors for CHD risk stratification should be investigated, given that they are amenable to medical and lifestyle intervention, including aerobic exercise and stress management training, antidepressants, and beta-blockers and antianginal drugs.”
Read the full study here.