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Psychosomatic Medicine:
doi: 10.1097/PSY.0000000000000045
Original Article

Sex Differences in Mental Stress–Induced Myocardial Ischemia in Young Survivors of an Acute Myocardial Infarction

Vaccarino, Viola MD, PhD; Shah, Amit J. MD, MSCR; Rooks, Cherie PhD; Ibeanu, Ijeoma MPH; Nye, Jonathon A. PhD; Pimple, Pratik MBBS, MPH; Salerno, Amy MD; D’Marco, Luis MD; Karohl, Cristina MD; Bremner, James Douglas MD; Raggi, Paolo MD

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Abstract

Objectives: Emotional stress may disproportionally affect young women with ischemic heart disease. We sought to examine whether mental stress–induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than in men.

Methods: We studied 98 post-MI patients (49 women and 49 men) aged 38 to 60 years. Women and men were matched for age, MI type, and months since MI. Patients underwent technetium-99m sestamibi perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Perfusion defect scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions.

Results: Women 50 years or younger, but not older women, showed a more adverse psychosocial profile than did age-matched men but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease. Compared with age-matched men, women 50 years or younger exhibited a higher SDS with mental stress (3.1 versus 1.5, p = .029) and had twice the rate of MSIMI (SDS ≥3; 52% versus 25%), whereas ischemia with physical stress did not differ (36% versus 25%). In older patients, there were no sex differences in MSIMI. The higher prevalence of MSIMI in young women persisted when adjusting for sociodemographic and life-style factors, coronary artery disease severity, and depression.

Conclusions: MSIMI post-MI is more common in women 50 years or younger compared with age-matched men. These sex differences are not observed in post-MI patients who are older than 50 years.

Copyright © 2014 by American Psychosomatic Society

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