Women, unmarried men at increased risk for mental stress-induced myocardial ischemia

February 22, 2013 – Eric Velazquez, MD, was senior author of a new study that analyzed stress-induced ischemia in coronary heart disease patients.

Women, unmarried men, and people who live alone are at increased risk of mental stress-induced myocardial ischemia (MSIMI), according to a new study by the DCRI’s Richard Becker, MD; Joseph Rogers, MD; Christopher O’Connor, MD; Eric Velazquez, MD; and other Duke researchers.

Velazquez served as senior author of the study, which appeared in the February 19 issue of the Journal of the American College of Cardiology.

Defined as the reduction of blood flow to the heart, MSIMI is common in patients with coronary heart disease and exercise stress-induced myocardial ischemia (ESIMI). MSIMI is generally believed to exist only in conjunction with ESIMI in coronary heart disease patients. However, there is some evidence to suggest that patients with no sign of ischemia during exercise could develop MSIMI.

To better understand the prevalence of MSIMI relative to ESIMI in coronary heart disease patients, the researchers studied data from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. REMIT was a double-blind, placebo-controlled study to determine the effectiveness of the drug escitalopram on MSIMI. For the newer study, researchers analyzed data from 310 patients with documented coronary heart disease and MSIMI during screening.

Patients were evaluated by an interview designed to collect demographic and clinical characteristics data, a structured psychiatric assessment, a series of psychometric tests, and resting vital sign measurements. Participants completed the stress testing on a separate day. Echocardiography and electrocardiography were used to assess myocardial ischemia. Descriptive statistics and plots were used to assess the demographic and clinical characteristic differences of the following: 1) patients with and without MSIMI; 2) patients with and without ESIMI; and 3) patients with MSIMI only versus patients with ESIMI only.

The researchers found that MSIMI occurred in 43.45 percent of patients, whereas ESIMI occurred in 33.79 percent. Women, patients who were not married, and patients who lived alone were more likely to have MSIMI. Although all patients who were married or living with someone were less likely to develop MSIMI, men appeared to benefit more than women.

The researchers concluded that MSIMI is more prevalent among coronary heart disease patients than previously thought and appears in patients with and without ESIMI. It also exists independent of conventional cardiovascular risk factors. More research is needed to better understand the underlying mechanisms of MSIMI, as well as the roles of sex, marriage, and living arrangements.