Advertisement

Comparison of Peripheral Arterial Response to Mental Stress in Men Versus Women With Coronary Artery Disease

      There are profound gender-related differences in the incidence, presentation, and outcomes of coronary artery disease (CAD). These differences are not entirely explained by traditional cardiovascular risk factors. Nontraditional risk factors, such as psychological traits, have increasingly been recognized as important contributors to the genesis and outcomes of CAD. Mental stress induces significant peripheral arterial vasoconstriction, with consequent increases in heart rate and blood pressure. These changes are thought to underlie the development of myocardial ischemia and other mental stress–induced adverse cardiac events in patients with CAD. This study examined for gender-related differences in peripheral arterial response to mental stress in a cohort of patients with CAD using a novel peripheral arterial tonometric (PAT) technique. There were 211 patients (77 women; 37%) with a documented history of CAD and a mean age of 64 ± 9 years. Patients were enrolled from August 18, 2004, to February 21, 2007. Mental stress was induced using a public speaking task. Hemodynamic and PAT measurements were recorded during rest and mental stress. The PAT response was calculated as a ratio of pulse wave amplitude during stress to at rest. PAT responses were compared between men and women. The PAT ratio (during stress to at rest) was significantly higher in women compared with men. Mean PAT ratio was 0.80 ± 0.72 in women compared with 0.59 ± 0.48 in men (p = 0.032). This finding remained significant after controlling for possible confounding factors (p = 0.037). In conclusion, peripheral vasoconstrictive response to mental stress was more pronounced in men compared with women. This finding may suggest that men have higher susceptibility to mental stress–related adverse effects. Additional studies are needed to determine the significance of this finding.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kneale B.J.
        • Chowienczyk P.J.
        • Cockcroft J.R.
        • Coltart D.J.
        • Ritter J.M.
        Vasoconstrictor sensitivity to noradrenaline and NG-monomethyl-l-arginine in men and women.
        Clin Sci. 1997; 93: 513-518
        • Colucci W.S.
        • Gimbrone M.A.
        • McLaughlin M.K.
        • Halpern W.
        • Alexander R.W.
        Increased vascular catecholamine sensitivity and α-adrenergic receptor affinity in female and estrogen-treated male rats.
        Circ Res. 1982; 50: 805-811
        • Freedman R.R.
        • Sabharwal S.C.
        • Desai N.
        Sex differences in peripheral vascular adrenergic receptors.
        Circ Res. 1987; 61: 581-585
        • Kneale B.J.
        • Chowienczyk P.J.
        • Brett S.E.
        • Coltart D.J.
        • Ritter J.M.
        Gender differences in sensitivity to adrenergic agonists of forearm resistance vasculature.
        J Am Coll Cardiol. 2000; 36: 1233-1238
        • Li Z.
        • Duckles S.P.
        Influence of gender on vascular reactivity in the rat.
        J Pharmacol Exp Ther. 1994; 286: 1426-1431
        • Sudhir K.
        • Elser M.D.
        • Jennings G.L.
        • Komesaroff P.A.
        Estrogen supplementation decreases norepinephrine-induced vasoconstriction and total body norepinephrine spillover in perimenopausal women.
        Hypertension. 1997; 30: 1538-1543
        • Sudhir K.
        • Jennings G.L.
        • Funder J.W.
        • Komesaroff P.A.
        Estrogen enhances basal nitric oxide release in the forearm vasculature in perimenopausal women.
        Hypertension. 1996; 28: 330-334
        • Forte P.
        • Copland M.
        • Smith L.M.
        • Milne E.
        • Sutherland J.
        • Benjamin N.
        Basal nitric oxide synthesis in essential hypertension.
        Lancet. 1997; 349: 837-842
        • Jiang W.
        • Babyak M.
        • Krantz D.S.
        • Waugh R.A.
        • Coleman R.E.
        • Hanson M.M.
        • Frid D.J.
        • McNulty S.
        • Morris J.J.
        • O'Connor C.M.
        • Blumenthal J.A.
        Mental stress-induced myocardial ischemia and cardiac events.
        JAMA. 1996; 275: 1651-1656
        • Jain D.
        • Burg M.
        • Soufer A.
        • Zaret B.L.
        Prognostic implications of mental stress-induced silent left ventricular dysfunction in patients with stable angina pectoris.
        Am J Cardiol. 1995; 76: 31-35
        • Krantz D.S.
        • Santiago H.T.
        • Kop J.W.
        • Bairey Merz C.N.
        • Rozanski A.
        • Gottdiener J.S.
        Prognostic value of mental stress testing in coronary artery disease.
        Am J Cardiol. 1999; 84: 1292-1297
        • Sheps D.S.
        • McMahon R.P.
        • Becker L.
        • Carney R.M.
        • Freedland K.E.
        • Cohen J.D.
        • Sheffield D.
        • Goldberg A.D.
        • Ketterer M.W.
        • Pepine C.J.
        • et al.
        Mental stress-induced ischemia and all-cause mortality in patients with coronary artery disease: results from the Psychophysiological Investigations of Myocardial Ischemia study.
        Circulation. 2002; 105: 1780-1784
        • Kaufmann P.G.
        • McMahon R.P.
        • Becker L.C.
        • Bertolet B.
        • Bonsall R.
        • Chaitman B.
        • Cohen J.D.
        • Forman S.
        • Goldberg A.D.
        • Freedland K.
        • et al.
        The Psychophysiological Investigations of Myocardial Ischemia (PIMI) study: objective, methods, and variability of measures.
        Psychosom Med. 1998; 60: 56-63
        • Goor D.A.
        • Sheffy J.
        • Schnall R.P.
        • Arditti A.
        • Caspi A.
        • Bragdon E.E.
        • Sheps D.S.
        Peripheral arterial tonometry: a diagnostic method for detection of myocardial ischemia induced during mental stress tests: a pilot study.
        Clin Cardiol. 2004; 27: 137-141
        • Gottdiener J.S.
        • Krantz D.S.
        • Howell R.H.
        • Hecht G.M.
        • Klein J.
        • Falconer J.J.
        • Rozanski A.
        Induction of silent myocardial ischemia with mental stress testing: relation to the triggers of ischemia during daily life activities and to ischemic functional severity.
        J Am Coll Cardiol. 1994; 24: 1645-1651
        • Gullette E.C.
        • Blumenthal J.A.
        • Babyak M.
        • Jiang W.
        • Waugh R.A.
        • Frid D.J.
        • O'Connor C.M.
        • Morris J.J.
        • Krantz D.S.
        Effects of mental stress on myocardial ischemia during daily life.
        JAMA. 1997; 277: 1521-1526
        • Gabbay F.H.
        • Krantz D.S.
        • Kop W.J.
        • Hedges S.M.
        • Klein J.
        • Gottdiener J.S.
        • Rozanski A.
        Triggers of myocardial ischemia during daily life in patients with coronary artery disease: physical and mental activities, anger and smoking.
        J Am Coll Cardiol. 1996; 27: 585-592
        • Stone P.H.
        • Krantz D.S.
        • McMahon R.P.
        • Goldberg A.D.
        • Becker L.C.
        • Chaitman B.R.
        • Taylor H.A.
        • Cohen J.D.
        • Freedland K.E.
        • Bertolet B.D.
        • et al.
        Relationship among mental stress-induced ischemia and ischemia during daily life and during exercise: the Psychophysiologic Investigations of Myocardial Ischemia (PIMI) study.
        J Am Coll Cardiol. 1999; 33: 1476-1484
        • Blumenthal J.A.
        • Jiang W.
        • Waugh R.A.
        • Frid D.J.
        • Morris J.J.
        • Coleman R.E.
        • Hanson M.
        • Babyak M.
        • Thyrum E.T.
        • Krantz D.S.
        • O'Connor C.
        Mental stress-induced ischemia in the laboratory and ambulatory ischemia during daily life.
        Circulation. 1995; 92: 2102-2108
        • Spieker L.E.
        • Hurlimann D.
        • Ruschitzka F.
        • Corti R.
        • Enseleit F.
        • Shaw S.
        • Hayoz D.
        • Deanfield J.E.
        • Lüscher T.F.
        • Noll G.
        Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors.
        Circulation. 2002; 105: 2817-2820
        • Mendelsohn M.E.
        Nongenomic, ER-mediated activation of endothelial nitric oxide synthase: how does it work?.
        Circ Res. 2000; 87: 956-960
        • Arnal J.F.
        • Clamens S.
        • Pechet C.
        • Negre-Salvayre A.
        • Allera C.
        • Girolami J.P.
        • Salvayre R.
        • Bayard F.
        Ethinylestradiol does not enhance the expression of nitric oxide synthase in bovine aortic endothelial cells but increases the release of bioactive nitric oxide by inhibiting superoxide anion production.
        Proc Natl Acad Sci U S A. 1996; 93: 4108-4113
        • Darblade B.
        • Pendaries C.
        • Krust A.
        • Dupont S.
        • Fouque M.J.
        • Rami J.
        • Chambon P.
        • Bayard F.
        • Arnal J.F.
        Estradiol alters nitric oxide production in the mouse aorta through the alpha-, but not beta-, estrogen receptor.
        Circ Res. 2002; 90: 413-419
        • Martin P.
        • Lee H.-S.
        Indicators of active and passive coping in myocardial infarction victims.
        J Gerontol Psychol Sci. 1992; 47: 238-241
        • Bogg J.
        • Thornton E.
        • Bundred P.
        Gender variability in mood, quality of life and coping following primary myocardial infarction.
        Coronary Health Care. 2000; 4: 163-168
        • LaCharity L.A.
        The experiences of younger women with coronary artery disease.
        J Women's Health Gend Based Med. 1999; 8: 773-785
        • York K.M.
        • Hassan M.
        • Li Q.
        • Li H.
        • Fillingim R.B.
        • Lucey D.
        • Bestland M.
        • Sheps D.S.
        Do men and women differ on measures of mental stress-induced ischemia?.
        Psychosom Med. 2007; 69: 918-922
        • Kannel W.B.
        • Abbott R.D.
        Incidence and prognosis of myocardial infarction in women.
        in: Eaker E.D. Packard B. Wenger N.K. Clarkson T.B. Tyroler H.A. Coronary Heart Disease in Women. Haymaker Doymer, New York1987: 208-214
        • Lerner D.J.
        • Kannel W.B.
        Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population.
        Am Heart J. 1986; 3: 383-390