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.
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Article Info
Publication History
Published online: July 28, 2008
Accepted:
June 2,
2008
Received in revised form:
June 2,
2008
Received:
March 11,
2008
Footnotes
This study was supported by Grants HL 070265 and HL 072059 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. This material was also the result of work supported with resources and use of facilities at the Department of Veterans Affairs Medical Center, Gainesville, Florida.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
