Public Release:  Impact of mental stress on heart varies between men, women

Study looks at mental and physical stress on patients with stable heart disease

American College of Cardiology

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IMAGE: This graphic shows the effects of mental stress on psychophysiological domains, myocardial ischemia, and outcomes in men and women. view more

Credit: Zainab Samad, Stephen Boyle, Mads Ersboll, Amit N. Vora, Ye Zhang, Richard C. Becker, Redford Williams, Cynthia Kuhn, Thomas L. Ortel, Joseph G. Rogers, Christopher M. O'Connor, Eric J. Velazquez, Wei Jiang,...

WASHINGTON (Oct. 13, 2014) -- Men and women have different cardiovascular and psychological reactions to mental stress, according to a study of men and women who were already being treated for heart disease. The study, published today in the Journal of the American College of Cardiology, looked at 56 women and 254 men diagnosed with heart disease enrolled in a larger REMIT study of the impact of the medication escitalopram on heart disease induced by mental stress.

After undergoing baseline testing, participants carried out three mentally stressful tasks -- a mental arithmetic test, a mirror tracing test, and an anger recall test -- followed by a treadmill exercise test. During mental stress tasks and rest periods between tests, researchers conducted echocardiography to study changes in the heart, took blood samples, and measured blood pressure and heart rate.

Researchers from the Duke Heart Center found that while men had more changes in blood pressure and heart rate in response to the mental stress, more women experienced myocardial ischemia, decreased blood flow to the heart. Women also experienced increased platelet aggregation, which is the start of the formation of blood clots, more than men. The women compared with men also expressed a greater increase in negative emotions and a greater decrease in positive emotions during the mental stress tests.

"The relationship between mental stress and cardiovascular disease is well known," said the study lead author Zainab Samad, M.D., M.H.S., assistant professor of medicine at Duke University Medical Center, Durham, North Carolina. "This study revealed that mental stress affects the cardiovascular health of men and women differently. We need to recognize this difference when evaluating and treating patients for cardiovascular disease."

"At this point, further studies are needed to test the association of sex differences in the heart's responses to mental stress and long term outcomes," Samad said. "This study also underscores the inadequacy of available risk prediction tools, which currently fail to measure an entire facet of risk, i.e. the impact of negative physiological responses to psychological stress in both sexes, and especially so among women."

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The American College of Cardiology is a 47,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit cardiosource.org/ACC.

The Journal of the American College of Cardiology, which publishes peer-reviewed research on all aspects of cardiovascular disease, is the most widely read cardiovascular journal in the world. JACC is ranked No. 1 among cardiovascular journals for its scientific impact.

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