Silent myocardial ischemia and cardiovascular responses to anger provocation in older adults

To determine if older, asymptomatic individuals with no prior history of coronary heart disease with exercise-induced silent myocardial ischemia (SI) during graded exercise treadmill testing exhibit exaggerated cardiovascular reactivity to anger provocation, we compared 42 SI participants and 95 controls. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) changes from baseline to three tasks--anger recall, speech role-play, and mental arithmetic with harassment--were assessed. Compared to controls, SI displayed greater HR responses for the speech role-play task only. The SI group was significantly older, had higher levels of fasting glucose and triglycerides, and had lower HDL-cholesterol. In multiple regression analyses, after controlling for these differences, SI was significantly associated with greater HR responses to the speech role-play. In sum, the SI group significantly exaggerated HR responses to the speech role-play task, whereas SBP and DBP reactivity were comparable between groups. This suggests minimally enhanced cardiovascular reactivity among older SI patients that may nonetheless increase risk for cardiac events.