Everyday Discrimination and Mental Stress-Induced Myocardial Ischemia
Izraelle I McKinnon1, Amit J Shah, Bruno Lima
1From the Department of Epidemiology (McKinnon, Shah, Moazzami, Sullivan, Elon, Vaccarino, Lewis), Rollins School of Public Health, Emory University; Division of Cardiology, Department of Medicine (Shah, Lima, Moazzami, Young, Almuwaqqat, Quyyumi, Vaccarino), Emory University School of Medicine, Atlanta; Atlanta VA Medical Center (Shah, Bremner), Decatur; Department of Radiology (Garcia), Emory University School of Medicine; Department of Psychiatry and Behavioral Sciences (Bremner, Raggi), Emory University School of Medicine, Atlanta, Georgia; and Mazankowski Alberta Heart Institute (Raggi), University of Alberta, Edmonton, Canada.
Objective:
Mental stress-induced myocardial ischemia (MSIMI), a transient myocardial ischemic response to mental stress, is associated with poorer outcomes among patients with coronary heart disease and is more likely to occur among women. However, predictors of MSIMI are not well explored. The current study investigated the association between experiences of everyday discrimination and MSIMI among patients with recent myocardial ischemia and contrasted the results with conventional stress-induced myocardial ischemia (CSIMI). We examined sex differences in associations.
Methods:
We studied 295 post-MI patients (145 women, 150 men). Provocation of myocardial ischemia with mental stress (speech task) and conventional stress (exercise or pharmacologic) was assessed by myocardial perfusion imaging. Frequency of exposure to everyday discrimination was assessed via questionnaire using the Everyday Discrimination Scale (EDS).
Results:
The mean age was 51 years in both women and men, and the EDS score ranged from 10 to 38 (mean [standard deviation] = 17 [6] years). After multivariable analysis, each standard deviation increase in the EDS score (more frequent exposure) was associated with an increased odds of MSIMI (odds ratio [OR] = 1.57 [1.10-2.23]). The EDS score was not associated with CSIMI (OR = 0.86 [0.64-1.17]). Women demonstrated a twofold increase (OR = 1.96 [1.13-3.38], p = .02) in the adjusted odds of MSIMI, with each standard deviation increase in the EDS score compared with a 1.4-fold increase (OR = 1.40 [0.80-2.44], p = .24) among men; however, interaction was not statistically significant.
Conclusions:
Among post-MI patients, everyday discrimination was positively associated with occurrence of MSIMI, but not with CSIMI; associations were more pronounced among women.
Insights
Everyday discrimination is linked to mental stress-induced myocardial ischemia (MSIMI) in post-MI patients, particularly women. This association was not found with conventional stress-induced myocardial ischemia (CSIMI).
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Health Disparities
Background:
- Mental stress-induced myocardial ischemia (MSIMI) is a significant risk factor for adverse outcomes in coronary heart disease patients, disproportionately affecting women.
- Predictors of MSIMI remain underexplored, highlighting a gap in understanding its etiology.
- Everyday discrimination is a psychosocial stressor with potential cardiovascular implications.
Purpose of the Study:
- To investigate the association between everyday discrimination and MSIMI in patients with recent myocardial infarction (MI).
- To compare these associations with conventional stress-induced myocardial ischemia (CSIMI).
- To examine potential sex differences in these associations.
Main Methods:
- A cohort of 295 post-MI patients (145 women, 150 men) was studied.
- Myocardial ischemia was assessed using myocardial perfusion imaging following mental stress (speech task) and conventional stress (exercise or pharmacologic).
- The frequency of everyday discrimination was measured using the Everyday Discrimination Scale (EDS).
Main Results:
- Increased everyday discrimination (per standard deviation increase in EDS score) was associated with higher odds of MSIMI (OR=1.57).
- No significant association was found between everyday discrimination and CSIMI (OR=0.86).
- Women showed a significantly higher adjusted odds of MSIMI associated with everyday discrimination (OR=1.96) compared to men (OR=1.40), though interaction was not statistically significant.
Conclusions:
- Everyday discrimination is positively associated with the occurrence of MSIMI in post-MI patients.
- This association was specific to MSIMI and not observed with CSIMI.
- The impact of everyday discrimination on MSIMI was more pronounced in women.
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