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Racial Differences in Mental Stress-Induced Transient Endothelial Dysfunction and Its Association With Cardiovascular

Alexis K Okoh1, An Young, Mariana Garcia

  • 1From the Department of Medicine, Division of Cardiology (Okoh, Young, Garcia, Almuwaqqat, Moazzami, Uphoff, Lima, Shah, Quyyumi, Vaccarino), Emory University School of Medicine; Departments of Epidemiology (Okoh, Sullivan, Liu, Jajeh, Rout, Gupta, Shah, Lewis, Vaccarino) and Biostatistics and Bioinformatics (Hu, Ko, Elon), Rollins School of Public Health, Emory University, Atlanta; Atlanta VA Medical Center (Shah, Bremner), Decatur; and Department of Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine, Atlanta, Georgia.

Psychosomatic Medicine
|April 13, 2023
PubMed

Insights

Black individuals with coronary heart disease (CHD) experience more transient endothelial dysfunction (TED) after mental stress. This dysfunction significantly contributes to their increased risk of adverse cardiovascular events.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Biology
  • Health Disparities

Background:

  • Coronary heart disease (CHD) affects diverse populations, with varying impacts on cardiovascular outcomes.
  • Endothelial dysfunction, a precursor to cardiovascular events, may be exacerbated by mental stress.
  • Understanding racial differences in stress-induced endothelial dysfunction is crucial for targeted interventions.

Purpose of the Study:

  • To investigate racial disparities in transient endothelial dysfunction (TED) following mental stress among patients with CHD.
  • To assess the impact of TED on cardiovascular outcomes in Black versus non-Black individuals with CHD.

Main Methods:

  • A cohort of 812 stable CHD patients (Black and non-Black) underwent flow-mediated vasodilation (FMD) assessment before and after mental stress.
  • TED was defined as a post-stress FMD lower than pre-stress FMD.
  • Associations between TED, race, and a composite endpoint of cardiovascular death or myocardial infarction were analyzed.

Main Results:

  • Black participants exhibited lower prestress FMD and higher incidence of TED (76% vs. 67%) compared to non-Black participants.
  • Black patients had a 41.9% higher risk of cardiovascular death or myocardial infarction.
  • TED following mental stress accounted for 69% of the excess cardiovascular risk observed in Black patients.

Conclusions:

  • Black individuals with CHD are more prone to developing mental stress-induced endothelial dysfunction.
  • Transient endothelial dysfunction significantly mediates the elevated risk of adverse cardiovascular events in Black patients.
  • These findings highlight the need for culturally sensitive approaches to managing cardiovascular risk in diverse populations.
Abstract

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