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Hemodynamic Reactivity to Mental Stress and Cognitive Function in Coronary Artery Disease
Kasra Moazzami1, Ambar Kulshreshtha, Matthew Gold
1From the Division of Cardiology, Department of Medicine (Moazzami, Gold, Rahbar, Quyyumi), Emory Clinical Cardiovascular Research Institute; Grady Health System (Moazzami); Department of Epidemiology, Rollins School of Public Health (Kulshreshtha, Shah, Vaccarino), Emory University; Departments of Family and Preventive Medicine (Kulshreshtha) and Neurology (Goldstein), and Goizuetta Alzheimer's Disease Research Center (Goldstein), Emory University School of Medicine, Emory University, Atlanta; Atlanta VA Medical Center (Shah, Bremner), Decatur; Departments of Radiology and Imaging Sciences (Bremner) and Psychiatry and Behavioral Sciences (Bremner), Emory University School of Medicine, Atlanta, Georgia.
Objective:
People with coronary artery disease (CAD) are at higher risk of cognitive impairment than those without CAD. Psychological stress is a risk factor for both conditions, and assessing the hemodynamic reactivity to mental stress could explain the link between stress and cognitive function.
Methods:
A total of 779 individuals with stable CAD from two prospective cohort studies were included. All individuals underwent acute mental stress testing, as well as conventional stress testing. Cognitive function was assessed both at baseline and at a 2-year follow-up. The rate-pressure product (RPP) was calculated as the mean systolic blood pressure times the mean heart rate at rest. RPP reactivity was defined as the maximum RPP during standardized mental stress test minus the RPP at rest.
Results:
After multivariable adjustment, every standard deviation decrease in RPP reactivity with mental stress was associated with slower completion of Trail-A and Trail-B in both cohorts (13% and 11% in cohort 1, and 15% and 16% in cohort 2, respectively; p for all <.01). After a 2-year follow-up period, every standard deviation decrease in RPP reactivity with mental stress was associated with a 8% and 9% slower completion of Trail-A and Trail-B, respectively ( p for all <.01). There was no significant association between RPP reactivity with conventional stress testing and any of the cognitive tests.
Conclusion:
In the CAD population, a blunted hemodynamic response to mental stress is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
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