Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery
Kasra Moazzami1,2,3, Samaah Sullivan4, Maggie Wang1,2
1Department of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USA.
Insights
Mental stress impacts cardiovascular health in coronary artery disease patients. A new risk score measuring hemodynamic and vascular responses to stress predicts adverse cardiovascular events, improving risk prediction beyond traditional factors.
Area of Science:
- Cardiology
- Psychophysiology
- Vascular Biology
Background:
- Acute psychological stress can trigger physiological changes, including hemodynamic and vascular effects, potentially leading to adverse health outcomes.
- Patients with coronary artery disease (CAD) are particularly vulnerable to these stress-induced changes.
- Understanding the link between stress reactivity and cardiovascular events is crucial for risk stratification in CAD patients.
Purpose of the Study:
- To investigate the association between aggregated stress-induced changes in hemodynamic and vascular function and adverse cardiovascular outcomes in patients with stable CAD.
- To develop and validate a cardiovascular reactivity risk score to enhance prediction of adverse cardiovascular events.
Main Methods:
- Two prospective cohort studies involving 629 participants with stable CAD were analyzed.
- Hemodynamic reactivity (rate-pressure product), endothelial function (flow-mediated vasodilation), and vasoconstriction (peripheral arterial tonometry) were assessed during mental stress.
- A cardiovascular reactivity risk score (0-9) was computed based on responses in these three areas.
Main Results:
- Blunted hemodynamic response, decreased flow-mediated vasodilation, and increased peripheral vasoconstriction to mental stress were independently linked to higher adverse cardiovascular outcomes.
- The cardiovascular reactivity risk score significantly improved the predictive ability (C-statistic increased by 10%, P<0.001) beyond traditional risk factors.
- These findings were consistent across both study cohorts.
Conclusions:
- A risk score derived from cardiovascular reactivity to mental stress effectively predicts adverse cardiovascular outcomes in individuals with stable CAD.
- This reactivity-based risk score offers prognostic value beyond established cardiovascular risk factors.
- Mental stress assessment provides a novel avenue for improving cardiovascular risk prediction in CAD patients.
Background:
Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress-induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in patients with coronary artery disease, after adjusting for sociodemographic and clinical factors.
Methods And Results:
Individuals with stable coronary artery disease from 2 prospective cohort studies were studied. Hemodynamic reactivity, changes in endothelial function, and vasoconstriction during mental stress were evaluated using changes in rate-pressure product, brachial artery flow-mediated vasodilation, and peripheral arterial tonometry, respectively. A cardiovascular reactivity risk score was calculated by allotting 0 to 3 points for each quartile of increasing abnormality for each of the 3 reactivity responses and summing the quartile points from the MIPS (Mental Stress Ischemia Prognosis Study) to yield a cardiovascular reactivity risk score ranging from 0 to 9. The outcome was a composite of cardiovascular death, nonfatal myocardial infarction, and heart failure hospitalizations during follow-up. A total of 629 participants were included. After adjustment for demographic and traditional risk factors, a blunted hemodynamic response, a greater decrease in flow-mediated vasodilation, and a greater degree of peripheral vasoconstriction to mental stress were all independently associated with a higher risk of adverse outcomes in both cohorts. By adding the cardiovascular reactivity risk score, the C-statistic increased significantly by 10% (P<0.001).
Conclusions:
Among individuals with stable coronary artery disease, a risk score derived from cardiovascular reactivity to mental stress was predictive of adverse cardiovascular outcomes beyond traditional cardiovascular risk factors.
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