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Sex Differences in Psychosocial Factors and Angina in Patients With Chronic Coronary Disease
Anaïs Hausvater1, Rebecca Anthopolos2, Alexa Seltzer1
1Department of Medicine, Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology NYU Grossman School of Medicine New York NY USA.
Insights
High stress and depressive symptoms independently worsen angina and health status in both men and women with coronary artery disease (CAD) or ischemia with no obstructive CAD (INOCA). Other factors contribute to worse outcomes in women.
Area of Science:
- Cardiology
- Psychosomatic Medicine
- Health Services Research
Background:
- Women with chronic coronary disease (CAD) experience more frequent angina and worse health status than men, despite having less obstructive CAD.
- Investigating the mediating roles of perceived stress and depressive symptoms in sex differences in angina is crucial.
- Understanding these differences in both obstructive CAD and ischemia with no obstructive coronary artery disease (INOCA) is important.
Purpose of the Study:
- To examine whether perceived stress and depressive symptoms mediate sex differences in angina-related health status.
- To determine if this relationship differs between obstructive CAD and INOCA.
Main Methods:
- Analysis of data from the ISCHEMIA trial and CIAO-ISCHEMIA ancillary study.
- Assessed perceived stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8).
- Evaluated angina-related health status using the Seattle Angina Questionnaire (SAQ).
Main Results:
- Women reported worse SAQ scores than men in both CAD and INOCA cohorts.
- Higher stress and depressive symptoms were linked to worse angina in both groups.
- Female sex, stress, and depression were independently associated with poorer SAQ scores, but the CAD vs. INOCA cohort was not a significant factor.
Conclusions:
- High stress and depressive symptoms are independently linked to worse angina and poorer health status in patients with or without obstructive CAD.
- These psychological factors do not interact with sex to influence health status.
- Additional factors beyond stress and depression contribute to the poorer health status observed in women with obstructive CAD or INOCA.
Background:
Women with chronic coronary disease have more frequent angina and worse health status than men, despite having less coronary artery disease (CAD). We examined whether perceived stress and depressive symptoms mediate sex differences in angina, and whether this relationship differs in the setting of obstructive CAD or ischemia with no obstructive coronary artery disease (INOCA).
Methods:
We analyzed the association between sex, stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8) on angina-related health status (Seattle Angina Questionnaire [SAQ]) at enrollment in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial and CIAO-ISCHEMIA (Changes in Ischemia and Angina Over 1 Year Among ISCHEMIA Trial Screen Failures With No Obstructive CAD on Coronary CT [Computed Tomography] Angiography) ancillary study.
Results:
Scores for the SAQ, Perceived Stress Scale-4, and Patient Health Questionnaire-8 were available in 1626 participants (N=1439 CAD and N=187 INOCA). Women had lower (worse) SAQ-7 summary scores than men in both CAD and INOCA cohorts (CAD: median 76 [25th, 75th percentiles 60, 90] versus 83 [70, 96], P<0.001; INOCA: 80 [64,89] versus 85 [75, 93], P=0.012). Higher stress and depressive symptoms were associated with worse angina in both cohorts. Female sex, Perceived Stress Scale-4 score, and Patient Health Questionnaire-8 score were each independently associated with lower SAQ summary score, but CAD versus INOCA cohort was not. There was no interaction between sex and stress (-0.39 [95% CI, -1.01 to 0.23]) or sex and depression (-0.00 [95% CI, -0.53 to 0.53]) on SAQ summary score.
Conclusions:
High stress and depressive symptoms were independently associated with worse angina and poorer health status, without interaction with sex with or without obstructive CAD. Factors other than stress or depression contribute to worse health status in women with obstructive CAD or INOCA.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02347215, NCT01471522.
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