Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction: Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study

Puja K. Mehta, Melody Hermel, Michael D. Nelson, Galen Cook-Wiens, Elizabeth A. Martin, Ayman A. Alkhoder, Janet Wei, Margo Minissian, Chrisandra L. Shufelt, Sailaja Marpuri, David Hermel, Amit Shah, Michael R. Irwin, David S. Krantz, Amir Lerman, C. Noel Bairey Merz

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. Methods: 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. Results: Mean age of CVaD and control groups was 58. ±. 9 and 55. ±. 10. years (p = 0.73). Baseline RHI correlated with coronary endothelial function (r = 0.36, p = 0.03) and inversely with RHI change post-MST (r = -0.51, p <. 0.001). During MST, 10% of controls reported chest pain vs. 41% of CVaD subjects (p = 0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p = 0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r = -3.4, p = 0.03), frustration (r = -0.37, p = 0.02), and feeling challenged (r = -0.37, p = 0.02) in CVaD but not controls. Conclusions: Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - 2017

Fingerprint

National Heart, Lung, and Blood Institute (U.S.)
Autonomic Nervous System
Blood Vessels
Hyperemia
Chest Pain
Manometry
Vasoconstriction
Mental Recall
Ischemia
Frustration
Forehead
Anger
Nonparametric Statistics
Arousal

Keywords

  • Mental stress
  • Microvascular dysfunction
  • Vascular reactivity
  • Women heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction : Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study. / Mehta, Puja K.; Hermel, Melody; Nelson, Michael D.; Cook-Wiens, Galen; Martin, Elizabeth A.; Alkhoder, Ayman A.; Wei, Janet; Minissian, Margo; Shufelt, Chrisandra L.; Marpuri, Sailaja; Hermel, David; Shah, Amit; Irwin, Michael R.; Krantz, David S.; Lerman, Amir; Noel Bairey Merz, C.

In: International Journal of Cardiology, 2017.

Research output: Contribution to journalArticle

Mehta, PK, Hermel, M, Nelson, MD, Cook-Wiens, G, Martin, EA, Alkhoder, AA, Wei, J, Minissian, M, Shufelt, CL, Marpuri, S, Hermel, D, Shah, A, Irwin, MR, Krantz, DS, Lerman, A & Noel Bairey Merz, C 2017, 'Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction: Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study', International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2017.10.061
Mehta, Puja K. ; Hermel, Melody ; Nelson, Michael D. ; Cook-Wiens, Galen ; Martin, Elizabeth A. ; Alkhoder, Ayman A. ; Wei, Janet ; Minissian, Margo ; Shufelt, Chrisandra L. ; Marpuri, Sailaja ; Hermel, David ; Shah, Amit ; Irwin, Michael R. ; Krantz, David S. ; Lerman, Amir ; Noel Bairey Merz, C. / Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction : Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study. In: International Journal of Cardiology. 2017.
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title = "Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction: Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study",
abstract = "Background: Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. Methods: 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. Results: Mean age of CVaD and control groups was 58. ±. 9 and 55. ±. 10. years (p = 0.73). Baseline RHI correlated with coronary endothelial function (r = 0.36, p = 0.03) and inversely with RHI change post-MST (r = -0.51, p <. 0.001). During MST, 10{\%} of controls reported chest pain vs. 41{\%} of CVaD subjects (p = 0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p = 0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r = -3.4, p = 0.03), frustration (r = -0.37, p = 0.02), and feeling challenged (r = -0.37, p = 0.02) in CVaD but not controls. Conclusions: Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.",
keywords = "Mental stress, Microvascular dysfunction, Vascular reactivity, Women heart disease",
author = "Mehta, {Puja K.} and Melody Hermel and Nelson, {Michael D.} and Galen Cook-Wiens and Martin, {Elizabeth A.} and Alkhoder, {Ayman A.} and Janet Wei and Margo Minissian and Shufelt, {Chrisandra L.} and Sailaja Marpuri and David Hermel and Amit Shah and Irwin, {Michael R.} and Krantz, {David S.} and Amir Lerman and {Noel Bairey Merz}, C.",
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T1 - Mental stress peripheral vascular reactivity is elevated in women with coronary vascular dysfunction

T2 - Results from the NHLBI-sponsored Cardiac Autonomic Nervous System (CANS) study

AU - Mehta, Puja K.

AU - Hermel, Melody

AU - Nelson, Michael D.

AU - Cook-Wiens, Galen

AU - Martin, Elizabeth A.

AU - Alkhoder, Ayman A.

AU - Wei, Janet

AU - Minissian, Margo

AU - Shufelt, Chrisandra L.

AU - Marpuri, Sailaja

AU - Hermel, David

AU - Shah, Amit

AU - Irwin, Michael R.

AU - Krantz, David S.

AU - Lerman, Amir

AU - Noel Bairey Merz, C.

PY - 2017

Y1 - 2017

N2 - Background: Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. Methods: 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. Results: Mean age of CVaD and control groups was 58. ±. 9 and 55. ±. 10. years (p = 0.73). Baseline RHI correlated with coronary endothelial function (r = 0.36, p = 0.03) and inversely with RHI change post-MST (r = -0.51, p <. 0.001). During MST, 10% of controls reported chest pain vs. 41% of CVaD subjects (p = 0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p = 0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r = -3.4, p = 0.03), frustration (r = -0.37, p = 0.02), and feeling challenged (r = -0.37, p = 0.02) in CVaD but not controls. Conclusions: Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.

AB - Background: Women with chest pain, ischemia, and no obstructive coronary artery disease often have coronary vascular dysfunction (CVaD). Peripheral vascular reactivity to mental stress may contribute mechanistic understanding of stress-induced ischemia in women with CVaD. Methods: 62 women (41 CVaD and 21 controls) underwent mental stress testing (MST) with anger recall, mental arithmetic, and forehead cold pressor (COP) challenge. Emotional arousal was measured (Likert scale). Reactive hyperemia index (RHI) was calculated before and after MST by peripheral arterial tonometry (PAT). Stress PAT ratio (SPR) of pulse amplitude during stress to rest was obtained to measure vasoconstriction. Wilcoxson rank sum test was used for analysis. Results: Mean age of CVaD and control groups was 58. ±. 9 and 55. ±. 10. years (p = 0.73). Baseline RHI correlated with coronary endothelial function (r = 0.36, p = 0.03) and inversely with RHI change post-MST (r = -0.51, p <. 0.001). During MST, 10% of controls reported chest pain vs. 41% of CVaD subjects (p = 0.01). RHI did not change significantly after MST in either group. CVaD subjects had lower SPR vs. controls during mental arithmetic (0.54 [0.15, 1.46] vs. 0.67 [0.36, 1.8], p = 0.039), not evident in the other tasks. Vasoconstriction inversely correlated with anxiety (r = -3.4, p = 0.03), frustration (r = -0.37, p = 0.02), and feeling challenged (r = -0.37, p = 0.02) in CVaD but not controls. Conclusions: Mental stress peripheral vascular reactivity is elevated in women with CVaD compared to controls. Elevated vascular reactivity may be one contributor to stress-induced chest pain in CVaD. Interventions that modulate vasoconstrictive responses may be of benefit and should be tested in clinical trials in women with CVaD.

KW - Mental stress

KW - Microvascular dysfunction

KW - Vascular reactivity

KW - Women heart disease

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DO - 10.1016/j.ijcard.2017.10.061

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