Table 1.
Summary of Key Publications
| Publication | Study Design | Key Findings |
|---|---|---|
| Peix et al, 2006 | Tc‐99 m myocardial scintigraphy (exercise stress/mental stress protocol), brachial artery endothelial function measurement by ultrasonography, and 24‐hour ambulatory ECG recording (Holter) in 19 postmenopausal women with typical angina (n = 6) and normal coronary angiography (n = 10). | Patients with typical angina exhibited endothelial dysfunction more frequently than those without (83% vs 20%). |
| Exercise‐ and mental stress–induced ischemia was observed in 6 patients with angina. | ||
| Wei et al, 2014 | Systematic review and meta‐analysis of 5 prospective studies, examining the association between MSIMI and adverse outcome events in patients with stable CAD (n = 555). | MSIMI was associated with a 2× increased risk of a combined endpoint of cardiac events or total mortality (RR: 2.24, 95% CI: 1.59‐3.15). No heterogeneity was detected among the studies (Q = 0.39, I2 = 0.0%, P = 0.98). |
| Ramadan et al, 2013 | Tc‐99 m myocardial scintigraphy (exercise stress/mental stress protocol) and peripheral arterial tonometry in patients with CAD (n = 384). | Disease scores were not significantly associated with MSIMI. |
| Peripheral vascular tone was lower in those with MSIMI (0.55 ± 0.36 vs 0.76 ± 0.52; P = 0.009). | ||
| Multivariable analysis showed peripheral arterial tonometry ratio to be the only independent predictor of MSIMI (P = 0.009), whereas angiographic severity and extent of CAD independently predicted PSIMI. | ||
| Gale et al, 2014 | Interviews and historical registry data for 1 107 524 conscripted Swedish men. | Age‐adjusted HRs for CHD (95% CIs) at conscription were 1.30 (1.05‐1.62) for depressive disorders and 1.90 (1.58‐2.38) for alcohol‐related disorders. |
| Roest et al, 2013 | Secondary analysis on data from the ENRICHD trial comprising 1254 patients who had suffered an MI. | At 6 months, HR showed that positive changes (per 1‐point increase) in somatic depressive symptoms (0.95, 95% CI: 0.92‐0.98, P = 0.001) were related to a reduced risk of recurrent MI and mortality after adjustment for baseline depression scores. |
| Jiang et al, 2013 | Randomized, double‐blind, placebo‐controlled trial of 127 patients with clinically stable CHD and laboratory‐diagnosed MSIMI, receiving escitalopram (titrated to 20 mg/d) vs placebo treatment for 6 weeks. | 34.2% patients taking escitalopram vs 17.5% taking placebo had an absence of MSIMI during the 3 mental‐stressor tasks. (OR: 2.62, 95% CI: 1.06‐6.44) |
| Hassan et al, 2008 | Assessment of the association between β‐1 adrenergic receptor polymorphisms and perfusion defects in 148 patients with CAD | MSIMI occurred 3× more frequently among homozygous Ser49 allele carriers compared with the Gly49 allele carriers (P = 0.02). (Adjusted OR: 3.9, 95% CI: 1.2‐12.5, P = 0.02) |
| L'Abbate et al, 1991 | Assessment of MSIMI in 63 patients with a history of ischemia; 13 underwent angiography. | 44% of patients showed ECG indications of MSIMI; the majority experienced angina both at rest and during exercise. |
| Rate‐pressure product values suggested that ischemia was due to increased myocardial oxygen demand. | ||
| Lazzarino et al, 2013 | Salivary cortisol response to mental stress, plasma Tn concentration, and assessment of coronary calcification in 508 disease‐free participants. | Robust association between cortisol response and detectable Tn (OR: 3.98, 95% CI: 1.60‐9.92, P = 0.003). This association was independent of coronary calcification. |
| Lambert et al, 2010 | Pattern of sympathetic nervous firing in 8 women and 17 men with the metabolic syndrome and elevated BP in relation to their underlying psychological stress. | Single‐unit sympathetic nerve‐firing pattern correlated with anxiety state and trait and the affective component of the BDI score. In particular, higher trait anxiety score (OR: 0.557, P = 0.004) and higher affective depressive symptoms (0.517, P = 0.008). |
| Carroll et al, 2012 | Association between systolic and diastolic BP reactions to stress and CVD mortality in 431 Scottish participants followed for up to 16 years. | BP reactions were positively associated with future CVD mortality. |
| Kupper et al, 2015 | MSIMI assessment in 100 patients with systolic HF. | Over a median follow‐up period of 48.5 months, mortality rates were 2× higher (HR: 2.04, 95%CI: 1.15‐3.60, P = 0.014) among patients with the lowest diastolic responses (mean = −2.4 ± 5.4 mm Hg) to mental stress than among those patients with an intermediate diastolic BP response (mean = 7.3 ± 2.5 mm Hg). High diastolic responses were not related to mortality. |
| Similar results were observed for systolic BP but were not significant. | ||
| High heart rate response (≥6.3 bpm) to acute mental stress was associated with a reduced mortality risk (0.40, 95% CI: 0.16‐1.00, P = 0.051) compared with patients with intermediate responses. | ||
| Gulati et al, 2009 | Comparison of 540 symptomatic women with obstructive CAD from the WISE study and 100 matched asymptomatic women with no history of heart disease from the St. James WTH Project. | 5‐year annualized event rates for cardiovascular events were 16.0% in WISE women with nonobstructive CAD, 7.9% in WISE women with normal coronary arteries, and 2.4% in asymptomatic WTH women (P ≤ 0.002). |
Abbreviations: BDI, Beck Depression Inventory; BP, blood pressure; CAD, coronary artery disease; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; ECG, electrocardiographic; ENRICHD, Enhancing Recovery in Coronary Heart Disease; HF, heart failure; HR, hazard ratio; MI, myocardial infarction; MSIMI, mental stress–induced myocardial ischemia; OR, odds ratio; RR, relative risk; Tc, technetium; Tn, troponin; WISE, Women's Ischemia Syndrome Evaluation; WTH, Women Take Heart.