Mental Stress Might Worsen Cardiac Health In Patients With Stable CHD

Key Findings of the Study Were:

• Among 918 patients, 147 patients (16%) had mental stress-induced ischemia, 281 (31%) conventional stress ischemia, and 96 (10%) had both.
• The researchers noted that the primary endpoint occurred in 156 participants over a 5-year median follow-up. The pooled event rate was 6.9 per 100 patient-years and 2.6 per 100 patient-years among patients with and without mental stress-induced ischemia.
• They observed that the patients with no ischemia (event rate, 2.3 per 100 patient-years) had a significantly increased risk (event rate, 4.8 per 100 patient-years; HR, 2.0) when compared with the patients with mental stress-induced ischemia alone.
• They found similar findings in patients with both mental stress ischemia and conventional stress ischemia (event rate, 8.1 per 100 patient-years; HR, 3.8).
• They also noted that patients with conventional stress ischemia alone did not have a significantly increased risk (event rate, 3.1 per 100 patient-years; HR, 1.4).
• They further found that patients with both mental stress ischemia and conventional stress ischemia had an elevated risk compared with patients with conventional stress ischemia alone (HR, 2.7).
• They observed the secondary endpoint in 319 participants. The event rate was 12.6 per 100 patient-years and 5.6 per 100 patient-years for patients with and without mental stress-induced ischemia (adjusted HR, 2.0).

The authors concluded, "Among patients with stable coronary heart disease, the presence of mental stress-induced ischemia, compared with no mental stress-induced ischemia, was significantly associated with an increased risk of cardiovascular death or nonfatal myocardial infarction. "

They further added, "Although these findings may provide insights into mechanisms of myocardial ischemia, further research is needed to assess whether testing for mental stress-induced ischemia has clinical value."

For further information:

doi:10.1001/jama.2021.17649