Stress induced brain activation may lead to Angina in CAD patients: Study

A recent study found that Inferior frontal lobe activation with mental stress is positively associated with angina at baseline and follow-up. The study was published in the Journal, 'Circulation: Cardiovascular Imaging' 2020.

The inferior frontal lobe plays a pivotal role in stress regulation. Increased activation can incite a severe stress reaction. Stress is one of the important determinants of Angina which is a hallmark symptom of Coronary Artery Disease. Researchers from Emory University, Atlanta conducted a study to find the correlation between activation of inferior frontal lobe with stress and angina in individuals with coronary artery disease.

"Our study sought to understand the degree to which health care providers should incorporate stress and other psychological factors when evaluating and treating angina." Amit J. Shah, Study Lead Investigator, Emory University

Individuals with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe was evaluated as a ratio compared with whole brain flow for each scan. Angina was assessed with the Seattle Angina Questionnaire angina frequency subscale at baseline and 2 years follow-up.

The key findings of the study:

• 148 individuals with coronary artery disease were analysed.

• The mean age +/-SD of participants was 62 +/- 8 years.

• Out of the total there were 69% male

• 35.8% of the participants were Black.

• For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline (P=0.008) and 11.6 units during follow-up (P=0.01) in a model adjusted for baseline demographics.

• Mental stress-induced ischemia and activation of other brain pain processing regions like thalamus, insula, and amygdala accounted for 40.0% and 13.1% of the total effect of inferior frontal lobe activation on angina severity, respectively.

Thus, the researchers concluded that Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. They also added that Mental stress-induced ischemia and other pain processing brain regions may play a contributory role.  

For further reading, click the following link: : https://doi.org/10.1161/CIRCIMAGING.120.010710