Mental stress linked to major CV event risk via endothelial dysfunction

  • Lima BB & al.
  • JAMA Cardiol
  • 11 Sep 2019

  • International Clinical Digest
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Takeaway

  • In patients with coronary artery disease (CAD), mental stress is linked to effects on endothelial dysfunction and increased risk for major adverse cardiovascular (CV) events (MACEs).

Why this matters

  • This study connects the dots between acute mental stress, transient endothelial dysfunction, and MACE risk. 

Key results

  • Before mental stress, mean flow-mediated vasodilation (FMD) was 4.8% (standard deviation, 3.7%).
  • After stress, this value fell to 3.9% (3.6%), for a 23% drop (P<.001>
  • Brachial artery diameter dropped as well.
  • As expected, BP, heart rate increased.
  • 63.3% had transient endothelial dysfunction during this transition.
  • Among those with transient endothelial dysfunction, MACE risk was 1.78 (subdistribution HR; 95% CI, 1.15-2.76).
  • Decreased poststress FMD was specifically tied to MACE (P=.04).
  • Adding pre- or poststress FMD to usual prognostic factors increased predictive value for MACEs.

Study design

  • University-hospital-based cohort study, including 569 patients with CAD (mean age, 62.6 years; 73.8% men) who underwent pre- and poststress FMD testing, June 2011-August 2014.
  • The “mental stress” task was public speaking.
  • Median follow-up of 3.0 (interquartile range, 2.9-3.1) years.
  • Funding: NIH.

Limitations

  • Limited to patients with CAD.