Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease
Background Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress‐induced changes in hemodynamic and vascular function tests with adverse cardio...
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.034683 |
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| author | Kasra Moazzami Samaah Sullivan Maggie Wang Alexis K. Okoh Zakaria Almuwaqqat Brad Pearce Amit J. Shah Yan V. Sun Yi‐An Ko Paolo Raggi J. Douglas Bremner Viola Vaccarino Arshed A. Quyyumi |
| author_facet | Kasra Moazzami Samaah Sullivan Maggie Wang Alexis K. Okoh Zakaria Almuwaqqat Brad Pearce Amit J. Shah Yan V. Sun Yi‐An Ko Paolo Raggi J. Douglas Bremner Viola Vaccarino Arshed A. Quyyumi |
| author_sort | Kasra Moazzami |
| collection | DOAJ |
| description | Background Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress‐induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in patients with coronary artery disease, after adjusting for sociodemographic and clinical factors. Methods and Results Individuals with stable coronary artery disease from 2 prospective cohort studies were studied. Hemodynamic reactivity, changes in endothelial function, and vasoconstriction during mental stress were evaluated using changes in rate‐pressure product, brachial artery flow‐mediated vasodilation, and peripheral arterial tonometry, respectively. A cardiovascular reactivity risk score was calculated by allotting 0 to 3 points for each quartile of increasing abnormality for each of the 3 reactivity responses and summing the quartile points from the MIPS (Mental Stress Ischemia Prognosis Study) to yield a cardiovascular reactivity risk score ranging from 0 to 9. The outcome was a composite of cardiovascular death, nonfatal myocardial infarction, and heart failure hospitalizations during follow‐up. A total of 629 participants were included. After adjustment for demographic and traditional risk factors, a blunted hemodynamic response, a greater decrease in flow‐mediated vasodilation, and a greater degree of peripheral vasoconstriction to mental stress were all independently associated with a higher risk of adverse outcomes in both cohorts. By adding the cardiovascular reactivity risk score, the C‐statistic increased significantly by 10% (P<0.001). Conclusions Among individuals with stable coronary artery disease, a risk score derived from cardiovascular reactivity to mental stress was predictive of adverse cardiovascular outcomes beyond traditional cardiovascular risk factors. |
| format | Article |
| id | doaj-art-10f3b92f286949d59ac1b22a30695b32 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-10f3b92f286949d59ac1b22a30695b322025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.124.034683Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery DiseaseKasra Moazzami0Samaah Sullivan1Maggie Wang2Alexis K. Okoh3Zakaria Almuwaqqat4Brad Pearce5Amit J. Shah6Yan V. Sun7Yi‐An Ko8Paolo Raggi9J. Douglas Bremner10Viola Vaccarino11Arshed A. Quyyumi12Department of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USADepartment of Epidemiology, Human Genetics, and Environmental Sciences. School of Public Health The University of Texas Health Science Center‐Houston Houston Texas USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USADepartment of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USAGrady Health System Atlanta GA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USADepartment of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USADepartment of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USADivision of Cardiology, Department of Medicine University of Alberta Edmonton Alberta CanadaAtlanta VA Healthcare System Decatur GA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USADepartment of Medicine, Division of Cardiology Emory University School of Medicine Atlanta GA USABackground Acute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. We studied the association between the aggregated stress‐induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in patients with coronary artery disease, after adjusting for sociodemographic and clinical factors. Methods and Results Individuals with stable coronary artery disease from 2 prospective cohort studies were studied. Hemodynamic reactivity, changes in endothelial function, and vasoconstriction during mental stress were evaluated using changes in rate‐pressure product, brachial artery flow‐mediated vasodilation, and peripheral arterial tonometry, respectively. A cardiovascular reactivity risk score was calculated by allotting 0 to 3 points for each quartile of increasing abnormality for each of the 3 reactivity responses and summing the quartile points from the MIPS (Mental Stress Ischemia Prognosis Study) to yield a cardiovascular reactivity risk score ranging from 0 to 9. The outcome was a composite of cardiovascular death, nonfatal myocardial infarction, and heart failure hospitalizations during follow‐up. A total of 629 participants were included. After adjustment for demographic and traditional risk factors, a blunted hemodynamic response, a greater decrease in flow‐mediated vasodilation, and a greater degree of peripheral vasoconstriction to mental stress were all independently associated with a higher risk of adverse outcomes in both cohorts. By adding the cardiovascular reactivity risk score, the C‐statistic increased significantly by 10% (P<0.001). Conclusions Among individuals with stable coronary artery disease, a risk score derived from cardiovascular reactivity to mental stress was predictive of adverse cardiovascular outcomes beyond traditional cardiovascular risk factors.https://www.ahajournals.org/doi/10.1161/JAHA.124.034683adverse outcomescoronary artery diseaseendothelial functionhemodynamic reactivitymental stressvasoconstriction |
| spellingShingle | Kasra Moazzami Samaah Sullivan Maggie Wang Alexis K. Okoh Zakaria Almuwaqqat Brad Pearce Amit J. Shah Yan V. Sun Yi‐An Ko Paolo Raggi J. Douglas Bremner Viola Vaccarino Arshed A. Quyyumi Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adverse outcomes coronary artery disease endothelial function hemodynamic reactivity mental stress vasoconstriction |
| title | Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease |
| title_full | Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease |
| title_fullStr | Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease |
| title_full_unstemmed | Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease |
| title_short | Cardiovascular Reactivity to Mental Stress and Adverse Cardiovascular Outcomes in Patients With Coronary Artery Disease |
| title_sort | cardiovascular reactivity to mental stress and adverse cardiovascular outcomes in patients with coronary artery disease |
| topic | adverse outcomes coronary artery disease endothelial function hemodynamic reactivity mental stress vasoconstriction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.034683 |
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