Abstract
Acute emotionally reactive mental stress (MS) can provoke prognostically relevant deficits in cardiac function and myocardial perfusion, and chronic inflammation increases risk for this ischemic phenomenon. We have described parasympathetic withdrawal and generation of inflammatory factors in MS. Adiposity is also associated with elevated markers of chronic inflammation. High body mass index (BMI) is frequently used as a surrogate for assessment of excess adiposity, and associated with traditional CAD risk factors, and CAD mortality. BMI is also associated with autonomic dysregulation, adipose tissue derived proinflammatory cytokines, which are also attendant to emotion provoked myocardial ischemia. Thus, we sought to determine if body mass index (BMI) contributes to risk of developing myocardial ischemia provoked by mental stress. We performed a prospective interventional study in a cohort of 161 patients with stable CAD. They completed an assessment of myocardial blood flow with single photon emission computed tomography (SPECT) simultaneously during 2 conditions: laboratory mental stress and at rest. Multivariate logistic regression determined the independent contribution of BMI to the occurrence of mental-stress induced ischemia. Mean age was 65.6 ±9.0 years; 87.0% had a history of hypertension, and 28.6% had diabetes. Mean BMI was 30.4 ± 4.7. Prevalence of mental stress ischemia was 39.8%. BMI was an independent predictor of mental stress ischemia, OR=1.10, 95% CI [1.01-1.18] for one-point increase in BMI and OR=1.53, 95% CI [1.06-2.21] for a 4.7 point increase in BMI (one standard deviation beyond the cohort BMI mean), p=0.025 for all. These data suggest that BMI may serve as an independent risk marker for mental stress ischemia. The factors attendant with greater BMI, which include autonomic dysregulation and inflammation, may represent pathways by which high BMI contribute to this risk and serve as a conceptual construct to replicate these findings in larger CAD populations.
Highlights
Mental and emotional stress can trigger acute coronary syndrome (ACS), but more often it provokes asymptomatic myocardial ischemia [1,2,3], a syndrome associated with an independent, 2.4- to three-fold increased risk of early morbidity and mortality in patients with known coronary artery disease (CAD) [4,5,6,7]
Patients with versus without this ischemia were comparable with regard to clinical manifestations of CAD, with no BL differences in primary risk factors, medications, comorbidities, LVEF, severity of CAD and prior revascularization, or hemodynamics
At BL, the mean SBP was 133 (±18), mean DBP was 75 (±10) and mean heart rate (HR) was 59 (±11), while the mean LVEF derived from single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) was 56.0 (±10.8)
Summary
Mental and emotional stress can trigger acute coronary syndrome (ACS), but more often it provokes asymptomatic myocardial ischemia [1,2,3], a syndrome associated with an independent, 2.4- to three-fold increased risk of early morbidity and mortality in patients with known coronary artery disease (CAD) [4,5,6,7]. MS-provoked ischemia is distinguished by several unique pathophysiologic features It is characterized by a transient increase in coronary vasomotion that creates a dynamic coronary obstruction [8,9] and is associated with a distinct autonomic pattern that has been found by others to acutely increase circulating inflammatory markers derived from macrophages termed the parasympathetic inflammatory reflex [10]. The link between obesity/adiposity and CAD-related prognosis includes both physiological and psychosocial pathways
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