ArticlePsychosomatic medicine2019
Sex-Specific Association Between Coronary Artery Disease Severity and Myocardial Ischemia Induced by Mental Stress.
Article in Psychosomatic medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 27 citations in OpenAlex.
- Association of Sex With Severity of Coronary Artery Disease, Ischemia, and Symptom Burden in Patients With Moderate or Severe Ischemia: Secondary Analysis of the ISCHEMIA Randomized Clinical Trial.JAMA cardiology · 2020Trial
- Assessing myocardial microcirculation in post-PCI patients with chest pain and anxiety: a dynamic CT myocardial perfusion study with mental stress testing.BMC medical imaging · 2026Article
- Psychosocial stress and cardiovascular disease.American journal of preventive cardiology · 2025Review
- Toxic stress is associated with cardiovascular disease among younger but not older women in the United States: Results from the research goes red registry.Preventive medicine reports · 2025Article
- Stress and cardiovascular disease: an update.Nature reviews. Cardiology · 2024Review
- The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review.Journal of the American College of Cardiology · 2024Review
- Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease.Circulation. Cardiovascular imaging · 2024Article
- Differences in Risk Factors for Coronary Atherosclerosis According to Sex.Journal of lipid and atherosclerosis · 2024Review
- Quantitation of diffuse myocardial ischemia with mental stress and its association with cardiovascular events in individuals with recent myocardial infarction.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Article
- Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE).Korean circulation journal · 2023Review
- The prognostic study of mental stress-induced myocardial ischemia in coronary revascularization patients with depression/anxiety: rationale and design.BMC cardiovascular disorders · 2023Article
- Transient Global Amnesia (TGA): Sex-Specific Differences in Blood Pressure and Cerebral Microangiopathy in Patients with TGA.Journal of clinical medicine · 2022Article
- Association of Perceived Stress and Physical Activity Level with Severity of Coronary Artery Disease in Gaza Strip, Palestine: A Cross-Sectional Study.Korean journal of family medicine · 2022Article
- The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina.Frontiers in cardiovascular medicine · 2022Review
- Brain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient.Atherosclerosis · 2021Review
- The Role of Mental Stress in Ischaemia with No Obstructive Coronary Artery Disease and Coronary Vasomotor Disorders.European cardiology · 2021Review
- Sex differences in the inflammatory response to stress and risk of adverse cardiovascular outcomes among patients with coronary heart disease.Brain, behavior, and immunity · 2020Article
- Research progress regarding the diagnosis and treatment of mental stress-induced myocardial ischemia.Anatolian journal of cardiology · 2020Review
- Coronary Artery Spasm, Coronary Reactivity, and Their Psychological Context.Psychosomatic medicine · 2019Article
Corrections and comments
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Authors and funding
18 authors at 1 institution in 1 country.
Funding
Abstract
objectiveIt is unclear whether mental stress-induced myocardial ischemia (MSIMI) is related to obstructive coronary artery disease (CAD). We examined this question and contrasted results with ischemia induced by conventional stress testing (CSIMI). Because women are more susceptible to ischemia without coronary obstruction than men, we examined sex differences.
methodsWe studied 276 patients 61 years and younger with recent myocardial infarction. CAD severity was quantified using the log-transformed Gensini Score (lnGS) and the Sullivan Stenosis Score. Patients underwent myocardial perfusion imaging with mental stress (public speaking) and conventional (exercise or pharmacological) stress testing. MSIMI and CSIMI were defined as a new or worsening perfusion defect.
resultsThe prevalence of MSIMI was 15% in men and 20% in women. The median GS for patients with MSIMI was 65.0 in men and 28.5 in women. In logistic regression models adjusted for demographic and cardiovascular risk factors, CAD severity was associated with CSIMI in the full sample (odds ratio [OR] = 1.49, 95% [CI], 1.14-1.95, per 1-unit increase in lnGS), with no significant difference by sex. Although CAD severity was not associated with MSIMI in the entire sample, results differed by sex. CAD severity was associated with MSIMI among men (OR = 1.95, 95% CI, 1.13-3.36, per 1-unit increase in lnGS), but not among women (OR = 1.02, 95% CI, 0.74-1.42, p = .042 for interaction). Analysis using Sullivan Stenosis Score yielded similar results.
conclusionsFindings suggest that CAD severity is related to MSIMI in men but not women. MSIMI in women may therefore be driven by alternative mechanisms such as coronary microvascular disease.
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