Mental stress is associated with coronary endothelial dysfunction in women with chest pain and non-obstructive coronary artery disease.

Objective: We evaluate the association between chronic mental stress (MS) and coronary endothelial function in patients with chest pain and nonobstructive coronary artery disease (CAD) separately in males and females. Methods: Patients with nonobstructive CAD (stenosis <40 %) at coronary angiography underwent an invasive assessment for coronary endothelial dysfunction (CED). Macrovascular CED was defined as a percentage change in coronary artery diameter to acetylcholine (%ΔCADAch) ≤ -10 % and microvascular CED was defined as a percentage change in coronary blood flow to acetylcholine (%ΔCBFAch) ≤-50 %. Patients completed a questionnaire within 2 years of the index procedure that included questions regarding chronic MS. The frequency of macrovascular, microvascular and any type of CED was compared across groups. Logistic regression analyses were performed to assess the association between MS and CED. Results: Between January 2017 and December 2022, 211 patients (mean (sd) age 54.4 (13.6) yrs, 71.0 % female) were included. One hundred forty-two (67.3 %) patients had any type of CED. In females with significant MS there was a higher proportion of individuals with any type of CED compared to without CED (43 (42.6 %) vs. 12 (24.5 %), p = 0.0362). In a multivariable analysis MS was associated with any type of CED in females: OR (95 % CI) 2.70 (1.24-6.25); p = 0.0156. Conclusion: Chronic MS is associated with CED in females with chest pain and nonobstructive CAD. Chronic MS may underly the mechanism for chest pain in these patients and may play a contributory to cardiovascular disease through its association with endothelial dysfunction.