Pratik Pimple1, Amit Shah2, Cherie Rooks1, J Douglas Bremner3, Jonathon Nye4, Ijeoma Ibeanu1, Nancy Murrah1, Lucy Shallenberger1, Mary Kelley5, Paolo Raggi6, Viola Vaccarino7. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. 3. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. 4. Department of Radiology, Emory University School of Medicine, Atlanta, GA. 5. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA. 6. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, Edmonton, Alberta, Canada. 7. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. Electronic address: viola.vaccarino@emory.edu.
Abstract
BACKGROUND: Mental stress-induced myocardial ischemia is associated with adverse prognosis in coronary artery disease patients. Anger is thought to be a trigger of acute coronary syndromes and is associated with increased cardiovascular risk; however, little direct evidence exists for a link between anger and myocardial ischemia. METHODS: [(99m)Tc]-sestamibi single-photon emission tomography was performed at rest, after mental stress (a social stressor with a speech task) and after exercise/pharmacologic stress. Summed scores of perfusion abnormalities were obtained by observer-independent software. A summed-difference score, the difference between stress and rest scores, was used to quantify myocardial ischemia under both stress conditions. The Spielberger's State-Trait Anger Expression Inventory was used to assess different anger dimensions. RESULTS: The mean age was 50 years, 50% were female, and 60% were non-white. After adjusting for demographic factors, smoking, coronary artery disease severity, depressive, and anxiety symptoms, each IQR increment in state-anger score was associated with 0.36 U-adjusted increase in ischemia as measured by the summed-difference score (95% CI 0.14-0.59); the corresponding association for trait anger was 0.95 (95% CI 0.21-1.69). Anger expression scales were not associated with ischemia. None of the anger dimensions was related to ischemia during exercise/pharmacologic stress. CONCLUSION: Anger, both as an emotional state and as a personality trait, is significantly associated with propensity to develop myocardial ischemia during mental stress but not during exercise/pharmacologic stress. Patients with this psychologic profile may be at increased risk for silent ischemia induced by emotional stress, and this may translate into worse prognosis.
BACKGROUND:Mental stress-induced myocardial ischemia is associated with adverse prognosis in coronary artery diseasepatients. Anger is thought to be a trigger of acute coronary syndromes and is associated with increased cardiovascular risk; however, little direct evidence exists for a link between anger and myocardial ischemia. METHODS: [(99m)Tc]-sestamibi single-photon emission tomography was performed at rest, after mental stress (a social stressor with a speech task) and after exercise/pharmacologic stress. Summed scores of perfusion abnormalities were obtained by observer-independent software. A summed-difference score, the difference between stress and rest scores, was used to quantify myocardial ischemia under both stress conditions. The Spielberger's State-Trait Anger Expression Inventory was used to assess different anger dimensions. RESULTS: The mean age was 50 years, 50% were female, and 60% were non-white. After adjusting for demographic factors, smoking, coronary artery disease severity, depressive, and anxiety symptoms, each IQR increment in state-anger score was associated with 0.36 U-adjusted increase in ischemia as measured by the summed-difference score (95% CI 0.14-0.59); the corresponding association for trait anger was 0.95 (95% CI 0.21-1.69). Anger expression scales were not associated with ischemia. None of the anger dimensions was related to ischemia during exercise/pharmacologic stress. CONCLUSION: Anger, both as an emotional state and as a personality trait, is significantly associated with propensity to develop myocardial ischemia during mental stress but not during exercise/pharmacologic stress. Patients with this psychologic profile may be at increased risk for silent ischemia induced by emotional stress, and this may translate into worse prognosis.
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