Emotional Stress in Women Appears Linked to Artery
Dysfunction, Heart Attacks
Women may have chest pain related to the heart being
starved for oxygen but have no evidence of arterial obstruction
March 13, 2014 In research to be presented today,
researchers describe their study finding that emotional stressors such
as those provoking anger may cause changes in the nervous system that
controls heart rate and trigger a type of coronary artery dysfunction,
primarily in women that may lead to heart attacks and other cardiac
In men with coronary artery disease, the large
arteries feeding the heart tend to become clogged by plaque, and these
blockages are evident on coronary angiograms. Women, however, may have
chest pain related to the heart being starved for oxygen but have no
evidence of arterial obstruction.
"Women who go to emergency rooms and cardiologists
because they have chest pain often are told that their arteries are
clear and their hearts are fine. But the reality is that women's
coronary artery disease tends to be different from men's, said C. Noel
Bairey Merz, MD, professor of medicine, medical director of the Barbra
Streisand Women's Heart Center, director of the Preventive and
Rehabilitative Cardiac Center and the Linda Joy Pollin Women's Heart
Health Program and the Women's Guild Chair in Women's Health.
In women, the large arteries may remain clear but
the smaller branches that connect to the even-smaller capillaries lose
their ability to widen. Whether the large arteries are blocked or the
small arterioles don't function correctly, the result is the same the
heart becomes starved for oxygen."
Bairey Merz, senior author of the abstract that
will be presented, chairs the Women's Ischemic Syndrome Evaluation
study. WISE research, which began in 1997 and is sponsored by the
National Heart, Lung, and Blood Institute, has brought to light
gender-related differences in heart disease.
After finding that many women's small arteries fail
to function properly a condition called coronary microvascular
dysfunction Bairey Merz and her colleagues set out to discover the
cause or causes.
"We know that women who have chest pain and reduced
oxygen to the heart in the absence of 'male-pattern' obstructive
coronary artery disease may experience microvascular dysfunction
during times of emotional distress even though their heart rates stay
relatively low, explains Puja K. Mehta, MD, director of the
Non-Invasive Vascular Function Research Lab at the center and
co-director of the Cardio-Oncology Program.
In this study, we evaluated the heart's autonomic
system the nerve network that regulates heart rate," she said
These findings come from her NIH-funded grant on
Cardiac Autonomic Nervous System (CANS) function in women.
Sixteen women diagnosed with coronary microvascular
dysfunction participated, as did eight women of similar age and weight
who did not have coronary microvascular dysfunction, said Mehta, the
abstract's first author.
"We measured heart rate, blood pressure and heart
rate variability alterations in the time from one beat to the next.
These were measured when the women were at rest and again when they were
subjected to several types of mental stress using standardized tests for
anger, performing mental arithmetic and having a cold pack placed on the
forehead," Mehta said.
Both groups responded in the same way to the
stressors except when dealing with the emotional stress of anger. In
women with microvascular dysfunction, emotional stress appeared to
increase sympathetic nerve stimulation which is associated with the
quickened heart rate of the fight or flight mechanism and decreased
parasympathetic nerve activity, which relaxes and slows heart rate.
Mehta said these results suggest that the autonomic
nervous system may be one pathway involved in microvascular dysfunction
"More specifically, we hypothesize that emotional
stress may trigger microvascular dysfunction and lead to heart attacks
and other cardiac problems in women," she said, adding that more
research is needed to better understand this mechanism and identify
others that might exist.
The research will be presented today at the
American Psychosomatic Society annual meeting in San Francisco.
The study was supported by contracts from the
National Heart, Lung and Blood Institute, National Institute on Aging;
GCRC Clinical Research Feasibility Funds; National Center for Advancing
Translational Sciences (NCATS); and grants from the Gustavus and Louis
Pfeiffer Research Foundation, Danville, NJ; The Women's Guild of
Cedars-Sinai Medical Center; The Ladies Hospital Aid Society of Western
Pennsylvania, Pittsburgh; QMED, Inc., Laurence Harbor, NJ; the Edythe L.
Broad Women's Heart Research Fellowship, Cedars-Sinai Medical Center;
the Barbra Streisand Women's Cardiovascular Research and Education
Program, Cedars-Sinai Medical Center; The Society for Women's Health
Research (SWHR), Washington, D.C.; and the Linda Joy Pollin Women's
Heart Health Program.
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