The Relationship Between Mental Stress and Hemodynamic Responses in Patients with Coronary Artery Disease Public

Abstract

Background

Cardiovascular disease remains a major cause of mortality worldwide, and growing evidence

suggests that stress, particularly mental stress and mental stress-induced myocardial ischemia,

may serve as a critical link between stress and adverse cardiovascular outcomes in stable

coronary artery disease (CAD) and post-MI patients. Recent efforts to address the gap between

self-reported stress and physiological stress have utilized large observational datasets, such as the

Myocardial Infarction and Mental Stress Study 2 (MIMS2), and the Mental Stress and

Myocardial Ischemia after MI: Sex Differences, Mechanisms, and Prognosis study (MIMS3).

Methods

From a sample of 829 participants from the MIMS2 and MIMS3 databases, blood pressure

characteristics and Subjective Units of Distress Scale (SUDS) scores were assessed before,

during, and after mental stress proxy test. CAD measurement was examined with coronary

angiograms, and Gensini Scores were calculated to assess severity. Pearson correlations and

multivariate regression modeling was performed.

Results

In our sample of 829 study participants, 440 (53%) are female with a mean age of 50.9 ± 7.2

years. Mean percent increase for systolic blood pressure (SBP) was 24.4 ± 15.2 mmHg, diastolic

blood pressure (DBP) 24.4 ± 15.6 mmHg, and heart rate (HR) 88.0 ± 71.0 mmHg. There was no

significant linear association between the subjective stress response and hemodynamic changes

(SBP, r = 0.050; DBP, r = 0.054; HR, r = -0.030). No significant regression estimates were

observed for predicting SUDS score changes from hemodynamic variables after adjusting for

age, race, sex, and MI status. Further analysis with Gensini Scores for the MI investigation arms

included a total of 594 participants, and no significant regression estimates were observed.

Conclusion

These findings suggest that self-reported stress and physiological responses to mental stress, as

measured by hemodynamic changes, may not represent the same underlying construct in this

population and stresses the ongoing need for a multidimensional and time-varying approach to

stress assessment that integrates both psychological and physiological markers independently.

Table of Contents

Introduction - 1

Methods - 3

Results - 5

Discussion - 7

Figures - 10

References - 16

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	cardiovascular disease hemodynamic changes coronary artery disease hemodynamics cardiology self-reported stress mental stress stress
Committee Chair / Thesis Advisor	Amit Shah, MD, MSCR, Emory University

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