Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction

Psychosom Med. 2014 Apr;76(3):171-80. doi: 10.1097/PSY.0000000000000045.


Objectives: Emotional stress may disproportionally affect young women with ischemic heart disease. We sought to examine whether mental stress-induced myocardial ischemia (MSIMI), but not exercise-induced ischemia, is more common in young women with previous myocardial infarction (MI) than in men.

Methods: We studied 98 post-MI patients (49 women and 49 men) aged 38 to 60 years. Women and men were matched for age, MI type, and months since MI. Patients underwent technetium-99m sestamibi perfusion imaging at rest, after mental stress, and after exercise/pharmacological stress. Perfusion defect scores were obtained with observer-independent software. A summed difference score (SDS), the difference between stress and rest scores, was used to quantify ischemia under both stress conditions.

Results: Women 50 years or younger, but not older women, showed a more adverse psychosocial profile than did age-matched men but did not differ for conventional risk factors and tended to have less angiographic coronary artery disease. Compared with age-matched men, women 50 years or younger exhibited a higher SDS with mental stress (3.1 versus 1.5, p = .029) and had twice the rate of MSIMI (SDS ≥ 3; 52% versus 25%), whereas ischemia with physical stress did not differ (36% versus 25%). In older patients, there were no sex differences in MSIMI. The higher prevalence of MSIMI in young women persisted when adjusting for sociodemographic and life-style factors, coronary artery disease severity, and depression.

Conclusions: MSIMI post-MI is more common in women 50 years or younger compared with age-matched men. These sex differences are not observed in post-MI patients who are older than 50 years.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Exercise
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / psychology
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Ischemia / epidemiology*
  • Myocardial Ischemia / etiology
  • Myocardial Perfusion Imaging / methods
  • Myocardial Perfusion Imaging / statistics & numerical data
  • Rest / physiology
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution
  • Stress, Psychological / complications
  • Stress, Psychological / epidemiology*
  • Survivors / statistics & numerical data*
  • Tomography, Emission-Computed, Single-Photon / methods
  • Young Adult