Racial Differences in Mental Stress-Induced Transient Endothelial Dysfunction and Its Association With Cardiovascular Outcomes.
Racial Differences in Mental Stress-Induced Transient Endothelial Dysfunction and Its Association With Cardiovascular Outcomes.
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精神压力引起的短暂性内皮功能障碍的种族差异及其与心血管结果的关系。
DOI：
10.1097/psy.0000000000001201
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发表时间：
2023
影响因子：
3.3
通讯作者：
中科院分区：
文献类型：
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作者：
Okoh,AlexisK;Young,An;Garcia,Mariana;Sullivan,Samaah;Almuwaqqat,Zakaria;Hu,Yingtian;Liu,Chang;Moazzami,Kasra;Uphoff,Irina;Lima,BrunoB;Ko,Yi-An;Elon,Lisa;Jajeh,Nour;Rout,Pratik;Gupta,Shishir;Shah,AmitJ;Bremner,JDouglas;
目的本研究旨在调查患有冠心病 (CHD) 的黑人和非黑人个体中短暂性内皮功能障碍 (TED) 与精神压力的差异，及其对心血管结局的潜在影响。方法我们在 2011 年 6 月至 2016 年 3 月期间对 812 名稳定型 CHD 患者进行了检查，并在大学附属医院网络中进行了随访直至 2020 年 2 月。在精神压力之前和之后 30 分钟评估血流介导的血管舒张（FMD）。 TED 被定义为应力后 FMD 低于应力前 FMD。我们比较了黑人和非黑人参与者的应激前 FMD、应激后 FMD 和 TED。在两组中，在调整人口、临床和社会经济因素后，我们检查了 TED 与心血管死亡或非致命性心肌梗死（首次和复发事件）复合终点的关联。 结果黑人参与者的预应力 FMD 低于非黑人参与者（3.7 [2.8] 对比 4.9 [3.8]，p <. 001），并且两组中都随着精神压力而显着下降。黑人患者 (76%) 的 TED 发生率高于非黑人患者 (67%；多变量调整比值比 = 1.6，95% 置信区间 = 1.5–1.7)。在中位（四分位距）75（65-82）个月的随访期内，142 名（18%）患者经历了心血管死亡或非致命性心肌梗死。黑人参与者的研究结果风险比非黑人参与者高 41.9%（95% 置信区间 = 1.01–1.95）。 TED 与精神压力解释了这种超额风险的 69%。 结论 在 CHD 患者中，黑人比非黑人个体更有可能因精神压力而出现内皮功能障碍，这反过来又解释了他们发生不良事件的超额风险的很大一部分。
ObjectiveThis study aimed to investigate differences in transient endothelial dysfunction (TED) with mental stress in Black and non-Black individuals with coronary heart disease (CHD), and their potential impact on cardiovascular outcomes.MethodsWe examined 812 patients with stable CHD between June 2011 and March 2016 and followed through February 2020 at a university-affiliated hospital network. Flow-mediated vasodilation (FMD) was assessed before and 30 minutes after mental stress. TED was defined as a lower poststress FMD than prestress FMD. We compared prestress FMD, post-stress FMD, and TED between Black and non-Black participants. In both groups, we examined the association of TED with an adjudicated composite end point of cardiovascular death or nonfatal myocardial infarction (first and recurring events) after adjusting for demographic, clinical, and socioeconomic factors.ResultsPrestress FMD was lower in Black than non-Black participants (3.7 [2.8] versus 4.9 [3.8], p<. 001) and significantly declined with mental stress in both groups. TED occurred more often in Black (76%) than non-Black patients (67%; multivariable-adjusted odds ratio= 1.6, 95% confidence interval= 1.5–1.7). Over a median (interquartile range) follow-up period of 75 (65–82) months, 142 (18%) patients experienced either cardiovascular death or nonfatal myocardial infarction. Black participants had a 41.9% higher risk of the study outcome than non-Black participants (95% confidence interval= 1.01–1.95). TED with mental stress explained 69% of this excess risk.ConclusionsAmong CHD patients, Black individuals are more likely than non-Black individuals to develop endothelial dysfunction with mental stress, which in turn explains a substantial portion of their excess risk of adverse events.