Mental Stress and Myocardial Ischemia: Young Women at Risk.
Mental Stress and Myocardial Ischemia: Young Women at Risk.
复制标题
精神压力和心肌缺血：年轻女性面临风险。
DOI：
10.1161/jaha.116.004196
复制
发表时间：
2016
影响因子：
5.4
通讯作者：
Pepine,CarlJ
中科院分区：
文献类型：
--
作者：
Wokhlu,Anita;Pepine,CarlJ
与其他可比男性相比，患有阻塞性冠状动脉疾病（CAD）的女性预后较差。首次心肌梗死后死亡的女性多于男性。1相对于男性，年轻女性（< 55岁）在心肌梗死后的预后特别不利。2这些不同结果的机制尚不清楚，但由于年轻女性的事件前健康状况比男性更差，包括整体和心理健康生活质量较低，3很可能不良状况在急性事件发生前很久就开始了。注意力越来越集中在心理或精神压力作为潜在的非传统CAD风险条件。在心肌缺血的心理生理学调查研究中，我们发现精神应激诱发的心肌缺血可预测阻塞性CAD和运动诱发的心肌缺血患者全因死亡的风险增加。4在一组女性缺血综合征评估中有缺血性心脏病症状和体征的女性（平均年龄58岁）中，大多数没有阻塞性CAD，我们发现心理社会因素与过早死亡之间存在关联。5在9.3年的时间里，Spielberger特质焦虑指数和Beck抑郁量表评分（风险比分别为1.09，95% CI 1.02-1.15和0.86，CI 0.78-0.93）和非常好的自评健康（相对于差的自评健康，风险比0.33，CI 0.12-0.96）都独立预测死亡风险。这些结果扩展了女性缺血性心脏病/CAD人群的先验知识。显然，心理社会因素与女性缺血性心脏病患者的不良结局有关，但精神压力如何独特地调节年轻女性的病程仍不清楚。
Women with obstructive coronary artery disease (CAD) have poor outcomes relative to otherwise comparable men. More women than men die after a first myocardial infarction. 1 Younger women (< 55 years) have a particularly unfavorable prognosis after myocardial infarction relative to male counterparts. 2 Mechanisms for these differential outcomes are unclear, but since younger women have worse preevent health status versus men, including lower overall and mental health qualities of life, 3 it is likely that the adverse condition begins long before the acute event. Attention has increasingly focused on psychosocial or mental stressors as potential nontraditional CAD risk conditions. In the Psychophysiological Investigations of Myocardial Ischemia Study, we found that mental stress–induced ischemia predicted increased risk for all-cause mortality in patients with obstructive CAD and exerciseinduced ischemia. 4 In a cohort of women with symptoms and signs of ischemic heart disease (mean age 58 years) from the Women’s Ischemia Syndrome Evaluation, mostly without obstructive CAD, we found associations between psychosocial factors and premature mortality. 5 Over 9.3 years, the Spielberger Trait Anxiety Index and Beck Depression Inventory scores (hazard ratio 1.09, 95% CI 1.02–1.15, and hazard ratio 0.86, CI 0.78–0.93, respectively) and very good self-rated health (versus poor self-rated health, hazard ratio 0.33, CI 0.12–0.96) each independently predicted mortality risk. These results extend prior knowledge in female ischemic heart disease/CAD populations. Clearly, psychosocial factors link with adverse outcomes among women with ischemic heart disease, but how mental stress uniquely modulates the course of younger women remains unclear.