Everyday Discrimination and Mental Stress-Induced Myocardial Ischemia.
Everyday Discrimination and Mental Stress-Induced Myocardial Ischemia.
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日常歧视与精神应激性心肌缺血。
DOI：
10.1097/psy.0000000000000941
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发表时间：
2021-06-01
影响因子：
3.3
通讯作者：
Lewis TT
中科院分区：
文献类型：
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作者：
McKinnon II;Shah AJ;Lima B;Moazzami K;Young A;Sullivan S;Almuwaqqat Z;Garcia M;Elon L;Bremner JD;Raggi P;Quyyumi AA;Vaccarino V;Lewis TT
精神应激性心肌缺血（MSIMI）是一种对精神应激的短暂性心肌缺血反应，与冠心病（CHD）患者预后较差相关，且更容易发生在女性中。然而，MSIMI的预测因素还没有得到很好的探索。本研究调查了近期心肌梗死患者的日常歧视经历与MSIMI之间的关系，并将结果与常规应激性心肌缺血（CSIMI）进行了对比。我们研究了联想的性别差异。我们研究了295名心肌梗死后患者（145名女性，150名男性）。通过心肌灌注显像评估精神应激（言语任务）和常规应激（运动或药理学）对心肌缺血的诱发作用。使用日常歧视量表（EDS）通过问卷评估日常歧视的暴露频率。男女患者的平均年龄为51岁，EDS评分范围为10 ~ 38分（平均17分，标准差6分）。多变量分析后，EDS评分每增加一个标准差（暴露频率越高）与MSIMI的几率增加相关（OR=1.57[1.10 - 2.23]）。EDS评分与CSIMI无相关性（OR=0.86[0.64 - 1.17]）。EDS评分每增加一个标准差，女性患MSIMI的几率增加两倍（OR=1.96 [1.13 - 3.38], p=0.02），而男性则增加1.4倍（OR=1.40 [0.80 - 2.44], p=0.24）；然而，交互作用在统计学上不显著。在心肌梗死后患者中，日常歧视与MSIMI的发生呈正相关，但与CSIMI无关；这种关联在女性中更为明显。
Mental stress-induced myocardial ischemia (MSIMI), a transient myocardial ischemic response to mental stress, is associated with poorer outcomes among patients with coronary heart disease (CHD) and is more likely to occur among women. Yet, predictors of MSIMI are not well explored. The current study investigated the association between experiences of everyday discrimination and MSIMI among patients with recent MI and contrasted the results with conventional stress-induced myocardial ischemia (CSIMI). We examined sex differences in associations. We studied 295 post-MI patients (145 women, 150 men). Provocation of myocardial ischemia with mental stress (speech task) and conventional stress (exercise or pharmacologic) was assessed by myocardial perfusion imaging. Frequency of exposure to everyday discrimination was assessed via questionnaire using the Everyday Discrimination Scale (EDS). The mean age was 51 years in both women and men, and the EDS score ranged from 10 to 38 (mean 17; SD 6). After multivariable analysis, each standard deviation increase in EDS score (more frequent exposure) was associated with an increased odds of MSIMI (OR=1.57 [1.10 – 2.23]). EDS score was not associated with CSIMI (OR=0.86 [0.64 – 1.17]). Women demonstrated a two-fold increase (OR=1.96 [1.13 – 3.38], p=0.02) in the adjusted odds of MSIMI with each standard deviation increase in EDS score compared to a 1.4-fold increase (OR=1.40 [0.80 – 2.44], p=0.24) among men; however, interaction was not statistically significant. Among post-MI patients, everyday discrimination was positively associated with occurrence of MSIMI, but not with CSIMI; associations were more pronounced among women.