Key result
Higher body mass index was an independent predictor of mental stress-induced myocardial ischemia in patients with stable coronary artery disease, with a 10% increased risk for each 1-point increase in BMI.
Why the study?
Does higher body mass index increase the risk of mental stress-provoked myocardial ischemia in patients with stable coronary artery disease?
Cohort (n=161)
Blinded outcome assessment
Yes
Does higher body mass index increase the risk of mental stress-provoked myocardial ischemia in patients with stable coronary artery disease?
Higher body mass index is an independent predictor of mental stress-induced myocardial ischemia in patients with stable coronary artery disease, suggesting adiposity contributes to vulnerability to stress-provoked ischemia.
Answers are grounded in this paper and cite their sources.
May identify higher BMI as a risk marker for mental stress ischemia in stable CAD; hypothesis-generating and leaves causal role of adiposity open.
Acute emotionally reactive mental stress (MS) can provoke prognostically relevant deficits in cardiac function and myocardial perfusion, and chronic inflammation increases risk for this ischemic phenomenon. We have described parasympathetic withdrawal and generation of inflammatory factors in MS. Adiposity is also associated with elevated markers of chronic inflammation. High body mass index (BMI) is frequently used as a surrogate for assessment of excess adiposity, and associated with traditional CAD risk factors, and CAD mortality. BMI is also associated with autonomic dysregulation, adipose tissue derived proinflammatory cytokines, which are also attendant to emotion provoked myocardial ischemia. Thus, we sought to determine if body mass index (BMI) contributes to risk of developing myocardial ischemia provoked by mental stress. We performed a prospective interventional study in a cohort of 161 patients with stable CAD. They completed an assessment of myocardial blood flow with single photon emission computed tomography (SPECT) simultaneously during 2 conditions: laboratory mental stress and at rest. Multivariate logistic regression determined the independent contribution of BMI to the occurrence of mental-stress induced ischemia. Mean age was 65.6 ±9.0 years; 87.0% had a history of hypertension, and 28.6% had diabetes. Mean BMI was 30.4 ± 4.7. Prevalence of mental stress ischemia was 39.8%. BMI was an independent predictor of mental stress ischemia, OR=1.10, 95% CI [1.01-1.18] for one-point increase in BMI and OR=1.53, 95% CI [1.06-2.21] for a 4.7 point increase in BMI (one standard deviation beyond the cohort BMI mean), p=0.025 for all. These data suggest that BMI may serve as an independent risk marker for mental stress ischemia. The factors attendant with greater BMI, which include autonomic dysregulation and inflammation, may represent pathways by which high BMI contribute to this risk and serve as a conceptual construct to replicate these findings in larger CAD populations.
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Soufer et al. (2016) conducted a cohort in Stable coronary artery disease (n=161). Body mass index (BMI) vs. Lower BMI was evaluated on Mental stress-provoked myocardial ischemia (new or worsening myocardial perfusion defect from baseline to mental stress) (OR 1.10, 95% CI 1.01-1.18, p=0.025). Higher body mass index was an independent predictor of mental stress-induced myocardial ischemia in patients with stable coronary artery disease, with a 10% increased risk for each 1-point increase in BMI.
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