Maladaptive Cardiovascular Reactivity to Mental Stress Linked to Adverse Outcomes

Risk score derived from cardiovascular reactivity predictive of adverse outcomes beyond traditional cardiovascular risk factors in CAD

By Elana Gotkine HealthDay Reporter

MONDAY, Feb. 3, 2025 (HealthDay News) — A risk score derived from cardiovascular reactivity to mental stress improves prediction of adverse cardiovascular outcomes over traditional cardiovascular risk factors among individuals with stable coronary artery disease, according to a study published online Jan. 23 in the Journal of the American Heart Association.

Kasra Moazzami, M.D., M.P.H., from the Emory University School of Medicine in Atlanta, and colleagues examined the association of aggregated stress-induced changes in hemodynamic and vascular function tests with adverse cardiovascular outcomes in 629 patients with coronary artery disease from two prospective cohort studies. Changes in rate-pressure product, brachial artery flow-mediated vasodilation, and peripheral arterial tonometry were used to assess hemodynamic reactivity, changes in endothelial function, and vasoconstriction during mental stress. By allotting 0 to 3 points for each quartile of increasing abnormality for each of the three reactivity responses and summing quartile points from the Mental Stress Ischemia Prognosis Study, a cardiovascular reactivity risk score ranging from 0 to 9 was calculated.

After adjusting for demographic and traditional risk factors, the researchers found that a blunted hemodynamic response, greater decrease in flow-mediated vasodilation, and greater degree of peripheral vasoconstriction to mental stress were all independently associated with an increased risk for adverse outcomes (composite of cardiovascular death, nonfatal myocardial infarction, and heart failure hospitalization) in both cohorts. The C-statistic increased significantly by 10 percent by adding to the cardiovascular reactivity risk score.

“It is also crucial to explore how changes in these cardiovascular reactivity measures may influence the long-term outcomes for patients with coronary artery disease,” the authors write.