Sex Differences in Psychosocial Factors and Angina in Patients With Chronic Coronary Disease.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-02-25 DOI:10.1161/JAHA.124.037909

Anaïs Hausvater, Rebecca Anthopolos, Alexa Seltzer, Tanya M Spruill, John A Spertus, Jesus Peteiro, Jose Luis Lopez-Sendon, Jelena Čelutkienė, Elena A Demchenko, Sasko Kedev, Branko D Beleslin, Mandeep S Sidhu, Anna Grodzinsky, Jerome L Fleg, David J Maron, Judith S Hochman, Harmony R Reynolds

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引用次数: 0

Abstract

Background: Women with chronic coronary disease have more frequent angina and worse health status than men, despite having less coronary artery disease (CAD). We examined whether perceived stress and depressive symptoms mediate sex differences in angina, and whether this relationship differs in the setting of obstructive CAD or ischemia with no obstructive coronary artery disease (INOCA).

Methods: We analyzed the association between sex, stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8) on angina-related health status (Seattle Angina Questionnaire [SAQ]) at enrollment in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial and CIAO-ISCHEMIA (Changes in Ischemia and Angina Over 1 Year Among ISCHEMIA Trial Screen Failures With No Obstructive CAD on Coronary CT [Computed Tomography] Angiography) ancillary study.

Results: Scores for the SAQ, Perceived Stress Scale-4, and Patient Health Questionnaire-8 were available in 1626 participants (N=1439 CAD and N=187 INOCA). Women had lower (worse) SAQ-7 summary scores than men in both CAD and INOCA cohorts (CAD: median 76 [25th, 75th percentiles 60, 90] versus 83 [70, 96], P<0.001; INOCA: 80 [64,89] versus 85 [75, 93], P=0.012). Higher stress and depressive symptoms were associated with worse angina in both cohorts. Female sex, Perceived Stress Scale-4 score, and Patient Health Questionnaire-8 score were each independently associated with lower SAQ summary score, but CAD versus INOCA cohort was not. There was no interaction between sex and stress (-0.39 [95% CI, -1.01 to 0.23]) or sex and depression (-0.00 [95% CI, -0.53 to 0.53]) on SAQ summary score.

Conclusions: High stress and depressive symptoms were independently associated with worse angina and poorer health status, without interaction with sex with or without obstructive CAD. Factors other than stress or depression contribute to worse health status in women with obstructive CAD or INOCA.

Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02347215, NCT01471522.

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背景：与男性相比，患有慢性冠状动脉疾病（CAD）的女性心绞痛发生率更高，健康状况更差。我们研究了感知到的压力和抑郁症状是否会介导心绞痛的性别差异，以及这种关系在阻塞性冠状动脉疾病（CAD）或无阻塞性冠状动脉疾病（INOCA）的缺血情况下是否有所不同：方法：我们分析了性别、压力（感知压力量表）与心绞痛之间的关系、方法：我们分析了ISCHEMIA（国际医疗和侵入性方法健康效果比较研究）试验和CIAO-ISCHEMIA（ISCHEMIA试验筛选失败且冠状动脉CT[计算机断层扫描]血管造影显示无阻塞性CAD的患者1年内缺血和心绞痛的变化）辅助研究入选时性别、压力（感知压力量表-4）和抑郁症状（患者健康问卷-8）与心绞痛相关健康状况（西雅图心绞痛问卷[SAQ]）之间的关系。研究结果1626名参与者（1439人患有CAD，187人患有INOCA）的SAQ、Perceived Stress Scale-4和Patient Health Questionnaire-8得分情况。在 CAD 和 INOCA 组群中，女性的 SAQ-7 总分均低于男性（更差）（CAD：中位数 76 [第 25、75 百分位数 60、90] 对 83 [第 70、96]，PP=0.012）。在两个队列中，较高的压力和抑郁症状与心绞痛恶化有关。女性性别、感知压力量表-4（Perceived Stress Scale-4）得分和患者健康问卷-8（Patient Health Questionnaire-8）得分均与较低的SAQ总分独立相关，但CAD队列与INOCA队列无关。性别与压力（-0.39 [95% CI, -1.01 to 0.23]）或性别与抑郁（-0.00 [95% CI, -0.53 to 0.53]）对 SAQ 总分没有交互作用：高压力和抑郁症状与更严重的心绞痛和更差的健康状况独立相关，但与是否存在阻塞性 CAD 的性别无关。在患有阻塞性 CAD 或 INOCA 的女性中，压力或抑郁以外的因素也会导致健康状况恶化：URL: https://www.clinicaltrials.gov; Unique identifiers：NCT02347215、NCT01471522。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.