A NOVEL cardiovascular reactivity risk score, based on stress-induced changes in vascular and hemodynamic function, has been shown to predict worse outcomes in patients with coronary artery disease, beyond traditional risk factors.
Psychological stress has long been suspected to contribute to cardiovascular disease, but direct measurement of its physiological impact has been challenging. Researchers at Emory University conducted a study to determine whether stress-related changes in blood pressure, blood flow, and vascular function could predict adverse cardiac events in individuals with stable coronary artery disease. By evaluating these responses and creating a composite cardiovascular reactivity risk score, the study aimed to enhance risk assessment in clinical practice.
The study analysed 629 participants across two prospective cohort studies, assessing their physiological responses to acute mental stress induced by a public speaking task. Researchers measured changes in rate-pressure product, brachial artery flow-mediated dilation, and peripheral arterial tonometry to quantify hemodynamic reactivity, endothelial function, and vasoconstriction, respectively. Each participant was assigned a cardiovascular reactivity risk score from 0 to 9, based on the degree of abnormality in these responses. The study found that a blunted hemodynamic response, reduced endothelial function, and increased vasoconstriction were each independently associated with a higher risk of cardiovascular events, including heart attack, heart failure hospitalization, and cardiovascular death. Incorporating the cardiovascular reactivity risk score into risk assessment models significantly improved predictive accuracy, increasing the C-statistic by 10% (P<0.001).
These findings highlight the critical role of psychological stress responses in cardiovascular health. The development of a cardiovascular reactivity risk score provides a new tool for identifying high-risk coronary artery disease patients, allowing for more personalized prevention strategies. Clinicians may integrate stress testing into routine assessments to better predict and mitigate risks associated with mental stress. Future research should explore how targeted interventions—such as stress management programs or personalized treatment plans—could reduce stress-induced cardiovascular risks and improve patient outcomes. By recognizing the impact of psychological stress on heart disease, this study paves the way for more comprehensive, individualized approaches to cardiovascular care.
Katrina Thornber, EMJ
Reference
Moazzami K et al. Cardiovascular reactivity to mental stress and adverse cardiovascular outcomes in patients with coronary artery disease. Journal of the American Heart Association. 2024:e034683.
