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March 19, 2020

Stressful times are particularly dangerous for heart attack survivors, study finds

Mental stress can trigger a second – and potentially fatal – cardiac event

Adult Health Heart Attacks
Times of stress can trigger a second heart attack, new study finds Thom Carroll/PhillyVoice

Mental stress – like that caused by the coronavirus pandemic – can put heart attack survivors at greater risk of having a second cardiac event, according to a study conducted by Emory University researchers.

Stress levels are understandably high as the United States faces a growing coronavirus threats. 

But such stress could put heart attack survivors at greater risk for a second cardiac event, according to a new study conducted by Emory University researchers. 

People who experience myocardial ischemia – reduced blood flow to the heart – caused by mental stress are two times more likely to have another heart attack – or die from heart disease – than other heart attack survivors, researchers found. 

"In our study, myocardial ischemia provoked by mental stress was a better risk indicator than what we were able to see with conventional stress testing," said Dr. Viola Vaccarino, a cardiovascular researcher at Emory.

"These data point to the important effect that psychological stress can have on the heart and on the prognosis of patients with heart disease. It gives us tangible proof of how psychological stress, which is not specifically addressed in current clinical guidelines, can actually affect outcomes."

The tendency to have reduced blood flow to the heart during severe psychological stress poses substantial risk to these patients, she said. 

Because of this, clinicians should consider patients' psychological stress when evaluating their risk for recurrent heart attack or death, Vaccarino said. Additionally, better stress management strategies are needed for heart attack survivors.

The study included 306 young and middle-aged heart attack survivors who had been hospitalized with a heart attack within the previous eight months. 

Researchers found that only mental stress – not physical stress – induced myocardial ischemia. 

"This points to the fact that stress provoked by emotions has a distinct mechanism of risk for heart disease and its complications compared with physical stress," Vaccarino said.

All study participants underwent two different stress tests to examine blood flow to the heart – one that focused on mental stress and a more conventional stress test. Researchers tracked their health for three years.

Mental stress induced myocardial ischemia in 16% of the patients and conventional ischemia – lack of blood flow to other parts of the body – in 35%. During the follow-up, 10% of the patients had suffered another heart attack. Two had died of heart-related problems.

The researchers acknowledged that their sample size was small and that a larger study is needed to confirm the results.

Their findings were presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology.

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