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Ischemia produced by mental stress has been associated with an increased risk of health events and death in heart patients who also suffer ischemia during physical stress. Dr. Sheps emphasized that this study just showed that mental stress ischemia can happen even in heart patients who are free of exercise-induced ischemia. The researchers do not know whether the silent ischemia they detected is hazardous to the health of the patients.

"Nobody has followed the patients that we are talking about in this article. Nobody has followed that population. So we don't know whether it is predictive in this population or not. It's an important question," he said.

The results tend to support proposals that mental stress works through a different mechanism than physical stress. This study did not explore the possible mechanisms, but the researchers noted that some hypotheses include effects on very small blood vessels in the heart muscle or on the endothelium, the inner layer of blood vessels that helps control responses to changes in blood flow.

"The basic message is that psychological stress or behavioral stressors are important. The effects are hard to measure, but several groups of researchers are interested in them and I think we are going to find out a lot more about them in the years to come," Dr. Sheps said. "We and others are also looking at interventions to try to teach people how to tolerate stress better."

David S. Krantz, Ph.D., from the Uniformed Services University in Bethesda, Maryland, who was not connected with this study, said this study expands the group of patients who may be vulnerable to the effects of mental stress.

"It has previously been shown that mental stress can induce myocardial ischemia in a substantial number of coronary artery disease patients. The common t
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Contact: Amy Murphy
amurphy@acc.org
301-581-3476
American College of Cardiology
7-Mar-2006