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Heart Disease, Sex Differences, & Mental Stress

Heart Disease, Sex Differences, & Mental Stress

Clinical research has demonstrated that there is a relationship between mental stress and cardiovascular diseases, including ischemic heart disease (IHD). Studies indicate that emotional stress is associated with IHD and has been linked to clinical events, but few investigations have explored sex-specific differences in the psychobiological responses to mental stress. To address this research gap, Zainab Samad, MD, MHS, and colleagues had a study published in the Journal of the American College of Cardiology that examined differential psychological and cardiovascular responses to mental stress between men and women with stable IHD. For the analysis, 254 men and 56 women with stable IHD underwent psychometric assessments, transthoracic echocardiography, and platelet aggregation studies at baseline and after three mental stress tasks, which included 1) a math test, 2) a mirror tracing test, and 3) an anger recall test.             Most baseline characteristics were similar between women and men with known IHD, including heart rate, blood pressure, and left ventricular ejection fraction (LVEF). However, women were more likely to be non-white, living alone, and unmarried. They also had higher levels depression and anxiety at baseline. At rest, women had higher platelet aggregation responses to serotonin and epinephrine than men. Important Findings The investigators defined mental stress-induced myocardial ischemia (MSIMI) as the development or worsening of regional wall motion abnormalities, reductions of LVEF to 8% or lower, and/or ischemic ST-segment changes on electrocardiogram during one or more of the three mental stress tasks. “Women had more MSIMI than men and expressed more negative emotions and fewer positive emotions while doing the stressful tasks,” says Dr. Samad. Women were also more likely to experience decreased...
On the Unity of Doctors

On the Unity of Doctors

Doctors are facing challenges like never before. Not only are new medications being discovered and novel technologies being implemented, we are being bombarded with new regulations. Years ago, people were talking about how to improve the doctor-patient relationship. Currently, all the journals are talking about big data, EHR, meaningful use, and ICD-10. Not only do we need to stay current with all the medical innovation taking hold, we need to learn how to comply with all these regulations. Many doctors feel these requirements are actually not helpful as being touted. In fact, we feel there is harm being done because they are taking us away from direct contact with the patient. According to a study out of the American Journal of Emergency Medicine, it has been estimated that ER docs spend 44% of time on electronic data entry and 28% on patient contact. Doctors are becoming increasingly vocal on speaking up against these regulations that we are forced to comply with. However, after years of being forbidden to unionize or collectively bargain, we are often doing it alone. We feel isolated in this sea of chaos. Polices will never change based on just one voice. If we are to drive policy change and shape regulations to become meaningful for the quality of medicine, we need to find a unified voice. How can doctors find unity and speak up against wrongful healthcare policies? 1. We can share information about these policy changes. We all need to stay up-to-date with them for our own practices. When we are aware, share them and discuss with other doctors why or why not these...
Unhealthy Heart Behaviors: Getting Ahead of the Curve

Unhealthy Heart Behaviors: Getting Ahead of the Curve

The American Heart Association (AHA) has set a 2020 goal of improving the heart health of all Americans by 20% while reducing deaths from cardiovascular disease (CVD) and stroke by 20%. The AHA’s 2020 goals were designed strategically to help all individuals prevent declines in their current health behaviors and take a step toward better heart health by progressing toward ideal healthy lifestyle behaviors. “To achieve these goals, prevention is the top priority,” says Bonnie Spring, PhD. “Major strides have been made toward reducing risks for CVD and stroke, but the significant economic toll linked to these health challenges necessitates a new approach.” According to recent estimates, direct annual CVD-related costs are projected to triple, rising from $272 billion in 2010 to $818 billion in 2030. A Call to Action In 2013, the AHA released a science advisory, published in Circulation, emphasizing the importance of greater efforts to preserve cardiovascular health from childhood and to treat health risk behaviors into older ages. The call-to-action statement addresses three novel approaches to attain the AHA’s 2020 goals: 1. Preserving positive cardiovascular health by promoting healthy lifestyle behaviors. 2. Treating unhealthful behaviors in addition to risk biomarkers. 3. Combining individual-level and population-based health promotion strategies that steer the public toward the next level of improved cardiovascular health. “Clinicians need to treat unhealthy behaviors as aggressively as they treat high blood pressure (BP), cholesterol, and other CVD risk factors,” says Dr. Spring, who was lead author of the AHA statement. “It’s a paradigm shift from only treating biomarkers to also helping people change unhealthy behaviors.” Clinicians already treat physical risk factors, but people...
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