Hemodynamic Reactivity to Mental Stress and Cognitive Function in Coronary Artery Disease

Kasra Moazzami; Ambar Kulshreshtha; Matthew Gold; Alireza Rahbar; Felicia Goldstein; Amit J Shah; J Douglas Bremner; Viola Vaccarino; Arshed A Quyyumi

doi:10.1097/PSY.0000000000001314

Hemodynamic Reactivity to Mental Stress and Cognitive Function in Coronary Artery Disease

Psychosom Med. 2024 Apr 16. doi: 10.1097/PSY.0000000000001314. Online ahead of print.

Authors

Kasra Moazzami, Ambar Kulshreshtha, Matthew Gold¹, Alireza Rahbar¹, Felicia Goldstein, Amit J Shah, J Douglas Bremner, Viola Vaccarino², Arshed A Quyyumi¹

Affiliations

¹ Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Atlanta, GA.
² Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.

PMID: 38648028
DOI: 10.1097/PSY.0000000000001314

Abstract

Objective: People with coronary artery disease (CAD) are at higher risk of cognitive impairment than those without CAD. Psychological stress is a risk factor for both conditions and assessing the hemodynamic reactivity to mental stress could explain the link between stress and cognitive function.

Methods: Individuals with stable CAD from two prospective cohort studies were included. All individuals underwent acute mental stress testing, as well as conventional stress testing. Cognitive function was assessed both at baseline and at a 2-year follow-up. The rate-pressure product (RPP) was calculated as the mean systolic blood pressure times the mean heart rate at rest. RPP reactivity was defined as the maximum RPP during standardized mental stress test minus the RPP at rest.

Results: After multivariable adjustment, every standard deviation decrease in RPP reactivity with mental stress was associated with slower completion of Trail-A and Trail-B in both cohorts (13% and 11% in cohort 1, and 15% and 16% in cohort 2, respectively, p for all <0.01). After a 2-year follow-up period, every standard deviation decrease in RPP reactivity with mental stress was associated with a 8%, and 9% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). There was no significant association between RPP reactivity with conventional stress testing and any of the cognitive tests.

Conclusion: In the CAD population, a blunted hemodynamic response to mental stress is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.