Cardiovascular stress response and coronary artery disease: Evidence of an adverse postmenopausal effect in women

Objectives: To test the hypothesis that postmenopausal women demonstrate greater vascular instability, measured by enhanced cardiovascular stress responses during mental stress, compared with men and premenopausal women. Background: Recent data suggest that estrogen plays a role in regulating vascular tone. The possible consequences of estrogen deficiency during menopause on systemic vascular reactivity is largely unexplored. Methods: One hundred subjects (84 men and 16 women) underwent mental stress testing with radionuclide ventriculography. Study subjects included 19 normal volunteers, 23 control subjects with chest pain syndromes or hypertension but without coronary artery disease, and 58 coronary artery disease subjects. The subjects performed a series of three mental stress tasks, during which hemodynamic data and radionuclide ventriculograms were obtained. Results: Overall, women demonstrated greater hemodynamic responses during mental stress measured by changes in heart rate, systolic and diastolic blood pressure, and double product compared with those of men (all p < 0.05). Women with coronary artery disease demonstrated greater heart rate, diastolic blood pressure, and double product stress responses than their male counterparts (all p < 0.05). Women of postmenopausal age demonstrated significantly greater systolic blood pressure reactivity than men or premenopausal women (p < 0.05). Conclusions: Women of postmenopausal age have greater cardiovascular responses to stress than men or premenopausal women. These Findings suggest an additional mechanism by which estrogen deficiency conveys a poor prognosis in female patients with coronary artery disease.