Georgia CTSA Investigators Research Clinical Significance of Mental Stress-Induced Myocardial Ischemia in CHD Patients


Woman looking stress with hands on chest

Long-standing Georgia CTSA investigators Arshed A. Quyyumi, MD, Viola Vaccarino, MD, PhD, and Emory colleagues, including former TL1 trainee and CPTR graduate Zakaria Almuwaqqat, MD, MPH, published novel research findings on the clinical significance of mental and conventional stress-induced myocardial ischemia with adverse cardiovascular events in patients with coronary heart disease (CHD).

In the article, Association of Mental Stress-Induced Myocardial Ischemia with Cardiovascular Events in Patients with Coronary Heart Disease, published on November 9, 2021, in JAMA, the investigators address the gaps in research on the common phenomenon of mental stress-induced ischemia in stable CHD patients.

Dr. Vaccarino shares details of her study, “Using rigorous methodology, our study demonstrated a mechanism through which psychological stress can increase the risk of adverse events in people with heart disease. Exposure to acute stress can cause a reduction of blood flow to the heart muscle in some people, and this can increase their risk of subsequent cardiac events or death.”

In two parallel prospective cohort studies of 918 total participants with underlying but stable CHD, participants were exposed to standardized mental and conventional (i.e., exercise or pharmacological) stress tests to assess if their hearts developed myocardial ischemia. Over the course of a 5-year patient follow-up, their findings suggest patients experiencing mental stress-induced ischemia were significantly associated with an increased risk of cardiovascular death or nonfatal myocardial infarction, as compared to patients with no mental stress-induced ischemia.

TL1 trainee and CPTR graduate, Dr. Almuwaqqat, elaborates on their research findings, “This association was independent of and more significant than myocardial ischemia induced by a conventional stress test, such as a treadmill test. Patients who developed ischemia with both stressors showed an almost fourfold increase in risk. These results suggest that ischemia with mental stress contributes substantially to patients with heart disease. It also underscores the importance of emotional factors on the morbidity and mortality of patients with heart disease.”

Further, Dr. Vaccarino emphasizes the importance behind this research, “Although we provoked stress in the laboratory, this ‘mental stress test’ likely reflects people’s reactions in everyday life and helped us to identify individuals that are vulnerable to such effect. Further studies are urgently needed to ascertain the utility of assessing and treating this response to mental stress in the clinical setting.”

Since its release three months ago, the publication has over 18,000 views and is in the top 5% of all research outputs scored by the Altmetric Explorer Database that tracks and analyzes online activity around scholarly research and among the highest scoring outputs of similar age from its publication source, JAMA. The research has received significant recognition from the media, including references from over 30 different news outlets, such as The New York Times and Yahoo, as well as mentions in almost 200 tweets from users with a combined Twitter following of over 1.8 M.

Crediting the significance of strong collaboration on the success of research, Dr. Vaccarino acknowledges, “…this study would not have been possible without our great collaborative research group, which includes experts in Cardiology, Epidemiology, Behavioral Sciences, Radiology/Imaging, Psychiatry, and Biostatistics.”

In direct parallel to the goals and purpose of the Georgia CTSA, Dr. Quyyumi also recognizes the importance of providing sustained access to clinical research resources, “Academic centers need to engage in clinical and translational research that provides opportunities for the students, trainees, and faculty to advance science and unravel the mysteries of human disease.”

Dr. Almuwaqqat shines light on how his participation in the Georgia CTSA TL1 program has contributed to successes in this research study, as well as his overall career, “As a TL1 fellow, I had the protected time and the appropriate funding resources to conduct critical parts of this study and take this fantastic project to the finish line. Through Georgia CTSA support and programs, I have also been lucky to receive outstanding mentorship and education from world-class mentors and educators who contributed enormously to my learning journey.”

Georgia CTSA's TL1 program provides outstanding opportunities for clinical and translational research training for predoctoral and postdoctoral trainees. The program is focused on providing didactic and mentored research training for predoctoral and postdoctoral trainees interested in a career focused on clinical and/or translational research relevant to human health. The Georgia CTSA is dedicated to providing predoctoral and postdoctoral trainees with state-of-the-art scientific knowledge, tools, and methods to improve human health through rigorous clinical and translational research training. Through the TL1 program, the Georgia CTSA will increase the translational research workforce and enhance the career development of future leaders of the biomedical research workforce, a major mission of NCATS and NIH.

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The Certificate Program in Translational Research (CPTR) is a formal 16-credit Emory Laney Graduate School program for trainees who seek to conduct research at the interface between basic and translational science and clinical medicine. The CPTR enhances and transforms translational research training for predoctoral PhD and PharmD students, postdoctoral fellows, and junior faculty at Emory, MSM, Georgia Tech, and UGA College of Pharmacy.

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The Georgia CTSA is a statewide partnership between Emory, MSM, Georgia Tech, and UGA and is one of over 60 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health's Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.

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