Stress may contribute to progression of coronary heart disease (CHD) through inflammation, especially among women. Thus, we sought to examine whether increased inflammatory response to stress among patients with CHD is associated with a greater risk of cardiovascular events and whether this risk is higher in women. We examined inflammatory biomarkers known to increase with mental stress (speech task), including interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and matrix metallopeptidase-9 (MMP-9) among 562 patients with stable CHD. Inflammatory response, the difference between post-stress and resting values, was examined as a predictor of major adverse cardiovascular events (MACE) using subdistribution hazards models for competing risks adjusting for demographics, cardiovascular risk factors, and medications. MACE was defined as a composite endpoint of cardiovascular death, myocardial infarction, unstable angina with revascularization, and heart failure. All biomarkers were standardized. The mean age was 63 years (range 34-79) and 24% were women. During a median follow-up of 3 years, 71 patients experienced MACE. Overall, there was no significant association between inflammatory response to stress and risk of MACE, but there were sex-based interactions for IL-6 (p = 0.001) and MCP-1 (p = 0.008). The risk of MACE increased 56% (HR: 1.56; 95% CI: 1.21, 2.01; p = 0.001) and 30% (HR: 1.30; 95% 1.09. 1.55; p = 0.004) for each standard deviation increase in IL-6 and MCP-1 response to mental stress for women, respectively, while there was no association among men. Increased inflammation in response to stress is associated with future adverse cardiovascular outcomes among women with CHD.

中文翻译：

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冠心病患者应激炎症反应和不良心血管结局风险的性别差异

压力可能通过炎症促进冠心病 (CHD) 的进展，尤其是在女性中。因此，我们试图检查冠心病患者对压力的炎症反应增加是否与心血管事件的风险增加有关，以及这种风险在女性中是否更高。我们检查了已知会随着精神压力（言语任务）而增加的炎症生物标志物，包括 562 名患有稳定的冠心病。炎症反应，即应激后值和静息值之间的差异，被检查为主要不良心血管事件 (MACE) 的预测因子，使用子分布风险模型对竞争风险进行人口统计学、心血管风险因素和药物调整。MACE 被定义为心血管死亡、心肌梗死、不稳定型心绞痛伴血运重建和心力衰竭的复合终点。所有生物标志物都是标准化的。平均年龄为 63 岁（范围 34-79），24% 为女性。在 3 年的中位随访期间，71 名患者经历了 MACE。总体而言，对压力的炎症反应与 MACE 风险之间没有显着关联，但 IL-6 (p = 0.001) 和 MCP-1 (p = 0.008) 存在基于性别的相互作用。IL-的每一个标准偏差增加，MACE 风险增加 56%（HR：1.56；95% CI：1.21、2.01；p = 0.001）和 30%（HR：1.30；95% 1.09.1.55；p = 0.004） 6 和 MCP-1 分别对女性的精神压力做出反应，而男性之间没有关联。