Myocardial Infarction in Women: Symptoms, Risk Factors, Neuropsychological Impairment, and Stress-Induced Physiological Changes
Creators: name: Narvaez Linares, Nicolás Francisco
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2022
Subjects: women
myocardial infarction
Trier Social Stress Test
cognitive functions
cortisol
heart rate variability
femmes
infarctus du myocarde
fonctions cognitives
variabilité du rythme cardiaque

description: Cardiovascular disease has been a leading cause of death worldwide over the last decades (Roth et al., 2015; WHO, 2021a). In countries with middle or elevated gross domestic product indices, stroke and myocardial infarction represent the prevalent causes of death. Over the years, the scientific community has identified significant cognitive and emotional impacts on survivors of coronary heart disease and cardiovascular disease. We know that ageing populations and high-stress levels associated with contemporary lifestyles play a crucial role in the prognosis and recovery of individuals with myocardial infarction. These factors are associated with an increased societal burden related to survivors’ care. As they age, a higher proportion of women than men are affected by coronary heart disease, including myocardial infarction. Nonetheless, women remain under-represented in studies addressing trajectories of recovery associated with myocardial infarction. The arching goal of this thesis is to expand the knowledge on the association of various environmental and physical factors with a history of myocardial infarction in a sample of Canadian women. The accomplished research is presented in the form of two empirical studies carried out on samples of Canadian women with and without a history of myocardial infarction, as well as two systematic reviews of the literature. The first study established the state of knowledge on the Trier Social Stress Test paradigm, a tool that we later used in our laboratory study. Through an in-depth examination of the protocols used by different research groups, this systematic review identified essential elements for valid conclusions and proposed a set of recommendations for standardizing the use of the Trier Social Stress Test in research. The second systematic review updated the current scientific knowledge concerning the cognitive consequences of women with a history of coronary heart disease. Despite cardiovascular disease, including coronary heart disease, remainsunderstudied in women, the last decade has seen an emergence of research supporting cognition to be affected. Our findings support subtle cognitive impairments in women with a history of coronary heart disease. Our literature review was conducted to facilitate interpreting the results obtained in a sample of women with a history of MI in this thesis’ fourth study. Regarding data collection, an online questionnaire validated the presence of specific risk factors and symptoms associated with myocardial infarction in a sample of middle-aged Canadian women (N = 366). Finally, a laboratory study measured alterations in the physiological responses (i.e., heart rate variability and salivary cortisol secretion) associated with exposure to a social stressor (i.e., Trier Social Stress Test) in women with a history of myocardial infarction and age-matched controls (N = 29). This body of data and analytic reviews contribute to expanding the knowledge of physiological and cognitive impairments in women with a MI history. Our research also helps improve testing paradigms to examine deficits and identify areas where further research is needed. Our findings support women experiencing different symptoms than those described in men, and it pleads for these to be no longer described as "atypical." Our work highlights a similar prevalence of certain factors (e.g., hypertension) in Canadian women and women from other parts of the world. In terms of the laboratory study, our results indicate subjective/perceived levels of stress intensity to be comparable between the myocardial infarction and non-myocardial infarction women groups. However, we only found tendencies in changes related to measured physiological variables.