Novel cardiovascular risk score uses stress test to predict heart disease more accurately

A study by Emory cardiovascular researchers has paved the way for the development of a new cardiovascular reactivity risk score that could better identify and improve how quickly high-risk patients under high stress are diagnosed and begin to receive treatment for heart disease.

The research, published on January 21 in the Journal of the American Heart Association and led by senior authors Arshed Quyyumi, MD and Viola Vaccarino, MD, Ph.D., along with lead author Kasra Moazzami, MD. Moazzami and a team of colleagues from Emory University, gathered data from a total of 629 individuals from 2011 to 2016, looking at three key ways that the study’s participants responded to a stress test administered in the lab.

Stress tests are designed to mimic the real-world pressure people may face in their day-to-day lives. To replicate those anxiety-inducing scenarios in the lab, researchers asked participating patients to deliver a three-minute public presentation on a topic that might typically make them uncomfortable, such as the mistreatment of a family member in a nursing home.

As the participants were speaking, the researchers carefully monitored key changes in their heart activity and blood pressure. This included how the lining inside of the blood vessels responded and how much the patients’ blood vessels tightened. The results from the overall tests showed how stress-related changes in blood flow and blood vessel function can be directly linked to heart disease.

“Our goal was to combine these three findings into a single risk score,” says Moazzami, MD, MSCR, MPH, Assistant Professor in the Division of Cardiology, Department of Medicine at Emory University School of Medicine.

“We wanted to see if the three key changes were connected, and more importantly, if bringing them together could improve our ability to predict risk.”

Measuring these factors helps identify if someone is at a higher risk for future cardiovascular events. Through the data collected in this study, researchers were able to find that as participants’ stress responses increased, so did their cardiovascular risk score for future cardiovascular events.

These findings are significant because, “Until recently, we were unable to directly measure the impact of stress on heart disease and had to rely mostly on patients’ subjective perceptions of stress, which are difficult to quantify and prone to bias,” Moazzami says.

“The present study, along with similar work, aims to create a paradigm shift by identifying objective markers of stress responses.” In other words, they aim to quantify what has, until now, been regarded primarily as a matter of individual experience and perception.

Over the last few decades, Emory cardiovascular researchers have led work on how stress impacts patients’ hearts. Puja Mehta, MD, and Viola Vaccarino, MD, Ph.D., along with many others have shown how mental stress can be a significant risk factor for heart disease, the number one killer in the United States—especially for women.

For this cohort of researchers at Emory, Moazzami says, it’s clear that addressing mental well-being is essential in preventing heart-related issues, particularly in patients who are more vulnerable to its effects.

In fact, Moazzami first joined Emory as a cardiology fellow in 2018, he says, because of its outstanding reputation as a leader in exploring these connections between the brain and heart, particularly how stress can influence cardiac events.

Authors of the paper note that future research is needed to see how the cardiovascular reactivity risk score can improve care for patients with heart disease. But the risk score is a step in the right direction.

“By adopting protocols similar to those used in this study, we can routinely evaluate the impact of stress in cardiology clinics and better understand its effects on heart health,” Moazzami says.

This is a critical shift toward a more individualized approach to treatment that could change the way doctors can prevent and manage patients with heart disease.

A study by Emory cardiovascular researchers has paved the way for the development of a new cardiovascular reactivity risk score that could better identify and improve how quickly high-risk patients under high stress are diagnosed and begin to receive treatment for heart disease.

The research, published on January 21 in the Journal of the American Heart Association and led by senior authors Arshed Quyyumi, MD and Viola Vaccarino, MD, Ph.D., along with lead author Kasra Moazzami, MD. Moazzami and a team of colleagues from Emory University, gathered data from a total of 629 individuals from 2011 to 2016, looking at three key ways that the study’s participants responded to a stress test administered in the lab.

Stress tests are designed to mimic the real-world pressure people may face in their day-to-day lives. To replicate those anxiety-inducing scenarios in the lab, researchers asked participating patients to deliver a three-minute public presentation on a topic that might typically make them uncomfortable, such as the mistreatment of a family member in a nursing home.

As the participants were speaking, the researchers carefully monitored key changes in their heart activity and blood pressure. This included how the lining inside of the blood vessels responded and how much the patients’ blood vessels tightened. The results from the overall tests showed how stress-related changes in blood flow and blood vessel function can be directly linked to heart disease.

“Our goal was to combine these three findings into a single risk score,” says Moazzami, MD, MSCR, MPH, Assistant Professor in the Division of Cardiology, Department of Medicine at Emory University School of Medicine.

“We wanted to see if the three key changes were connected, and more importantly, if bringing them together could improve our ability to predict risk.”

Measuring these factors helps identify if someone is at a higher risk for future cardiovascular events. Through the data collected in this study, researchers were able to find that as participants’ stress responses increased, so did their cardiovascular risk score for future cardiovascular events.

These findings are significant because, “Until recently, we were unable to directly measure the impact of stress on heart disease and had to rely mostly on patients’ subjective perceptions of stress, which are difficult to quantify and prone to bias,” Moazzami says.

“The present study, along with similar work, aims to create a paradigm shift by identifying objective markers of stress responses.” In other words, they aim to quantify what has, until now, been regarded primarily as a matter of individual experience and perception.

Over the last few decades, Emory cardiovascular researchers have led work on how stress impacts patients’ hearts. Puja Mehta, MD, and Viola Vaccarino, MD, Ph.D., along with many others have shown how mental stress can be a significant risk factor for heart disease, the number one killer in the United States—especially for women.

For this cohort of researchers at Emory, Moazzami says, it’s clear that addressing mental well-being is essential in preventing heart-related issues, particularly in patients who are more vulnerable to its effects.

In fact, Moazzami first joined Emory as a cardiology fellow in 2018, he says, because of its outstanding reputation as a leader in exploring these connections between the brain and heart, particularly how stress can influence cardiac events.

Authors of the paper note that future research is needed to see how the cardiovascular reactivity risk score can improve care for patients with heart disease. But the risk score is a step in the right direction.

“By adopting protocols similar to those used in this study, we can routinely evaluate the impact of stress in cardiology clinics and better understand its effects on heart health,” Moazzami says.

This is a critical shift toward a more individualized approach to treatment that could change the way doctors can prevent and manage patients with heart disease.