Among 602 adults (mean age 51; 46% women) studied within eight months of a premature myocardial infarction, mental stress-induced myocardial ischemia (MSIMI) — detected via nuclear perfusion imaging during a standardized mental stress task — was more prevalent in women than men (19.2% vs. 13.2%). In women, MSIMI carried a hazard ratio of 3.2 (95% CI 1.3–7.6) for cardiovascular death or recurrent MI, with an adjusted population attributable fraction of 27.6%, meaning more than one-quarter of primary events in women were statistically linked to mental stress ischemia. Men showed a non-significant HR of 1.9. Strikingly, all MSIMI-related primary events among women occurred in Black women (HR 4.3, 95% CI 1.7–11.1).
This preprint — not yet peer-reviewed — adds meaningful prospective data to the growing literature on psychosocial cardiovascular risk, which has historically been studied in older or predominantly male cohorts. The finding that peripheral microvascular reactivity (RHI) and interleukin-6 did not mediate the associations leaves the mechanistic pathway open, suggesting other pathways — autonomic, neuroendocrine, or platelet-mediated — deserve investigation. The disparity concentrated in Black women is clinically urgent but based on a small event count, warranting replication. Practically, adults recovering from MI — particularly younger women — should discuss stress management, including structured cardiac rehabilitation with psychological support, with their cardiologists. This finding is confirmatory in direction but noteworthy in the magnitude of sex-specific and racial risk stratification.