Young women after MI have a 2-fold likelihood of developing MSIMI compared with men and a similar increase in conventional stress ischemia. Microvascular dysfunction and peripheral vasoconstriction with mental stress are implicated in MSIMI among women but not among men, perhaps reflecting women's proclivity toward ischemia because of microcirculatory abnormalities.

Atrial fibrillation (AFib) is diagnosed by analysis of the morphological and rhythmic properties of the electrocardiogram. It was recently shown that accurate detection of AFib is possible using beat-to-beat interval variations. This raises the question of whether AFib detection can be performed using a pulsatile waveform such as the Photoplethysmogram (PPG). The recent explosion in use of recreational and professional ambulatory wrist-based pulse monitoring devices means that an accurate pulse-based AFib screening algorithm would enable large scale screening for silent or undiagnosed AFib, a significant risk factor for multiple diseases. We propose a noise-resistant machine learning approach to detecting AFib from noisy ambulatory PPG recorded from the wrist using a modern research watch-based wearable device (the Samsung Simband). Ambulatory pulsatile and movement data were recorded from 46 subjects, 15 with AFib and 31 non symptomatic. Single channel electrocardiogram (ECG), multi-wavelength PPG and tri-axial accelerometry were recorded simultaneously at 128 Hz from the non-dominant wrist using the Simband. Recording lengths varied from 3.5 to 8.5 minutes. Pulse (beat) detection was performed on the PPG waveforms, and eleven features were extracted based on beat-to-beat variability and waveform signal quality. Using 10-fold cross validation, an accuracy of 95 % on out-of-sample data was achieved, with a sensitivity of 97%, specificity of 94%, and an area under the receiver operating curve (AUROC) of 0.99. The described approach provides a noise-resistant, accurate screening tool for AFib from PPG sensors located in an ambulatory wrist watch. To our knowledge this is the first study to demonstrate an algorithm with a high enough accuracy to be used in general population studies that does not require an ambulatory Holter electrocardiographic monitor.

Women and men have distinct cardiovascular reactivity mechanisms for MSIMI. For women, stress-induced peripheral vasoconstriction with mental stress, and not increased hemodynamic workload, is associated with MSIMI, whereas for men, it is the opposite. Future studies should examine these pathways on long-term outcomes.

Background Higher symptom levels of a variety of measures of emotional distress have been associated with cardiovascular disease ( CVD ), especially among women. Here, our goal was to investigate the association between a composite measure of psychological distress and incident cardiovascular events. Methods and Results In a prospective cohort study, we assessed 662 individuals (28% women; 30% blacks) with stable coronary artery disease. We used a composite score of psychological distress derived through summation of Z‐transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress) as a predictor of an adjudicated composite end point of adverse events (cardiovascular death, myocardial infarction, stroke, heart failure, or unstable angina). During a mean follow‐up of 2.8 years, 120 (18%) subjects developed CVD events. In the overall population, there was no association between the psychological distress measure and CVD events, but there was a sex‐based interaction ( P =0.004). In women, higher psychological distress was associated with a higher incidence of CVD events; each SD increase in the composite score of psychological distress was associated with 1.44 times adjusted hazard of CVD events (95% CI, 1.09–1.92). No such association was found in men. Conclusions Among patients with coronary artery disease, higher psychological distress is associated with future cardiovascular events in women only.

Rationale Leucocyte telomere length (LTL) is a biological marker of aging, and shorter LTL is associated with adverse cardiovascular outcomes. Reduced regenerative capacity has been proposed as a mechanism. Bone marrow-derived circulating progenitor cells (PCs) are involved in tissue repair and regeneration. Objective To examine the relationship between LTL and PCs, and their impact on adverse cardiovascular outcomes. Methods and Results We measured LTL by quantitative PCR in 566 outpatients (age 63±9 years, 76% male) with coronary artery disease (CAD). Circulating PCs were enumerated by flow cytometry. After adjustment for age, gender, race, BMI, smoking and previous myocardial infarction, a shorter LTL was associated with a lower CD34+ cell count: for each 10% shorter LTL, CD34+ levels were 5.2% lower (p<0.001). After adjustment for the aforementioned factors, both short LTL (