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| GENDER DIFFERENCES IN ANGINAL PAIN PERCEPTION David S. Sheps, M.D.1, Peter G. Kaufmann, Ph.D.2 , Robert P. McMahon, Ph.D.3 , David Sheffield, Ph.D.1 , Bob Bonsall, Ph.D.4, Kathleen C. Light, Ph.D.5 , William Maixner, D.D.S., Ph.D.5 , Jerome D. Cohen, M.D.6 , A. David Goldberg, M.D.7 , Mark W. Ketterer , Ph.D.7 , James Raczynski, Ph.D.8 , Carl J. Pepine, M.D.9 for the PIMI Investigators 1 East Tennessee State University, 2 National Heart, Lung, and Blood Institute, 3Maryland Medical Research Institute, 4Emory University School of Medicine, 5University of North Carolina at Chapel Hill, 6St. Louis University Medical Center, 7 Henry Ford Hospital, 8 University of Alabama at Birmingham, 9 University of FloridaWomen have been suggested to have differences in clinical presentations of ischemic heart disease and a higher proportion of false positive stress tests for coronary artery disease compared with men. We therefore studied angina reporting during daily activities, and during exercise and mental stress in 170 male and 26 female patients. All patients had documented coronary artery disease (angiographic or prior MI) and all had >= 1 mm ST segment depression on treadmill exercise (ETT). Females reported angina more often than males during daily activities and during mental stress (P=.04 and .01) but not during exercise. Men had lower scores than women on measures of depression, trait anxiety, harm avoidance, and reward dependence. Females had significantly lower plasma Beta endorphin levels at rest (4.2 ± 3.9 vs. 5.0 ± 2.5 p mol/L for men, P= 0.005), at maximal mental stress (6.4 ± 5.1 vs. 7.4 ± 3.5 p mol/L for men). There was a higher proportion of females with hot pain threshold (HPT) < 41° C vs. >= 41° C, 33% vs. 10%, P=0.001. In conclusion: Compared with men, females with coronary artery disease have 1) more angina during daily life and during mental stress, but not during exercise stress, 2) differences in psychological characteristics, 3) differences in hot pain thresholds and plasma Beta-endorphins. These differences may affect the affective and discriminative aspects of pain perception in women.
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