Yanting Liang,1,2,* Ping Xie,3,* Yuting Liu,1,2 Han Yin,1,2 Xinzhou Zhang,1 Huan Ma2 

1Department of Nephrology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, People’s Republic of China; 2Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China; 3Cardiovascular Department, Gansu Provincial Hospital, Lanzhou, 730000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xinzhou Zhang, Department of Nephrology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, People’s Republic of China, Email zhang.xinzhou@szhospital.com Huan Ma, Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, People’s Republic of China, Email mahuandoctor@163.com

Purpose: This study aimed to investigate the impact of mental health and lifestyle factors on women with angina with nonobstructive coronary arteries (ANOCA), and to identify potential risk factors associated with ANOCA.
Methods: In this cross-sectional study, 84 female patients diagnosed with ANOCA and 42 age-matched healthy women served as controls. All participants underwent endothelial function testing and laboratory assessments. Demographic data, psychological status, and lifestyle behaviors were evaluated using self-administered questionnaires, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), and Post-Traumatic Stress Disorder Checklist—Civilian Version (PCL-C). Group differences in key variables were analyzed, and logistic regression was performed to identify independent risk factors and examine potential mediation effects.
Results: Compared with controls, women with ANOCA exhibited significantly higher scores on HADS-depression, HADS-anxiety, PCL-C, and PSS, along with lower exercise frequency, elevated serum hs-C-reactive protein (hs-CRP), and higher white blood cell (WBC) counts (all P < 0.05). They were also more likely to report anxiety, depression, post-traumatic stress symptoms, poor sleep quality, and short sleep duration (all P < 0.05). Hypertension was more prevalent in ANOCA group, while no difference was found in peripheral vascular function. After multivariable adjustment, depressive symptoms, higher PSS scores, elevated WBC counts, and hs-CRP levels were identified as independent risk factors. Mediation analysis revealed that anxiety fully mediated the associations of exercise frequency (β = − 0.07, P > 0.05) and poor sleep quality (β = 0.48, P > 0.05) with ANOCA, and partially mediated the link between short sleep duration and ANOCA (β = 1.86, P < 0.01).
Conclusion: Women with ANOCA are more likely to experience psychological distress, unhealthy lifestyle habits, and systemic inflammation. Depression, perceived stress, elevated WBC counts, and hs-CRP levels are independent risk factors, and unhealthy lifestyle may affect ANOCA by exacerbating anxiety.

Keywords: angina with nonobstructive coronary arteries, psychological distress, lifestyle behavior, inflammation