Stress A Problem for Young Women with Heart Disease

New research finds that emotional stress can cause reduced blood flow to the heart among young women with stable coronary heart disease.

Investigators discovered blood flow restrictions were not associated with physical stress and that women were more likely than men to have reduced cardiac blood flow.

The research was presented at the American Heart Association’s Scientific Sessions.

Compared to men of the same age, when subjected to a mental stress test, women:

  • age 55 and younger had three times greater reduction in blood flow to the heart;
  • age 56-64 had double the reduction in blood flow to the heart;
  • age 65 and older had no difference in blood flow to the heart.

“Women who develop heart disease at a younger age make up a special high-risk group because they are disproportionally vulnerable to emotional stress,” said Viola Vaccarino, M.D., Ph.D.

Women generally develop heart disease later in life than men. However, younger women who have premature heart attacks are more likely to die than men of similar age.┬áInvestigators said that risk factors, such as diabetes or high blood pressure, don’t explain these mortality differences.

In the study, researchers gave a standardized mental stress test and, on a separate day, a traditional physical stress test (exercise treadmill test or pharmacological stress test) to 534 patients with stable coronary heart disease.

For the mental stress protocol, patients were asked to imagine a stressful life situation and deliver a speech about this story in front of a small audience.

Researchers used nuclear imaging to take pictures of the heart while undergoing each of the two stress tests and while at rest. They also monitored heart rate and blood pressure during both mental and physical tests. Then they analyzed the differences in coronary blood flow based on gender and age.

In contrast to the large differences in blood flow observed with mental stress, there were no differences in blood flow with physical stress between women and men.

Researchers believe women may be more vulnerable to emotional stress because they encounter high levels of stress throughout their everyday life.

“Young and middle-age women encounter numerous stressors in everyday life such as managing kids, marriage, jobs, and caring for parents,” Vaccarino said.

Biology may also play a role. For example, a greater propensity towards abnormal blood vessel function during emotional stress, such as exaggerated constriction of coronary or peripheral blood vessels.

Health care providers should be aware of young and middle-age women’s special vulnerability to stress and “ask the questions about psychological stress that often don’t get asked,” Vaccarino said.

“If they note that their patient is under psychological stress or is depressed, they should advise the woman to get relevant help or support from mental health providers, stress reduction programs, or other means.”

Source: American Heart Association

Woman with heart disease photo by shutterstock.