How Does Stress Affect Women with Stable Coronary Heart Disease?

A new study suggests that young women with stable coronary heart disease who experience emotional stress are more likely to have reduced blood flow to the heart, in comparison to men with the disease.

A team of Emory University researchers studied 534 male and female patients with the disease, directing each participant to undergo a standardized mental stress test, which entailed imagining a stressful life situation and delivering a speech detailing this situation to an audience. On a separate day, the patients took a traditional physical stress test, performing either an exercise treadmill test or a pharmacological stress test. The authors used nuclear imaging to capture images of the heart while the participants completed the stress tests as well as when they were at rest. The researchers also monitored heart rate and blood pressure during both tests.
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The Emory researchers—who note that young women who experience earlier heart attacks are more likely to die than men of a similar age—analyzed the differences in coronary blood flow on both gender and age, finding that women 55 and younger had 3 times greater reduction in heart blood flow compared to men of the same age.

In addition, women between the ages of 56 and 64 saw double the reduction in blood flow to the heart in comparison to the men, with women over the age of 65 experiencing no difference compared to men of the same age. There were no gender differences in blood flow during the physical stress tests, which the authors say demonstrate that mental stress has a significant influence on blood flow for female coronary heart disease patients.

Given the findings, the researchers say that healthcare providers must be aware of the differences revealed by this study, particularly young and middle-age women’s susceptibility to stress, and should ask female patients with coronary heart disease questions about psychological stress.

“Our study results highlight the importance of stress on women’s cardiovascular disease risk, especially young women who already have heart disease,” says Viola Vaccarino, MD, PhD, professor and chair of the department of epidemiology at Emory University’s Rollins School of Public Health, and lead study author.

“Primary care providers should be aware of this, and work with their patients to identify dimensions in women’s lives where stress can be managed and reduced,” says Vaccarino. “This is an aspect that often gets overlooked in busy clinical care.”

Vaccarino urges primary care practitioners to encourage women to “engage in activities that may help them reduce stress, such as physical activity. They should be encouraged to reach out for help if they are overburdened with responsibilities, and to find some time for themselves.”

Women should also be encouraged to communicate with their providers if they have negative emotions such as depression or anger, she adds, noting that “primary care providers can help these patients find appropriate counseling and referrals when additional professional help is needed to manage psychological problems.”

The findings were originally presented at the American Heart Association's Scientific Sessions 2014, held November 15 - 19 in Chicago, Ill.

—Mark McGraw