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Gender, Health Care, Health Disparities, Healthcare, Mental Health, Mental Health Care, Mental Illness, Public Health, Science, Uncategorized, Women's Health

New Study Shows Stress Can Be Deadly For Young Women

Stress & heart health 2

Stress may play an important role in a person’s ability to recover from a heart attack, according to a new study, which found that young women are particularly vulnerable to the negative cardiovascular effects of stress.

Researchers at Yale University found that younger and middle-age men and women who had more mental stress in their lives tended to have worse recovery one month after a heart attack than those under less stress. Importantly, the results also showed that women experienced far higher levels of stress than men, which the researchers say could at least partially explain why women tend to have worse outcomes after a heart attack than men.

Each year, around 720,000 people in the United States have a heart attack. Of those people, about 435,000 are women, including 83,000 women under the age of 65 and 35,000 under age 55. After a heart attack, women have worse outcomes than men on nearly every relevant measure of health, with young women in particular experiencing disproportionate levels of post-heart attack morbidity and mortality. It is estimated that up to 42 percent of women who have a heart attack will die within 1 year, compared to 27 percent of men; under age 50, women’s heart attacks are twice as likely as men’s to be fatal.

While these gender disparities are likely caused by a variety of factors — including a lack of gender-specific research, inequities in treatment, and higher rates of misdiagnosis among women — recent research suggests that stress may play a unique role in women’s heart health.

Higher levels of mental stress are known to affect blood flow in the heart and are linked with plaque formation in the arteries, said Dr. Xiao Xu, one of the study’s authors and an assistant professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine in New Haven, Connecticut.

A previous study had suggested a link between higher levels of perceived stress and poorer health outcomes and death rates in older heart attack patients, but much less is known about this connection in younger people, who typically experience greater amounts of mental stress, especially younger women.

Worse Health Outcomes

For this international study, the Yale researchers looked at nearly 2,400 women and close to 1,200 men ages 18 to 55 who were hospitalized following a heart attack. While recovering in the hospital, patients from the United States, Spain and Australia were asked about the stress in their lives during the time leading up to their heart attacks.

The findings revealed that women had significantly higher levels of mental stress than men. Women were more likely to feel stressed by caregiving demands, family problems and limited finances than men were, and they also were more likely to report a stressful life event in the past year, such as a death, a major illness striking a loved one, family-related conflicts or a personal health problem.

The data also showed that women experienced worse health outcomes in the first month after suffering a heart attack, which the researchers say is likely due in part to women’s higher stress-levels. Compared to men the same age, women had more chest pain, a lower quality of life, and poorer overall health, the researchers found.

The findings are published this week in the journal Circulation.

Few studies have examined why younger women experience worse health outcomes than younger men after having a heart attack, so the reasons are not fully understood, the researchers said. Besides the influence of stress, studies have shown that women’s symptoms are more likely to be dismissed or misdiagnosed by both patients and doctors, largely because they often don’t look like the ‘classic’ heart attack victim — which, as it turns out, characterizes male heart victims, not females. Women who have heart attacks also tend to be sicker than men prior to the attack, which may complicate their recovery, the researchers added.

Psychosocial Risk Factors

The authors note that the results are correlational — not causal — in nature, and therefore it’s not possible to determine exactly how, or even if, stress directly impacts heart attack recovery. For instance, stress has been linked to behaviors that may negatively impact health outcomes; it could be that people with higher stress-levels may be less likely to exercise, quit smoking, eat a heart-healthy diet, and/or adhere to treatment.

Either way, the researchers say their findings emphasize the need to consider how stress and other psychosocial factors may affect the recovery of patients following heart attack.

“We need to think more broadly about our patients,” said Dr. Harlan Krumholz, the study’s senior author and director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital and a professor in Yale’s School of Medicine and Public Health. “We have to consider their state of mind and the experiences of their lives.”

This is especially true for younger women, said Dr. Krumholz, as they are often juggling numerous responsibilities, including caring for children and sick family members, in addition to working. Doctors need to be more proactive in assessing women’s stress levels, anxiety and depression, he said.

Gender, Stress, & Heart Health

These findings support those of a study released in October 2014, in which researchers found that the effects of mental stress on the heart vary between men and women. In that study, published in the Journal of the American College of Cardiology, the team found that women exposed to mental stress were more likely to have myocardial ischemia – reduced blood flow to the heart – and early formation of blood clots than stressed men.

“This study revealed that mental stress affects the cardiovascular health of men and women differently,” said study leader Dr. Zainab Samad, of Duke University in Durham, NC. “We need to recognize this difference when evaluating and treating patients for cardiovascular disease.”

Similar findings have also reported for women with depression. According to a 2014 study published in the Journal of the American Heart Association, depression more than doubles the risk of heart attack for women under the age of 55, while the same was not found for men. Research indicates that depression can increase the risk of heart failure by as much as 40 percent. Studies have also linked a variety of other mental disorders — including schizophrenia, bipolar disorder, neurotic disorders, personality disorders and substance-use disorders — to a heightened risk of heart problems.



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