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Heart Heath Q&A: The Effects of Stress on Heart Health Differ Between Women and Men

May 28, 2015
by Women's Health Research at Yale

Previous research has indicated that mental stress can influence cardiovascular health, but no one had clearly identified any sex differences. A study published in the Journal of the American College of Cardiology last fall shows the effects of mental stress on the heart appear to differ between women and men. This new research explored sex differences in response to mental stress in a group of men and women with ischemic heart disease, a condition characterized by reduced blood supply to the heart that is the most common cause of death in most Western countries.

The study was publicized by Medical News Today on October 13, 2014.

Differing Effects of Stress on Heart Health Q&A

Q: Why is mental stress harmful to cardiovascular health?

A: A significant body of evidence has shown that stress can be a potential trigger for coronary artery disease (CAD) and other cardiac events, including increased risk of death. There are several mechanisms by which stress might cause heart disease and/or a heart attack. Increases in blood pressure, heart rate, blood vessel reactivity, and platelet clotting can occur with stress. These factors may all be related to abnormalities in the nervous system with activation of the sympathetic nervous system, which triggers what is often referred to as the fight-or-flight response. These nervous system responses may increase platelet clotting and also increase susceptibility to serious irregular heart rhythms. Stress has been shown to decrease blood flow through the blood vessels supplying the heart by altering the reactivity of the blood vessel. The decrease in blood flow noted during mental stress is typically not painful and not related to the severity of cholesterol blockages that may exist in the heart blood vessels. There is considerable variability in how each individual responds to mental stress. The stress typically causing cardiac issues frequently stems from sudden catastrophic life events, anger, and emotional trauma but does not need to be severe. Rather, it can be chronic stress experienced in everyday life. Thus far, there are no specific medications that can target and block the decrease in blood flow or abnormalities in blood vessel reactivity resulting from mental stress.

Q: How was this study conducted? What sex differences did the researchers find in the effects of mental stress on heart health?

A: Cardiovascular disease is the leading cause of death in women. Psychosocial and behavioral factors have been shown to be associated with an increased risk and a worse prognosis of CAD in women. This new study evaluated 310 patients – 56 women and 254 men – who were being treated for heart disease and who participated in the Responses of the Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study. As part of the study, the men and women completed three tests that caused mental stress: a mental arithmetic test, a mirror tracing test, and an anger recall test. The participants underwent measurements of blood pressure, a heart ultrasound, an electrocardiogram, and a lab test of platelet aggregation or clumping (blood clotting component). These assessments were done at rest and then repeated after the three separate mental stress-inducing tasks. All of the patients also underwent an exercise stress test. Analysis of the results showed measurable differences in response to mental stress in women compared to men. After stress, women expressed more negative and fewer positive emotions and an increased tendency toward blood clotting. Men exhibited measurable differences in certain clinical responses, including increased blood pressure and workload of the heart. Reference: “Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients with Stable Ischemic Heart Disease,” Journal of the American College of Cardiology, October 21, 2014.

Q: How will identifying and understanding these differences between women and men help improve prevention and treatment of cardiovascular disease?

A: There are significant differences between men and women in causes of heart disease, how to diagnosis and treat CAD, and long-term outcomes. These differences should be taken into account in the care of women with known or suspected heart disease. Although sex differences in cardiovascular disease have been noted for some time, the number of cardiovascular deaths in women has been greater than men for the last two decades. And yet studies show that compared to men, women have less CAD due to cholesterol build-up in the heart blood vessels and better heart pump function. Stress could account for some of this difference as researchers have demonstrated that it causes chemical changes within the body and harmful effects on the reactivity of the small blood vessels supplying the heart. Continuing to study the effects of mental stress on the heart can further our understanding of the interplay between psychology and physiology as it relates to differences in cardiac mechanisms and outcomes in women and men. The knowledge we obtain from these studies is leading to better diagnostic tests, medications, and treatments for the prevention of heart disease in both women and men.

Q: Are there ways to reduce both mental stress and the risk of ischemic heart disease resulting from mental stress?

A: For women and men at risk for cardiovascular conditions (including coronary artery disease and coronary heart disease) and under increased mental stress, a stress management program should be part of an overall preventive strategy. The main goal of a stress management program is to reduce the impact of stressful events and to moderate the stress response. Interventions may be considered at several levels and include decreasing the stress, modifying the perception of stress, reducing the impact of stress, and learning new coping strategies. While there is a clear link between stress and illness, the exact mechanisms underlying this connection continue to be examined. Mental stress can affect various factors and behaviors that increase the risk of heart disease (including high blood pressure, increased alcohol intake, poor sleep, tobacco use, and overeating). Daily exercise, maintaining a positive attitude, quitting and avoiding smoking, decreasing alcohol or caffeine consumption, eating a healthy diet, and relaxation techniques such as deep breathing are all good ways to deal with stress. In some cases, medications and counseling may help. You can ask your health care provider about resources for managing mental stress. Excellent online resources are offered by the American Heart Association and the American College of Cardiology.

Heart Health Q & A is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.

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Submitted by Carissa R Violante on May 28, 2015