Heart disease is the leading cause of death in the US for men and women alike, killing around 600,000 people each year. Coronary heart disease – the most common type – kills nearly 380,000 people annually. Now, new research suggests young women with stable coronary heart disease who are under emotional – but not physical – stress are more likely to have reduced blood flow to the heart than their male counterparts.

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Young women with coronary heart disease who are under emotional stress are more likely than their male counterparts to have reduced blood flow to the heart.

The research was presented recently at the American Heart Association’s (AHA) Scientific Sessions 2014.

In general, women tend to develop heart disease later in life than men, but younger women who have earlier heart attacks are more likely to die than men of a similar age, note the researchers, led by Dr. Viola Vaccarino of Emory University in Atlanta, GA.

What is more, risk factors do not explain these differences. According to the AHA, about 82% of people who die of coronary heart disease are 65 or older, and older women who have heart attacks are more likely than men to die with a few weeks.

However, other risk factors can contribute to the disease, including: smoking, high blood cholesterol, high blood pressure, physical inactivity, having excess body fat and diabetes.

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

To further investigate how stress affects women with stable coronary heart disease, the researchers had 534 patients with the disease – both men and women – take a standardized mental stress test. This involved imagining a stressful life situation and delivering a speech about this story in front of an audience.

Fast facts about heart disease in the US
  • Heart disease causes 1 in 4 deaths each year
  • Coronary heart disease alone costs the US $108.9 billion annually
  • Every year, around 720,000 Americans have a heart attack.

Learn more about heart disease

On a separate day, the patients took a traditional physical stress test, which consisted of either an exercise treadmill test or a pharmacological stress test.

In order to capture images of the heart while the patients participated in the stress tests and while they were at rest, the researchers used nuclear imaging. In addition, they monitored heart rate and blood pressure during both tests.

The team then examined the differences in coronary blood flow on both gender and age.

Results from the mental stress test revealed that, compared with men of the same age, women 55 and younger had three times greater reduction in heart blood flow.

Meanwhile, women between the ages of 56-64 had double the reduction in blood flow to the heart, compared with their male counterparts, and women over the age of 65 had no difference, compared with men of the same age.

Interestingly, there were not any gender differences in blood flow during the physical stress tests, revealing that mental stress has a significant influence on blood flow for female coronary heart disease patients.

The researchers say biology may play a role in their findings, pointing to a greater tendency in women’s bodies for emotional stress to trigger abnormal blood vessel function, including exaggerated coronary or peripheral blood vessel constriction.

In light of their results, the team says health care providers should be aware of these differences – particularly young and middle-age women’s vulnerability to stress – and should ask their female coronary heart disease patients questions about psychological stress.

Dr. Vaccarino adds:

”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.”

The researchers say younger women may be more susceptible to emotional stress because they face a lot of everyday stressors, such as managing kids, marriage, jobs and caring for parents.

In August of this year, Medical News Today reported on a study supporting this claim, which suggested that daughters spend twice as much time as sons in caring for elderly parents, placing significantly more stress on female children.