A new study finds that among young and middle-aged individuals who have a heart attack, women experience higher levels of mental stress than men, which could have negative implications for their recovery.

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Women aged 18-55 who had a heart attack had higher levels of mental stress and worse recovery than men.

The research team, led by Xiao Xu, PhD, assistant professor of obstetrics, gynecology and reproductive sciences at Yale University in New Haven, CT, publishes their findings in Circulation – a journal of the American Heart Association.

Each year, around 720,000 people in the US have a heart attack. Of these, around 35,000 occur among women under the age of 65.

The researchers explain that past studies have shown mental stress can reduce blood flow in the body and encourage plaque formation in the arteries, which can raise the risk of heart attack. In addition, stress has been linked to behaviors that may negatively impact health outcomes, including failure to adhere to treatment.

For their study, Xu and her team set out to determine whether there are differences in stress levels between men and women who experience heart attack, and if so, how these differences affect recovery.

The researchers analyzed data of 2,397 women and 1,175 men aged 18-55 who were a part of the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study.

All participants were heart attack survivors. During their first stay in hospital for the condition, the researchers used a 14-item scale to measure the subjects’ perceived stress levels.

At 1 month after heart attack, the researchers assessed how each patient was recovering, as measured by chest-pain-related physical function, overall health, quality of life, among other factors.

The team found that women had worse recovery following heart attack than men. In addition, women were found to have significantly higher levels of mental stress than men, which the researchers say may partly explain their poorer recovery.

The team found that women were more likely than men to report stress due to a family conflict in the past year (33% vs. 20%), a major personal injury or illness (22.4% vs. 16.6%) or the death or illness of a close relative (36.6% vs. 27.8%).

Stress due to a business or crop failure affected men more than women (7.4% vs. 3.5%), and men were more likely to be worried about financial issues.

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.

Senior study author Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital and a professor at the School of Medicine and Public Health at Yale University, adds:

We need to think more broadly about our patients. We have to consider their state of mind and the experiences of their lives.”

These findings support those of a study reported by Medical News Today in October 2014, in which researchers found 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, but men were more likely to experience changes in blood pressure and heart rate in response to mental stress.

“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.”