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A new study looks at the impact of stress on heart disease risk for women. Spencer Platt/Getty Images
  • According to a new study, the combined effect of stress from social interactions and paid work increases women’s likelihood of developing coronary heart disease (CHD) by 21%.
  • The study also found that high stress life events were linked with a 12% increase in the risk of developing CHD, while social strain increased the risk by 9%.
  • If accurate, these findings could help women reduce their risk of developing CHD by focusing on ways to prevent or manage work and social strain.

The relationship between psychosocial stress and CHD seems to be stronger in women than in men. It may also vary depending on the type of stress or stressor.

However, it is unclear how different types of psychosocial stress impact women’s risk of developing CHD.

For this reason, a research team from Drexel University Dornsife School of Public Health in Philadelphia, PA, decided to investigate the association of psychosocial stressors — including job strain, stressful life events, and social strain — with the incidence of CHD in women.

They combed through the data collected as part of the Women’s Health Initiative Observational Study (WHIOS), to assess the independent and combined impact of stressful life events, social relationships, and paid work.

Their findings, which appear in the Journal of the American Heart Association, indicate that work and social strain seem to pack a double punch, increasing women’s risk of developing CHD by 21%.

Stressful life events and social strain, that is, the negative aspects of social interactions or relationships, also increased women’s risk of developing CHD by 12% and 9%, respectively.

“Our findings are a critical reminder to women, and those who care about them, that the threat of stress to human health should not go ignored,” says Dr. Conglong Wang, the study’s lead author. “This is particularly pertinent during the stressors caused by a pandemic.”

If true, these findings could shift the focus of preventing CHD in women from managing current stress to finding ways to prevent stress at the source.

It would also serve as a serious reminder that stress is a major threat to human beings, women in particular, and that this threat must be addressed promptly and properly.

Over the past few years, several major studies have established that psychosocial stress from different aspects of life may impact the risk of developing CHD.

This is likely because psychosocial stress can disrupt homeostasis — the optimal internal functioning of organs and their systems — which can lead to an illness.

As a result, stress can intensify cardiovascular inflammation and reactivity, resulting in metabolic changes that increase the risk of developing CHD.

Psychosocial stress is also linked with behavioral patterns such as alcohol consumption, smoking, or being physically inactive. Certain medical conditions, including diabetes and hypertension, affect the risk of CHD as well.

Stress may impact men and women differently. The findings from a few studies indicate that the link between psychosocial stress and CHD may be stronger in women than in men.

In one study, women were more likely than men to document high average stress levels and associated emotional and physical symptoms, including exhaustion and depression.

Another study found that women may be exposed to psychological stressors that men experience less commonly.

However, scientists still do not know how different stressors influence women’s risk of having CHD. It is therefore unclear which stressors affect the risk of developing this condition the most.

This makes it difficult for healthcare professionals to advise women on the best ways to reduce their likelihood of developing CHD. It also means women cannot be sure which stressors are most important to address to keep CHD at bay.

In the new study, the research team analyzed data collected as part of the WHIOS, an initiative aimed at finding better ways to prevent heart disease, cancer, and osteoporosis in women.

The scientists analyzed data from 80,825 women living in a diverse array of states across the United States that had experienced menopause.

Participants were aged 50–79 when the WHIOS started tracking them, and the average time women were tracked was 14 years and 7 months. Women assessed stressors in the WHIOS using self-reporting questionnaires.

After adjusting for variables such as job tenure, socioeconomic factors, age, and additional stressors, the researchers found a high stressful life events score increased the risk of developing CHD by 12%, and high social strain — by 9%.

The team also noted that the impact of work and social strain seem to work synergistically, increasing women’s CHD risk by 21%. Job strain alone was not linked with a higher CHD risk.

These findings could have important implications for how healthcare professionals and women themselves decide to best tackle stress to reduce their CHD risk.

It is of note that a disproportionately large number of participants in the study were white and held more than a high school diploma. The team’s findings may also be impacted by the “healthy worker bias,” according to which people who are less healthy are more likely to be unemployed.

Moreover, the team did not take into account other important compounding factors, such as working hours and social support systems, which are associated with CHD.

Also, the scientists only focused on the impact of stress related to a person’s most recent or current job, ignoring the change of jobs throughout life.

The researchers write that more studies are necessary to determine the impact of job demands as they align with sex.

A person’s sex and socioeconomic status may also affect their ability to manage stress. That is why future studies will also have to identify subgroups of people that are more likely to benefit from preventative stress interventions than others.

However, these new findings help fuel the need for more advanced, diverse research exploring the link between stress, heart disease, and sex or gender.

They may also encourage healthcare professionals and women alike to reconsider their best options for reducing their CHD risk and improving overall health.

“The COVID-19 pandemic has highlighted ongoing stresses for women in balancing paid work and social stressors. We know from other studies that work strain may play a role in developing CHD, but now, we can better pinpoint the combined impact of stress at work and at home on these poor health outcomes.”

– Dr. Yvonne Michael, senior author and associate professor in the Dornsife School of Public Health

“My hope is that these findings are a call for better methods of monitoring stress in the workplace and remind us of the dual burden working women face as a result of their unpaid work as caregivers at home.”