Why Many Women May Struggle After Heart Attacks

Stress tied to worse heart attack recovery in young and middle aged women than in men

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Stress is a feared enemy of heart health, but most people have a hard time kicking it out of their lives. Learning to cope with stressful events may be an important step for women recovering from a heart attack.

Higher levels of stress in young and middle-aged women may explain why women in this age group often do not recover as well as men after a heart attack, a new study found.

"Helping patients develop positive attitudes and coping skills for stressful situations may not only improve their psychological well-being, but also help recovery after [a heart attack]," wrote lead author Harlan M. Krumholz, MD, a professor at Yale's School of Medicine and Public Health in New Haven, CT, and colleagues.

A heart attack occurs when part of the heart muscle is damaged or dies due to inadequate blood flow to the heart.

Dr. Krumholz and team looked at data on more than 3,500 heart attack survivors in the US, Spain and Australia. Of those, nearly 2,400 were women and nearly 1,200 were men — all aged 18 to 55.

In general, women had worse recovery one month after a heart attack, Dr. Krumholz and team found.

Female heart attack survivors had a higher level of perceived mental stress. They also had worse physical and mental health than men overall.

"Cardiologists and medical researchers have known for some time that women's heart attacks play out differently from men's, but we are only starting to understand what factors might be involved," said Sarah Samaan, MD, a cardiologist at the Baylor Heart Hospital in Plano, TX, in an interview with dailyRx News. "Mental stress is one issue that can be hard to study, but which women often experience differently from men. Other studies have found that mental stress can diminish blood flow in partially blocked arteries in women to a greater extent than what is typically seen in men. While we should always be careful in generalizing, women tend to have multiple competing sources of stress, including family, work and relationships."

Factors like family conflict, child care responsibilities, and death or illness of a close family member appeared to affect women more than men, Dr. Krumholz and team found. Men said they felt more stress from financial hardship or business failure.

Higher levels of stress in women may partially explain the significant differences in heart attack recovery between the sexes, these researchers said.

"Moreover, changes in social context, such as increased labor force participation among women and higher rates of divorce and single parenthood significantly influence social roles of women in the younger generation, which can become important stressors," Dr. Krumholz and colleagues wrote. "Hence, stress management interventions that recognize and address different sources of stress for men and women would be beneficial."

Stress can raise blood pressure and lead to unhealthy habits like stress eating and a sedentary lifestyle, Dr. Samaan said.

"It's especially important that women learn to ask for help when it's needed, and to say 'no' to unnecessary sources of stress in their lives," Dr. Samaan said. "Women (and men) should also nurture their health by making a healthy diet and regular exercise top priorities. In doing so, they may be able to offset some of the harmful effects of stress."

This study was published Feb. 9 in the journal Circulation.

The National Heart, Lung and Blood Institute, National Institutes of Health, and Spanish and Australian grants funded this research. Dr. Krumholz and colleague Dr. Hector Bueno received grants and fees from Medtronic, AstraZeneca, Bayer, Eli-Lilly and Novartis, among others.

Review Date: 
February 8, 2015
Last Updated:
February 10, 2015