Stress May Reduce Blood Flow for Some Heart Disease Patients

Women with coronary heart disease who were younger than 65 had reduced blood flow to their hearts when dealing with emotional stress

(RxWiki News) Some women who have coronary heart disease may not handle stress in the same way others do. New research suggests that these women may take stress to heart — literally.

Women younger than 65 had less blood flow to the heart when dealing with emotional stress than either men or older women, the research found.

Study lead author Viola Vaccarino, MD, of Emory University in Atlanta said that, if a woman is under stress, she should seek help from a mental health professional.

Stress can be a normal reaction to life events, but patients who feel stressed may have a physical response to their feelings. The body releases stress hormones, which can quicken the heart and breathing rates and raise blood pressure.

Coronary heart disease is a narrowing of the small blood vessels that bring oxygen to the heart. For the current research, Dr. Vaccarino and team studied 564 people with coronary heart disease. All were given a standardized mental and emotional stress test and a traditional physical test, such as a workout on a treadmill. To test emotional stress, the authors asked the patients to imagine a stressful life event and deliver a speech about that time to a small audience.

The study authors used nuclear imaging to see how the patients’ hearts fared while being tested. Nuclear imaging uses low doses of radioactive substances that are usually injected into the body through a vein. Using special equipment, the radioactive substances can be followed in the body to see where they concentrate. The researchers were able to see how blood flowed in the bodies of those taking the tests.

The blood flow to the heart remained similar for men and women when they took the physical test, regardless of age. But women 55 years and younger had a three-times greater reduction in blood flow to the heart than men when they took the mental stress test.

Women 55 to 64 years of age had double the reduction in blood flow to the heart during the mental stress test compared to men.

Women over 65 and men did not show any significant changes to the blood flow to their hearts during the mental stress test.

“The blood flow was reduced to a less extent in older women and men ... we are not yet sure why,” Dr. Vaccarino told dailyRx News. “It might be because younger women have more stress in their life. They also may have a higher propensity towards abnormal function of small vessels in their heart during stress, which may cause abnormalities in blood flow.”

The authors took into account other factors, such as the medication the women took and risk factors for coronary heart disease. Risk factors for heart disease include smoking and high blood pressure. Despite any of these factors, Dr. Vaccarino and colleagues still found a difference in blood flow to the heart between younger women and men or older women who took the mental stress test.

“I think women tend to take stress to heart (excuse the pun!) more than men," said Sarah Samaan, MD, FACC, a cardiologist at the Baylor Heart Hospital in Plano, TX, in an interview with dailyRx News. "We often take stress more personally, and consider ourselves at fault for the situation, whereas many men are able to shrug it off, or to compartmentalize the stress in their lives."

Dr. Samaan said that “Older studies have not found a strong correlation between stress and heart disease, but in general women, especially younger women, have not been part of these studies. Clearly more research is needed to understand how mental stress can have such a powerful physical effect on women.”

Dr. Samaan offered some advice for younger women with coronary heart disease.

“In the meantime, it's important for women to learn healthy strategies to cope with the stressful situations in their lives," she said. "Exercise is often a great way to blow off steam and to feel better about yourself in the process. Mindful activities like yoga and meditation can also make a difference, by teaching us how to breathe deeply and to clear out the negative thoughts and feelings that can keep us down. Even a fairly sedentary hobby like knitting or scrapbooking may help, by giving us something else to focus on, if only for a short time.”

Dr. Vaccarino and team presented this research Nov. 16 at the American Heart Association Scientific Sessions in Chicago. Research presented at conferences may not have been peer-reviewed.

The National Institutes of Health funded the study. The authors disclosed no conflicts of interest.

Review Date: 
November 13, 2014