Looking at Stress and Heart Disease in Women | AHA Scientific Sessions

Philadelphia - Stress can play a critical role in heart disease in women, and researchers say it’s an area that demands more study and attention.

Several researchers discussed the role that stress plays in cardiovascular disease among women during a session at the American Heart Association Scientific Sessions in Philadelphia Saturday. (Photo: Ron Southwick)

The role of stress in cardiovascular disease among women was the subject of a session at the American Heart Association Scientific Sessions in Philadelphia. Several researchers discussed their findings during a session Saturday morning, and examined the role of stress in women, including gender roles and the social determinants of health. Researchers also discussed the greater risks of heart disease among Black women.

Heart disease is the leading cause of death among women in America, according to data from the U.S. Centers for Disease Control & Prevention. More than 60 million women, about 44% of America’s women, are living with some form of heart disease, the CDC says.

Viola Vaccarino, a professor of cardiology at the Rollins School of Public Health at Emory University, said it’s important to consider that women respond to stress differently than men.

“It is possible that stress and mental health may have a disproportionate effect in cardiovascular disease among women compared to men,” Vaccarino said.

Mental stress-induced myocardial ischemia (MSIMI) is more common in young women and middle-aged women than in men, Vaccarino noted.

Microvascular ischemia with mental stress could explain why certain conditions are more common in women, including more angina in daily life, and takotsubo cardiomyopathy, also referred to as “broken heart syndrome.” She also noted that it could explain why women have higher mortality after a myocardial infarction, she noted.

Women who bear heavy responsibilities as caregivers also are at greater risk for hypertension, noted Milla Arabadjian, an assistant professor at the NYU School of Medicine.

“Caregiving is a source of chronic stress for women,” Arabadjian said.

Arabadjian focused on stress among women of reproductive age. Socially vulnerable mothers typically are so focused on taking care of their children that they don’t pay enough attention to their own health needs, including preventive care. She noted that Black women can face even higher stress in their roles as caregivers, since they often have less support.

Women who are caring for children and aging parents endure even heavier stress. She adds that there should be more research in this area, particularly as more women are having children a bit later in life. The median age of women giving birth has risen from 27 in 1990 to 30 in 2019, according to the U.S. Census Bureau.

“Less is known about women who care for both children and elders, and we probably need to rethink this concept of the ‘sandwich generation,’” Arabadjian said.

Jolaade Kalinowski, an assistant professor at the University of Connecticut, also pointed to the greater risks of cardiovascular disease among Black women. Black women have higher risks of hypertension, and Black women have higher mortality rates from cardiovascular disease than white women.

While noting that all women deal with gender-related stress, Kalinowski said Black women also must deal with bias and discrimination all too frequently. She described it as a “double jeopardy” of gender and race.

“There is this toxic combination of gender- and race-related stress,” Kalinowski said.

“We need to address this head on,” she said. “And to do that, we need interventions to tackle these issues.”

Kalinowski also said there’s a literature gap in stress management interventions generally, and for Black women in particular.

Tené T. Lewis, an epidemiology professor at the Rollins School of Public Health at Emory University, discussed the impact of racism and discrimination.

“Everyday discrimination does matter for health,” Lewis said.

Lewis described how one Black woman said she always dressed a certain way to ensure she wouldn’t be mistreated due to her race. She also talked about vicarious exposures of racism and their effect on stress, explaining that some African-Americans, upon seeing Black people killed in violence, think that could happen to them.

Lewis encouraged the audience of clinicians and researchers to consider how racism shapes perspectives on health, and also urged the audience to speak up and call out racism and discrimination when they see it.

Anaïs Hausvater, a cardiologist at NYU Langone Medical Center, discussed the importance of considering gender beyond biology. As more individuals choose to identify themselves with a gender that may be different than what was designated at birth, Hausvater discussed the importance of the consideration of gender roles. She said that’s an area also worthy of more discussion and research.

“We need more studies examining the intersection of sex and gender, and may need to study more on gender-based roles rather than biological sex,” Hausvater said.

Harmony Reynolds, a cardiologist at NYU Langone School of Health who focuses on heart disease in women, also discussed the importance of reconsidering gender-related variables in research, such as examining how such gender roles could affect the management of chest pain in the emergency department.

“Biological sex and gender are different constructs and they both impact cardiovascular health and disease,” Reynolds said.

When talking about biological sex, the discussion involves genetics, but in discussing gender, that considers lifestyle, societal stressors, psychological traits, and access to healthcare and health management, Reynold said. They’re independent concepts but also connected.

“Sex modifies behavior, and socio-cultural factors within gender can modify biology, lifestyle, and epigenetics,” Reynolds said.

At the end of the session, the researchers received praise from a number of members of the audience.

One audience member noted one way the session could have been even better, and that is if more men were in attendance. Women made up most of the audience, and he pointed out more male researchers and clinicians need to understand the role of stress and other factors affecting the cardiovascular health of women.