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 “It has been known for a while that (the) mortality rate is higher
in younger women than in younger men after heart attack,” said lead
author Xiao Xu, assistant professor of obstetrics, gynecology and
reproductive sciences at Yale University in New Haven, Connecticut.
But few studies have looked at gender differences in other outcomes,
Xu told Reuters Health by email.
“Women tend to experience greater stress than men, even in the
general population regardless of heart attack status,” she said.
“Our study confirmed such a gender difference in young and
middle-aged patients with heart attack.”
The researchers compared 2,397 women and 1,175 men under age 55 who
were hospitalized in the U.S., Spain or Australia with a heart
attack. The severity of the heart attacks was similar for women and
men.
While hospitalized, participants answered 14 questions about their
recent stress levels. One month later, researchers re-interviewed
them and assessed their recovery.
At the first interview, those who were younger and female tended to
have higher stress scores than those who were older or male, the
authors reported in a paper scheduled for publication in the journal
Circulation. On the 0- to 56-point stress scale, men averaged 23.4
points and women averaged 27 points.
A third of women had experienced major family conflict within the
past year compared to 20 percent of men. More women than men also
reported a major personal injury, illness or death of a family
member over the past year.
Women tend to have lower financial resources than men and are often
faced with more demands for family care, which may explain their
higher stress, Xu said.
Women in the study also had more diabetes, lung disease, kidney
problems, depression, cancer and previous heart problems.
At the one-month point, women had worse chest-pain related physical
function, quality of life and overall health.
“We had known that women have worse health status after a heart
attack for some time,” said Dr. Suzanne V. Arnold, a research
assistant professor at the University of Missouri in Kansas City.
“What we don't really understand is why.”
Arnold, who was not involved in the new study, noted that people who
have more issues with their health and personal lives also
experience more stress, and in this study, the women tended to have
more of both.
Stress is associated with heart attack and even death, Arnold said.
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“However, stress is associated with so many other things – including
smoking, lack of exercise, comorbidities, etc. – that are also
strong risk factors for heart attack,” so stress was probably not
the main cause of most of the heart attacks, she said.
After a heart attack, patients are often advised to adopt healthy
lifestyles and receive therapies such as beta-blockers, but people
under more stress may be less likely to comply, Xu said.
Stressed people are more likely to engage in smoking and drinking
behaviors or have disruptions in their treatment regimen, she said.
“When caring for younger patients with heart attack, especially
younger women patients, we should look beyond their physical health
and pay attention to their psychosocial status as well,” Xu said.
“Although our study demonstrated a strong relationship between
higher mental stress and worse recovery, we cannot make causal
inferences,” she said. “We still need more research to understand
the exact mechanisms through which mental stress operates to affect
recovery.”
All heart attack patients, regardless of gender, should be screened
for chronic stress, Arnold said.
“I think this research highlights again the importance of
recognizing and addressing the level of perceived stress of heart
attack patients,” she said. “I don't think men or women should be
treated differently, as any ‘intervention’ for stress would need to
be customized for the individual patient and his or her psychosocial
needs.”
SOURCE: http://bit.ly/1q3uqj1
Circulation, online February 9, 2015.
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