Why stress and depression take a toll on women’s heart health

Dianne Travis-Teague remembers clutching her chest as she navigated the chaos of a crowded hospital parking lot, looking for a spot amid the crowd of vehicles. For weeks, a clinic in his hometown of Santa Barbara had been telling him that the chest pain was simply the result of anxiety or indigestion.

In the emergency room, doctors quickly discovered that the two-time breast cancer survivor was having a heart attack. Surgery to unblock his arteries saved his life, but for the next four months his pain persisted. “I felt worse after the stent than before,” she said. “I suffered, sometimes in silence. My family also suffered.

It wasn’t until she consulted a female heart specialist that she found answers. Her doctor asked her questions about her life, her family and the stress of her job as director of alumni relations at a top school. Her doctor, C. Noel Bairey Merz, director of the Barbra Streisand Women’s Cardiology Center at the Smidt Heart Institute at Cedars-Sinai, also explained the connection between mental and heart health, particularly in women.

Bairey Merz prescribed a new blood pressure medication and a lifestyle focused on reducing stress. Travis-Teague felt better within weeks.

“It was like all of a sudden someone could hear me,” Travis-Teague said. “Now I know the importance of work-life balance.”

Why stress affects women’s hearts

Growing evidence suggests that the effects of mental health have a disproportionate impact on women’s bodies. Recent findings presented at the American College of Cardiology Annual Scientific Session in April indicate that depression and anxiety accelerate the development of new risk factors for cardiovascular disease, particularly in young and middle-aged women. .

Researchers followed 71,214 people participating in the Mass General Brigham Biobank for 10 years. People with a history of anxiety or depression before the study were about 55% more likely to develop high blood pressure, high cholesterol, or diabetes than those who did not. This finding was more pronounced among women with anxiety or depression under the age of 50, who were nearly twice as likely to develop cardiovascular risk factors as any other group.

“The goal of our project is to suggest that if a doctor has a patient with anxiety or depression, they should also think about screening for cardiovascular risk factors,” said lead author Giovanni Civieri, a cardiologist and researcher at the Massachusetts General Hospital. and Harvard Medical School.

Previous studies have also shown that stress and emotional health can have an outsized impact on women’s hearts.

A study of more than 3,600 men and women in Framingham, Massachusetts, looked at married partners who typically held back their feelings during an argument with their spouse. Women who kept silent during marital conflict were four times more likely to die during the 10-year study period than women who always spoke their minds. (The effect was not seen in men.) Whether the woman reported having had a happy or unhappy marriage did not change her risk.

An 18-year study of 860 Australian women concluded that having a depressive disorder is a risk factor for coronary heart disease in women. The strength of the association between depression and heart disease was greater than that of any other risk factor.

“The literature supports an even stronger association between depression and heart disease and poor outcomes in women than in men,” said Roy Ziegelstein, a cardiologist and professor of medicine at Johns Hopkins.

Ziegelstein pointed to a condition called Takotsubo cardiomyopathy – also known as “stress cardiomyopathy” or broken heart syndrome – which is more common in women. Up to 90 percent of cases occur in women aged 58 to 75. Although many people recover, the illness can be life-threatening and is often triggered by intense physical or emotional stress.

Regardless of age, ethnicity, and socioeconomic status, there are many stories of women whose symptoms go ignored, only to later discover that they suffered a heart attack or developed cardiovascular disease.

For Marianna Knopov, several New York doctors she saw over three years were unable to identify the cause of her intense heart palpitations and chest tension. In 2013, the 51-year-old Russian immigrant was a busy mother of two teenage sons who ran her own thriving dental clinic. “My life was like a roller coaster,” she said.

After years of the same cycle — pain, hospitals and home without relief — Knopov said she was ready to give up on her search for answers. “You go one after the other and they don’t listen to you. They can’t hear you. They just want to fire you, and that’s how I felt.

By the time she met Evelina Grayver in 2016, a cardiologist specializing in women’s heart health who now works at the Katz Institute for Women’s Health at Northwell Health in Queens, the vessels in her heart were narrowed and calcified, and she did not There was “absolutely nowhere” to connect a new bypass.

Doctors placed seven stents in her three major arteries and Grayver prescribed a lifestyle to better regulate anxiety and chronic stress that helped her achieve this. Knopov said the diagnosis had a “profound” effect on her. “I had to change something,” she says.

She eventually sold her practice, traded the bustling streets of New York for the serene beaches of Florida, and recently became a grandmother.

“I live a totally different life,” she says. Now 62, Knopov has incorporated meditation, yoga and abdominal breathing exercises into her daily routine, and she walks 10,000 steps a day.

Knopov said her doctors’ advice helped her “experience a different state of mind and being.” There is a lot of joy every day,” she said.

In the complex web of mental health and cardiovascular well-being, there is no clear explanation for why the link is so strong in women.

Studies from Emory University have shown that women experiencing acute mental stress are more susceptible than men to constriction of their small peripheral arteries, leading to decreased blood flow. The researchers found that the microvascular response to stress was also associated with adverse outcomes in women, but not in men.

This could be explained in particular by the fact that women’s blood vessels are smaller in terms of caliber and consistency than those of men. While men are prone to centralized plaque buildup in the larger arteries that supply blood to the heart, women typically have small, diffuse blockages throughout their blood vessels, “which is very dangerous” because they can be more difficult to remove. detect and treat, according to Grayver.

Additionally, experts say that stress in women appears to disrupt lipid balance, increase platelet aggregation, and impair glucose regulation. Chronic stress can further exacerbate the progression of coronary heart disease by fueling inflammation, a more pronounced risk factor in women. This increased inflammatory response increases the risk of major adverse cardiovascular events.

“We know that anxiety, stress and depression are bad. Now let’s figure out how to best identify and treat those at risk,” said Puja Mehta, director of women’s translational cardiovascular research at Emory Women’s Heart Center. “How can we help them manage stress so that it improves blood flow to the heart?” »

One of the main areas of interest among researchers is whether treating mental health problems, using existing medications such as antidepressants or traditional talk therapy, could mitigate cardiovascular risk. Others are studying a potential genetic link between depression and heart disease, hoping to discover new drugs that can treat both conditions simultaneously.

After an attack, reduce future risks

While it’s valuable to understand why women’s hearts are particularly vulnerable to stress, it’s more important that doctors recognize the connection up front.

“What tends to happen is that younger women who have risk factors, for example, only see their obstetrician-gynecologist for birth control, and by the time they come to the cardiologist, they have already developed heart disease or heart failure,” Mehta. said. “We need to do a better job of early identification and prevention. »

Following a heart attack, women have a higher risk of mortality within five years. Although not fully understood, one theory suggests that the increased risk could be attributed to adverse psychological reactions related to heart attack-related stress, according to JoAnn E. Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.

Research also shows that fewer women than men are referred to cardiac rehabilitation programs, which can help limit the psychological stress associated with heart disease, reduce the risk of associated mortality, and improve cardiovascular function to help patients to optimize their quality of life. Additionally, women are less likely to receive protective medications, such as cholesterol-lowering drugs. statins or beta blockers, to protect against future cardiovascular events.

Experts emphasize that lifestyle interventions are among the most effective and accessible tools for women managing both their mental health and cardiovascular issues. This includes regular physical activity, improved diet and sleep habits, and tools to manage stress, such as meditation and deep breathing.

Social support also appears to have a greater cardiac benefit for women than for men. According to Manson, the presence of family members or friends with whom women can maintain regular contact strongly predicts their cardiovascular health.

Travis-Teague continued to work with his doctors to manage his stress. Her advice to women facing similar challenges: “Understand that you have to…

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