Women with heart disease are more likely than men to suffer cardiovascular events due to microvascular response to stress, study finds

How women with heart disease respond to stress can increase their risk of developing adverse cardiovascular events, according to a new study co-authored by researchers with UTHealth Houston School of Public Health and Emory University in Atlanta.

The study was recently published in the American Heart Association’s Journal of Arteriosclerosis, Thrombosis, and Vascular Biology.

Researchers monitored 263 men and women over the course of five years. Participants were brought in to clinics to undergo a stress test that produced stressful scenarios similar to everyday life. During the test, researchers were able to measure their heart rate, blood pressure, and vascular function response in real time.

Women who participated in the study experienced more tightening of their small peripheral arteries than men did when under mental stress.

“We found that women and men with heart disease react differently to stress,” said Samaah Sullivan, PhD, first author on the study and assistant professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences at UTHealth Houston School of Public Health. “Particularly, women had a more severe microvascular response or constriction of the small vessels, so their risk of a cardiovascular outcome was greater. Men were not really impacted.”

According to Sullivan, who began the research at Emory University as a postdoctoral fellow, these findings align with prior studies which found women have distinct biological responses to stress that may increase their risk of cardiovascular events compared to men.  

“Prior studies have alluded to women having a distinct biological response to stress that may increase their risk of major cardiovascular events compared to men, but this is one of the first studies to show sex differences in microvascular dysfunction in response to stress including a diverse sample of women and men,” Sullivan said. “This research really shows that there is a female-specific mechanism that links psychologic stress to cardiovascular outcomes. These findings can help physicians recognize that stress is a risk factor for women and to address it so they can minimize that risk.”

Additional authors include: An Young, MD, MPH; Mariana Garcia, MD; Zakaria Almuwaqqat, MD, MPH; Kasra Moazzami, MD; Muhammad Hammadah, MD; Bruno B. Lima, MD, PhD; Yingtian Hu, BS; Mohamad Nour Jajeh, MD; Ayman Alkhoder, MD; Lisa Elon, MS, MPH; Tené T. Lewis, PhD; Amit J. Shah, MD, MSCR; Puja Mehta, MD; J. Douglas Bremner, MD; Arshed A. Quyyumi, MD; and Viola Vaccarino, MD, PhD, all with Emory University.

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