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Although stress affects both men and women, researchers found that women had higher levels of stress than men. Those higher stress levels may have played a role in their worse recovery in the month after suffering a heart attack. Women had more chest pain, poorer quality of life and worse overall health than men, the researchers found.
"People need to be aware of the adverse impact on health of mental stress, and in this particular case, it may affect recovery after heart attack," said lead author Xiao Xu, an assistant professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine.
"Also, younger women experience greater stress than younger men. This may put women at higher risk for poor recovery," she said.
Women tend to have higher stress than men for many reasons, Xu said. "For example, they usually have less financial resources and are often faced with greater demand for family care," she said.
While this study found a link between high stress levels and a worse outcome soon after a heart attack, it wasn't designed to prove whether or not stress was the direct cause of the poorer outcome.
The report was published online Feb. 9 in the journal Circulation.
For the study, Xu and her colleagues collected data on about 2,400 women and approximately 1,200 men ages 18 to 55 who had a heart attack. The study participants were from more than 100 hospitals in the United States, Spain and Australia.
Women in the study were more likely to have other medical problems, including diabetes, chronic lung disease, kidney problems, depression and cancer, as well as a history of heart problems and stroke.
To measure the patients' level of stress, researchers used a 14-item scale that indicated how much people felt their lives were uncontrollable and overloaded during the past month. Women were more likely to report stress over family issues. Men were more likely to be concerned about financial problems, according to the study.
One third of women and 21 percent of men said they had family conflict during the past year. In addition, 22 percent of the women reported suffering a major personal injury or illness in the past year, compared with 17 percent of men. Almost 40 percent of women said a close family member had a serious illness or died. For men, that number was 28 percent, the study noted.
However, when it came to financial problems, more men (about 7.5 percent) than women (3.5 percent), said they had stress due to a crop or business failure, Xu's team found.
The researchers found that one month after having a heart attack, women were more likely to have a poorer recovery.
They also found that people with moderate or high stress levels more likely to have a worse recovery than women with low levels of mental stress. However, the effect of stress on recovery didn't differ between men and women, according to the researchers. But because women experienced more stress overall, increased stress might partially explain their worse recovery, the researchers said.
Each year in the United States 35,000 women under age 65 experience a heart attack, according to background information in the study. This is one of the few studies that looks at how psychosocial factors affect recovery, the researchers said.
Mental stress may play an important role in influencing patients' recovery after a heart attack, Xu said. "When caring for younger heart attack patients, especially younger women, we need to pay attention to their life situations and mental state in addition to physical health," she added.
Simon Rego is director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City. He said: "Hopefully, increased recognition that perceived stress can have a negative impact both internally -- by reducing blood flow and promoting plaque forming in the arteries -- and externally -- by leading to behaviors that may adversely affect health outcomes, such as treatment noncompliance -- will encourage more medical professionals to consider the role and impact of psychological factors on medical events and outcomes."
Strong evidence exists that psychological treatments, particularly cognitive-behavioral therapy, can help patients manage stress, he said.
"This could not only improve patients' psychological well-being and potentially prevent medical problems from occurring, but also help in recovery after they have occurred," Rego said.
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