Stress and depression are common among women at the time of myocardial infarction (MI) and for two months after, and women with MI and obstructive coronary artery disease (MI-CAD) may have higher stress levels than those with MI with nonobstructive coronary arteries (MINOCA), according to a study published Oct. 16 in JACC.

Anaïs Hausvater, MD, et al., conducted a multicenter study with 486 women – 172 with MINOCA and 314 with MI-CAD – who completed questionnaires measuring their perceived stress and depression symptoms at the time of their MI and again two months later. Researchers then compared the results over time and looked at differences between the two types of MIs. Women with MINOCA were younger (age 59.4 years vs. 64.2 years; p<0.001) and more diverse than those with MI-CAD.

Results showed that high stress levels were reported by 63.0% of MI-CAD and 51.0% of MINOCA patients, whereas depressive symptoms were reported by 42.7% of MI-CAD and 36.2% of MINOCA patients at the time of MI. Women with MINOCA were less likely to report high levels of stress at the time of MI (51.0% vs. 63.0%; p=0.021) and at 2 months post-MI (32.5% vs. 46.3%; p=0.019) than women with MI-CAD.

Further, there was no difference in elevated depressive symptoms at the time of MI (36% vs. 43%; p=0.229) or at two months post-MI (39% vs. 40% p=0.999). There was also no differences in the rate of two-month decline in stress and depression scores between the two groups.

Hausvater said the study highlights the need for greater focus on mental health among women with heart disease. “It is important that clinicians, including cardiologists, screen their patients with heart disease for symptoms of stress, anxiety and depression.” She adds that because little is known about what causes MI-CAD or MINOCA, these patients are often left with few answers about why it happened to them and how they can prevent it from happening again. “We have observed clinically that this can cause distress among our patients,” she said. “Prior studies have suggested that stress might contribute more to their disease, but we found this might not be true.”

One possible explanation is that younger patients might have different sources of stress, she adds. Older women, who are more likely to have blocked arteries, may be coping with more financial stressors, as well as the illness or loss of aging partners.

Future studies from the group will focus on sex differences in psychosocial factors among men and women with MIs. Researchers are also working on a study that looks at stress interventions for women after MI.

In a related editorial comment, Roxana Mehran, MD, FACC, and Birgit Vogel, MD, note, “The high burden of stress and depressive symptoms in MI patients in this study emphasizes the importance of screening for stress and depression as part of optimal cardiovascular disease risk management. Further evidence on how to facilitate the implementation of proposed standardized screening pathways and how to incorporate psychosocial risk factors in cardiovascular risk assessment is urgently needed. Future studies must also investigate whether effective treatment of depression and the application of stress reduction techniques can reduce the risk of cardiovascular events and which populations would benefit the most. For these studies, it will be crucial to use well-validated assessment tools and cutoff scores to produce robust and reproducible evidence. Last, social disadvantages defined by socioeconomic disparities, which disproportionally affect women and minority populations, must be addressed as they represent major contributors to increased anxiety, stress and depression.”