The following are key points to remember from a state-of-the-art review about psychosocial stress on cardiovascular disease (CVD) in women:

1. Stress is linked to several cardiovascular disorders that disproportionately affect women including mental stress-induced myocardial ischemia, spontaneous coronary artery dissection, stress-induced cardiomyopathy, ischemia with nonobstructive coronary artery disease, myocardial infarction with nonobstructive coronary artery disease, and heart failure with preserved ejection fraction. Biological pathways implicated in response to stress involve neurobiology, vascular dysfunction, immune dysfunction, and inflammation. Repeated activation of the neuroendocrine axis can lead to alterations of immune function, blood pressure, vascular function, visceral fat deposition, coagulation, ovarian function, and metabolic effects. Stress ultimately causes cardiac electrical instability, myocardial ischemia, microvascular dysfunction, atherosclerotic plaque disruption, and thrombus formation.
2. Psychological stressors in women range from negative experiences in young age and midlife to higher prevalence of stress-related mood and anxiety disorders.
3. Psychosocial stressors disproportionally affecting women include early life stress or trauma, intimate partner violence, marital stress, and caregiving stress and have all been linked to cardiovascular risk. Early life stressors such as family conflict, divorce, sexual abuse, paternal absence, and stepfather presence are associated with early menarche.
4. Early (<12 years) or late (>17 years) menarche is associated with CVD. Preterm labor, low birth weight, and pregnancy-induced hypertension are linked to maternal morbidity, mortality, and CVD. Early-onset menopause (<40 years) is associated with increased risk of CVD.
5. CVD, hypertension, obesity, and lower life expectancy occur more often in Black women compared to White women. Psychosocial stress is associated with greater prevalence of CVD risk factors in Hispanic populations.
6. Fewer women meet the physical activity guidelines established by the U.S. Department of Health and Human Services compared to men (20% vs. 28%). Women are at higher risk of experiencing sleep disturbances during reproductive milestones, after traumatic stress exposures, and due to caregiving.
7. Psychosocial stress may be mitigated through individual, community, and policy interventions resulting in improved quality of life and increased adherence to health care recommendations.
8. Community interventions such as tailored neighborhood coalitions, support networks, promoting the role of nonphysicians, and geo-mapping may have even greater benefits than those focused on individuals.
9. Ability of clinicians to address psychosocial stress will be improved by design of randomized controlled trials for screening and management of psychosocial stressors evaluating clinical outcomes, epidemiologic and mechanistic studies correlating psychosocial stress and CVD risk, intervention and community-level studies targeting social environment contributors to psychosocial distress, and ensuring adequate representation of women in cardiovascular research.

Clinical Topics: Prevention, Stress, Cardiovascular Care Team

Keywords: Cardiovascular Diseases, Stress, Psychological, Women

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