Yale University. US: Young and middle-aged women experience more stress than their male
counterparts, which could contribute to worse recovery from acute
myocardial infarction (AMI), according to new findings by Yale School of
Medicine researchers and their colleagues.
The findings appear in the current issue of Circulation.
“Women
tend to report greater stress and more stressful life events than men,
potentially because of their different roles in family life and work, as
compared to men,” said first author Xiao Xu,
assistant professor in the Department of Obstetrics, Gynecology &
Reproductive Sciences at Yale School of Medicine. “This difference in
the level of stress may be an important reason for sex-based differences
in recovery after acute myocardial infarction.”
Xu and colleagues
used data from the Variation in Recovery: Role of Gender Outcomes on
Young AMI Patients (VIRGO) study, which is the largest prospective
observational study of young and middle-aged women and men with AMI.
VIRGO studied AMI patients 18 to 55 years old from a large, diverse
network of 103 hospitals in the United States, 24 in Spain and 3 in
Australia from 2008 to 2012.
Xu and the team measured each
patient’s self-perceived psychological stress during the initial
hospital stay for AMI using 14 questions, which asked participants about
the degree to which their life situations during the last month were
unpredictable, uncontrollable, and overloaded. One sample question
asked, “In the last month, how often have you been upset because of
something that happened unexpectedly?” Response to each item was scored
as never (0), almost never (1), sometimes (2), fairly often (3), and
very often (4). The team measured each patient’s recovery based on
changes in their angina-specific and overall health status between
initial hospitalization for AMI and one month after AMI.
Compared
with men, women had significantly higher rates of diabetes, chronic lung
disease, chronic renal dysfunction, depression, and cancer, as well as
previous stents, congestive heart failure, and stroke. Women were also
more likely to have children or grandchildren living in their household,
while experiencing greater financial strain.
“This study is
distinctive in focusing particularly on young women and going beyond
traditional predictors of risk to reveal how the context of these
people’s lives influences their prognosis,” said senior author Dr. Harlan M. Krumholz, principal investigator of the VIRGO study.
Xu
added, “Helping patients develop positive attitudes and coping skills
for stressful situations may not only improve their psychological
well-being, but also help recovery after AMI. Stress management
interventions that recognize and address different sources of stress for
men and women would be beneficial.
Other authors on the study
include Haikun Bao, Kelly Strait, Dr. John A. Spertus, Judith H.
Lichtman, Dr. Gail D’Onofrio, Dr. Erica Spatz, Emily M. Bucholz, Mary
Geda, Nancy P. Lorenze, Dr. Héctor Bueno, and John F. Beltrame.
The
study was funded by the National Heart, Lung, and Blood Institute,
National Institutes of Health, Department of Health and Human Services.
IMJOVEN (VIRGO in Spain) was supported by the Fondo de Investigaciones
Sanitarias del Instituto Carlos III, Ministry of Science and Technology,
and additional funds from the Centro Nacional de Investigaciones
Cardiovasculares. VIRGO Australia was supported in part by the Hospital
Research Foundation Program Grant for the Vascular Disease Therapeutic
Research Group. Xu and Krumholz were supported by the Center for
Cardiovascular Outcomes Research at Yale University. Bueno was supported
in part by the Fondo de Investigación Sanitaria del Instituto de Salud
Carlos III, Spain.
Citation: Circulation