Young Women with Myocardial Infarction Are Vulnerable to Mental Stress

Summary and Comment |
March 17, 2014

Young Women with Myocardial Infarction Are Vulnerable to Mental Stress

  1. Joel Yager, MD

Post-MI, women aged 50 and younger were twice as likely as men to develop myocardial ischemia after an emotionally stressful task, but not after physical stress.

  1. Joel Yager, MD

Each year, 10,000 American women under age 45 suffer a myocardial infarction (MI) and have roughly twice the risk for hospital mortality as similarly aged men. To study the various stressors on myocardial function in post-MI patients, investigators recruited 49 women within 6 months of MI and age matched them to 49 men with MI. The groups had similar numbers of participants aged 50 or younger and with non-ST elevation MIs.

Patients underwent single-proton emission computed tomography (SPECT) scans of myocardial perfusion at rest and during mental-stress and physical-stress tests. For the mental-stress task, participants had 5 minutes to prepare and present a videotaped talk to a “white-coat” audience concerning an imagined mistreated sick relative.

Analyses were stratified by age (≤50 vs. >50). In the younger group, mental stress provoked myocardial ischemia in twice as many women as men. Differences remained significant in analyses accounting for demographics, lifestyle factors, disease severity, depressive symptoms, and time since MI. Sex differences were not seen in the older group or with physical stress.


These results need to be confirmed in larger studies and those examining other stressors. Still, the findings suggest sex differences in stress vulnerability affecting myocardial function in younger patients. The underlying mechanisms for the different stress responses remain unclear, although other studies suggest that women have greater coronary artery reactivity and microvascular dysfunction with stress, factors that may foster ischemic heart disease. Clinicians working with young women after myocardial infarction should be particularly attentive to sources of mental distress and should intervene to help these patients increase stress tolerance and coping capacities.

Editor Disclosures at Time of Publication

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Research; Eating Disorders Review (Editor-in-Chief); Harvard Review of Psychiatry; International Journal of Eating Disorders; UpToDate Leadership positions in professional societies American Psychiatric Association (Chair, Steering Committee and Executive Committee on Practice Guidelines; Co-Chair, DSM5 Clinical and Public Health Committee; Chair, Council on Research and Quality Care)


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