Skip to main content

Sex and Gender Differences in Psychosocial Risk Factors for Ischemic Heart Disease

  • Chapter
  • First Online:
Book cover Manual of Gynecardiology

Abstract

Women have more depression and anxiety than men, which are associated with an increased risk of mortality in ischemic heart disease (IHD). Psychosocial factors are related to inflammation and an autonomic nervous system imbalance. Younger (premenopausal) women have a stronger effect for psychosocial factors and IHD outcomes than older women. Social norms and status, gender roles and expectations also contribute to health status in individuals with IHD. It may be difficult to distinguish cardiac symptoms from anxiety or a panic attack. Specific interventions are needed to reduce (chronic) psychosocial stress in women.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. WHO. The global burden of disease: 2004 update. WHO Library Cataloguing-in-Publication Data. Geneva: World Health Organization, Informatics DoHSa; 2008.

    Google Scholar 

  2. Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med. 2012:1–11.

    Google Scholar 

  3. Faravelli C, Alessandra Scarpato M, Castellini G, Lo Sauro C. Gender differences in depression and anxiety: the role of age. Psychiatry Res. 2013;210(3):1301–3.

    Article  PubMed  Google Scholar 

  4. Ferrari AJ, Charlson FJ, Norman RE, Flaxman AD, Patten SB, Vos T, et al. The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010. PLoS One. 2013;8(7):e69637.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Statline C. Huisarts geregistreerde diagnose van depressie en angst volgens de International Classification of Primary Care [Physician registered diagnosis of depression and anxiety according to the International Classification of Primary Care]. The Hague/Heerlen: Central Bureau of Statistics; 2011. http://statline.cbs.nl/. Accessed 01 Jun 2016.

  6. Roest AM, Martens EJ, Denollet J, de Jonge P. Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med. 2010;72(6):563–9.

    Article  PubMed  Google Scholar 

  7. Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry. 2008;65(1):62–71.

    Article  CAS  PubMed  Google Scholar 

  8. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763–74.

    Article  PubMed  Google Scholar 

  9. van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2004;66(6):814–22.

    Article  PubMed  Google Scholar 

  10. Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014;129(12):1350–69.

    Article  PubMed  Google Scholar 

  11. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):1237–46.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005;131(2):260–300.

    Article  PubMed  Google Scholar 

  13. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469–500.

    Article  PubMed  Google Scholar 

  14. Low CA, Thurston RC, Matthews KA. Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med. 2010;72(9):842–54.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Strike PC, Steptoe A. Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis. 2004;46(4):337–47.

    Article  PubMed  Google Scholar 

  16. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52.

    Article  PubMed  Google Scholar 

  17. Smyth A, O’Donnell M, Lamelas P, Teo K, Rangarajan S, Yusuf S. Physical activity and anger or emotional upset as triggers of acute myocardial infarction. The INTERHEART study. Circulation. 2016;134(15):1059–67.

    Article  PubMed  Google Scholar 

  18. Stringhini S, Berkman L, Dugravot A, Ferrie JE, Marmot M, Kivimaki M, et al. Socioeconomic status, structural and functional measures of social support, and mortality: the British Whitehall II Cohort Study, 1985–2009. Am J Epidemiol. 2012;175(12):1275–83.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–37.

    Article  PubMed  Google Scholar 

  20. Schiebinger L. Scientific research must take gender into account. Nature. 2014;507(7490):9.

    Article  CAS  PubMed  Google Scholar 

  21. Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, et al. Sex versus gender-related characteristics: which predicts outcome after acute coronary syndrome in the young? J Am Coll Cardiol. 2016;67(2):127–35.

    Article  PubMed  Google Scholar 

  22. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–701.

    Article  CAS  PubMed  Google Scholar 

  23. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol. 2016;23(11):np1–np96.

    Article  PubMed  Google Scholar 

  24. Van Montfort EV, Denollet J, Widdershoven J, Kupper N. Validity of the European society of cardiology’s psychosocial screening interview in patients with coronary heart disease—the THORESCI study. Psychosom Med. 2016. DOI: 10.1097/PSY.0000000000000433.

  25. Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Manfrini O, et al. Presentation, management, and outcomes of ischaemic heart disease in women. Nat Rev Cardiol. 2013;10(9):508–18.

    Article  PubMed  Google Scholar 

  26. Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, et al. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J. 2016;37(1):24–34.

    Article  PubMed  Google Scholar 

  27. Shaw JA, Kingwell BA, Walton AS, Cameron JD, Pillay P, Gatzka CD, et al. Determinants of coronary artery compliance in subjects with and without angiographic coronary artery disease. J Am Coll Cardiol. 2002;39(10):1637–43.

    Article  PubMed  Google Scholar 

  28. Jespersen L, Hvelplund A, Abildstrom SZ, Pedersen F, Galatius S, Madsen JK, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33(6):734–44.

    Article  PubMed  Google Scholar 

  29. Sedlak TL, Lee M, Izadnegahdar M, Merz CN, Gao M, Humphries KH. Sex differences in clinical outcomes in patients with stable angina and no obstructive coronary artery disease. Am Heart J. 2013;166(1):38–44.

    Article  PubMed  Google Scholar 

  30. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007;356(8):830–40.

    Article  CAS  PubMed  Google Scholar 

  31. Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J. 2014;35(17):1101–11.

    Article  PubMed  Google Scholar 

  32. Kemp Jr HG, Vokonas PS, Cohn PF, Gorlin R. The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med. 1973;54(6):735–42.

    Article  PubMed  Google Scholar 

  33. Arthur HM, Campbell P, Harvey PJ, McGillion M, Oh P, Woodburn E, et al. Women, cardiac syndrome X, and microvascular heart disease. Can J Cardiol. 2012;28(2 Suppl):S42–9.

    Article  PubMed  Google Scholar 

  34. Sara JD, Widmer RJ, Matsuzawa Y, Lennon RJ, Lerman LO, Lerman A. Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease. JACC Cardiovasc Interv. 2015;8(11):1445–53.

    Article  PubMed  Google Scholar 

  35. Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, et al. Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. 2006;47(3 Suppl):S21–9.

    Article  PubMed  Google Scholar 

  36. Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P, et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med. 2002;346(25):1948–53.

    Article  PubMed  Google Scholar 

  37. Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 2016;133(9):916–47.

    Article  CAS  PubMed  Google Scholar 

  38. Dreyer RP, Smolderen KG, Strait KM, Beltrame JF, Lichtman JH, Lorenze NP, et al. Gender differences in pre-event health status of young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardiovasc Care. 2016;5(1):43–54.

    Article  PubMed  Google Scholar 

  39. Mastenbroek MH, Versteeg H, Zijlstra W, Meine M, Spertus JA, Pedersen SS. Disease-specific health status as a predictor of mortality in patients with heart failure: a systematic literature review and meta-analysis of prospective cohort studies. Eur J Heart Fail. 2014;16(4):384–93.

    Article  PubMed  Google Scholar 

  40. Mommersteeg PMC, Denollet J, Spertus JA, Pedersen SS. Health status as a risk factor in cardiovascular disease: a systematic review of current evidence. Am Heart J. 2009;157(2):208–18.

    Article  PubMed  Google Scholar 

  41. Moller-Leimkuhler AM. Women with coronary artery disease and depression: a neglected risk group. World J Biol Psychiatry. 2008;9(2):92–101.

    Article  PubMed  Google Scholar 

  42. Shanmugasegaram S, Russell KL, Kovacs AH, Stewart DE, Grace SL. Gender and sex differences in prevalence of major depression in coronary artery disease patients: a meta-analysis. Maturitas. 2012;73(4):305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ferketich AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey. Arch Intern Med. 2000;160(9):1261–8.

    Article  CAS  PubMed  Google Scholar 

  44. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–62.

    Article  PubMed  Google Scholar 

  45. Rutledge T, Reis SE, Olson M, Owens J, Kelsey SF, Pepine CJ, et al. Depression is associated with cardiac symptoms, mortality risk, and hospitalization among women with suspected coronary disease: the NHLBI-sponsored WISE study. Psychosom Med. 2006;68(2):217–23.

    Article  PubMed  Google Scholar 

  46. Wang HX, Leineweber C, Kirkeeide R, Svane B, Schenck-Gustafsson K, Theorell T, et al. Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study. J Intern Med. 2007;261(3):245–54.

    Article  PubMed  Google Scholar 

  47. Smolderen KG, Strait KM, Dreyer RP, D'Onofrio G, Zhou S, Lichtman JH, et al. Depressive symptoms in younger women and men with acute myocardial infarction: insights from the VIRGO study. J Am Heart Assoc. 2015;4(4):e001424.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Xu X, Bao H, Strait K, Spertus JA, Lichtman JH, D’Onofrio G, et al. Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction. Circulation. 2015;131(7):614–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Shah AJ, Ghasemzadeh N, Zaragoza-Macias E, Patel R, Eapen DJ, Neeland IJ, et al. Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events. J Am Heart Assoc. 2014;3(3):e000741.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Zimmermann-Viehoff F, Wang HX, Kirkeeide R, Schneiderman N, Erdur L, Deter HC, et al. Women’s exhaustion and coronary artery atherosclerosis progression: The Stockholm Female Coronary Angiography Study. Psychosom Med. 2013;75(5):478–85.

    Article  PubMed  Google Scholar 

  51. Doyle F, McGee H, Conroy R, Conradi HJ, Meijer A, Steeds R, et al. Systematic review and individual patient data meta-analysis of sex differences in depression and prognosis in persons with myocardial infarction: a MINDMAPS Study. Psychosom Med. 2015;77(4):419–28.

    Article  PubMed  Google Scholar 

  52. Loerbroks A, Bosch JA, Mommersteeg PMC, Herr RM, Angerer P, Li J. The association of depression and angina pectoris across 47 countries: findings from the 2002 World Health Survey. Eur J Epidemiol. 2014;29(7):507–15.

    Article  PubMed  Google Scholar 

  53. Möller-Leimkühler AM. Higher comorbidity of depression and cardiovascular disease in women: a biopsychosocial perspective. World J Biol Psychiatry. 2010;11(8):922–33.

    Article  PubMed  Google Scholar 

  54. Kop WJ, Mommersteeg PMC. Psychoneuroimmunological processes in coronary artery disease and heart failure. In: Kusnecov AW, Anisman H, editors. The Wiley-Blackwell handbook of psychoneuroimmunology. 1st ed. Hoboken: Wiley; 2013.

    Google Scholar 

  55. Kop WJ, Mommersteeg PMC. Psychoneuroimmunological pathways and sex differences in coronary artery disease: the role of inflammation and estrogen. In: Orth-Gomér K, Schneiderman N, Vaccarino V, Deter H-C, editors. Psychosocial stress and cardiovascular disease in women concepts, findings, future perspectives. New York: Springer; 2015. p. 129–49.

    Google Scholar 

  56. Soares CN. Depression in peri- and postmenopausal women: prevalence, pathophysiology and pharmacological management. Drugs Aging. 2013;30(9):677–85.

    Article  CAS  PubMed  Google Scholar 

  57. Douma SL, Husband C, O'Donnell ME, Barwin BN, Woodend AK. Estrogen-related mood disorders: reproductive life cycle factors. Adv Nurs Sci. 2005;28(4):364–75.

    Article  CAS  Google Scholar 

  58. Williams KE, Marsh WK, Rasgon NL. Mood disorders and fertility in women: a critical review of the literature and implications for future research. Hum Reprod Update. 2007;13(6):607–16.

    Article  PubMed  Google Scholar 

  59. Dantzer R. Cytokine-induced sickness behavior: mechanisms and implications. Ann N Y Acad Sci. 2001;933(1):222–34.

    Article  CAS  PubMed  Google Scholar 

  60. De Jonge P, Rosmalen JG, Kema IP, Doornbos B, van Melle JP, Pouwer F, et al. Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery patients: a critical review of the literature. Neurosci Biobehav Rev. 2010;35(1):84–90.

    Article  PubMed  Google Scholar 

  61. Gidron Y, Kupper N, Kwaijtaal M, Winter J, Denollet J. Vagus-brain communication in atherosclerosis-related inflammation: a neuroimmunomodulation perspective of CAD. Atherosclerosis. 2007;195(2):e1–9.

    Article  CAS  PubMed  Google Scholar 

  62. Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease: is there a link? Lancet. 1997;350(9075):430–6.

    Article  CAS  PubMed  Google Scholar 

  63. Agushi E, Xhyheri B, Bugiardini R. Sex differences in biomarkers for predicting cardiovascular and coronary events. Curr Vasc Pharmacol. 2013;11(5):785–94.

    Article  CAS  PubMed  Google Scholar 

  64. Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331(7):417–24.

    Article  CAS  PubMed  Google Scholar 

  65. Kuller LH, Tracy RP, Shaten J, Meilahn EN. Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple risk factor intervention trial. Am J Epidemiol. 1996;144(6):537–47.

    Article  CAS  PubMed  Google Scholar 

  66. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973–9.

    Article  CAS  PubMed  Google Scholar 

  67. Lavie CJ, Milani RV, Verma A, O'Keefe JH. C-reactive protein and cardiovascular diseases-is it ready for primetime? Am J Med Sci. 2009;338(6):486–92.

    Article  PubMed  Google Scholar 

  68. Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350(14):1387–97.

    Article  CAS  PubMed  Google Scholar 

  69. Cossette E, Cloutier I, Tardif K, DonPierre G, Tanguay JF. Estradiol inhibits vascular endothelial cells pro-inflammatory activation induced by C-reactive protein. Mol Cell Biochem. 2013;373(1–2):137–47.

    Article  CAS  PubMed  Google Scholar 

  70. Gameiro CM, Romao F, Castelo-Branco C. Menopause and aging: changes in the immune system—a review. Maturitas. 2010;67(4):316–20.

    Article  CAS  PubMed  Google Scholar 

  71. Knowlton AA, Lee AR. Estrogen and the cardiovascular system. Pharmacol Ther. 2012;135(1):54–70.

    Article  CAS  PubMed  Google Scholar 

  72. van Sloten TT, Schram MT, Adriaanse MC, Dekker JM, Nijpels G, Teerlink T, et al. Endothelial dysfunction is associated with a greater depressive symptom score in a general elderly population: the Hoorn Study. Psychol Med. 2013;44(7):1403–16.

    Article  PubMed  Google Scholar 

  73. McSweeney JC, Cody M, O’Sullivan P, Elberson K, Moser DK, Garvin BJ. Women’s early warning symptoms of acute myocardial infarction. Circulation. 2003;108(21):2619–23.

    Article  PubMed  Google Scholar 

  74. DeVon HA, Pettey CM, Vuckovic KM, Koenig MD, McSweeney JC. A review of the literature on cardiac symptoms in older and younger women. J Obstet Gynecol Neonatal Nurs. 2016;45(3):426–37.

    Article  PubMed  Google Scholar 

  75. Madsen R, Birkelund R. Women’s experiences during myocardial infarction: systematic review and meta-ethnography. J Clin Nurs. 2016;25(5–6):599–609.

    Article  PubMed  Google Scholar 

  76. Chiaramonte GR, Friend R. Medical students’ and residents’ gender bias in the diagnosis, treatment, and interpretation of coronary heart disease symptoms. Health Psychol. 2006;25(3):255–66.

    Article  PubMed  Google Scholar 

  77. Roger VL, Farkouh ME, Weston SA, Reeder GS, Jacobsen SJ, Zinsmeister AR, et al. Sex differences in evaluation and outcome of unstable angina. JAMA. 2000;283(5):646–52.

    Article  CAS  PubMed  Google Scholar 

  78. Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics. 2003;44(3):222–36.

    Article  PubMed  Google Scholar 

  79. Mommersteeg PMC, Widdershoven JW, Aarnoudse W, Denollet J. Personality subtypes and chest pain in patients with nonobstructive coronary artery disease from the TweeSteden Mild Stenosis Study: mediating effect of anxiety and depression. Eur J Pain. 2016;20(3):427–37.

    Article  CAS  PubMed  Google Scholar 

  80. Katerndahl DA. Chest pain and its importance in patients with panic disorder: an updated literature review. Prim Care Companion J Clin Psychiatry. 2008;10(5):376–83.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, et al. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1 131 612 persons and 58 111 cardiac events. Psychol Med. 2015:1–12.

    Google Scholar 

  82. Fleet R, Lesperance F, Arsenault A, Gregoire J, Lavoie K, Laurin C, et al. Myocardial perfusion study of panic attacks in patients with coronary artery disease. Am J Cardiol. 2005;96(8):1064–8.

    Article  PubMed  Google Scholar 

  83. Arrighi JA, Burg M, Cohen IS, Soufer R. Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease. J Nucl Cardiol. 2003;10(3):267–74.

    Article  PubMed  Google Scholar 

  84. Kim CK, Bartholomew BA, Mastin ST, Taasan VC, Carson KM, Sheps DS. Detection and reproducibility of mental stress-induced myocardial ischemia with Tc-99m sestamibi SPECT in normal and coronary artery disease populations. J Nucl Cardiol. 2003;10(1):56–62.

    Article  PubMed  Google Scholar 

  85. Ronel J, Mehilli J, Ladwig KH, Blattler H, Oversohl N, Byrne RA, et al. Effects of verbal suggestion on coronary arteries: results of a randomized controlled experimental investigation during coronary angiography. Am Heart J. 2011;162(3):507–11.

    Article  PubMed  Google Scholar 

  86. Vermeltfoort IA, Raijmakers PG, Odekerken DA, Kuijper AF, Zwijnenburg A, Teule GJ. Association between anxiety disorder and the extent of ischemia observed in cardiac syndrome X. J Nucl Cardiol. 2009;16(3):405–10.

    Article  CAS  PubMed  Google Scholar 

  87. Paine NJ, Bacon SL, Pelletier R, Arsenault A, Diodati JG, Lavoie KL. Do women with anxiety or depression have higher rates of myocardial ischemia during exercise testing than men? Circ Cardiovasc Qual Outcomes. 2016;9(2 Suppl. 1):S53–61.

    Article  PubMed  Google Scholar 

  88. Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the panic screening score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Berthoud HR, Neuhuber WL. Functional and chemical anatomy of the afferent vagal system. Auton Neurosci. 2000;85(1–3):1–17.

    Article  CAS  PubMed  Google Scholar 

  90. Xhyheri B, Manfrini O, Mazzolini M, Pizzi C, Bugiardini R. Heart rate variability today. Prog Cardiovasc Dis. 2012;55(3):321–31.

    Article  PubMed  Google Scholar 

  91. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010;141(2):122–31.

    Article  PubMed  Google Scholar 

  92. Reyes del Paso GA, Langewitz W, Mulder LJ, van Roon A, Duschek S. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology. 2013;50(5):477–87.

    Article  PubMed  Google Scholar 

  93. Ong ME, Goh K, Fook-Chong S, Haaland B, Wai KL, Koh ZX, et al. Heart rate variability risk score for prediction of acute cardiac complications in ED patients with chest pain. Am J Emerg Med. 2013;31(8):1201–7.

    Article  PubMed  Google Scholar 

  94. Kahan T, Forslund L, Held C, Bjorkander I, Billing E, Eriksson SV, et al. Risk prediction in stable angina pectoris. Eur J Clin Investig. 2013;43(2):141–51.

    Article  CAS  Google Scholar 

  95. Steptoe A, Molloy GJ, Messerli-Burgy N, Wikman A, Randall G, Perkins-Porras L, et al. Fear of dying and inflammation following acute coronary syndrome. Eur Heart J. 2011;32(19):2405–11.

    Article  CAS  PubMed  Google Scholar 

  96. Lanza GA, Cianflone D, Rebuzzi AG, Angeloni G, Sestito A, Ciriello G, et al. Prognostic value of ventricular arrhythmias and heart rate variability in patients with unstable angina. Heart. 2006;92(8):1055–63.

    Article  CAS  PubMed  Google Scholar 

  97. Smoller JW, Pollack MH, Wassertheil-Smoller S, Brunner R, Curb D, Torner J, et al. Panic attacks, daily life ischemia, and chest pain in postmenopausal women. Psychosom Med. 2006;68(6):824–32.

    Article  PubMed  Google Scholar 

  98. Miwa K, Igawa A, Miyagi Y, Nakagawa K, Inoue H. Alterations of autonomic nervous activity preceding nocturnal variant angina: sympathetic augmentation with parasympathetic impairment. Am Heart J. 1998;135(5 Pt 1):762–71.

    Article  CAS  PubMed  Google Scholar 

  99. Liu CC, Kuo TB, Yang CC. Effects of estrogen on gender-related autonomic differences in humans. Am J Physiol Heart Circ Physiol. 2003;285(5):H2188–93.

    Article  CAS  PubMed  Google Scholar 

  100. Pivatelli FC, Dos Santos MA, Fernandes GB, Gatti M, de Abreu LC, Valenti VE, et al. Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients. Int Arch Med. 2012;5(1):31.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Haensel A, Mills PJ, Nelesen RA, Ziegler MG, Dimsdale JE. The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology. 2008;33(10):1305–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Thayer JF, Loerbroks A, Sternberg EM. Inflammation and cardiorespiratory control: the role of the vagus nerve. Respir Physiol Neurobiol. 2011;178(3):387–94.

    Article  CAS  PubMed  Google Scholar 

  103. Huston JM, Tracey KJ. The pulse of inflammation: heart rate variability, the cholinergic anti-inflammatory pathway and implications for therapy. J Intern Med. 2011;269(1):45–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Egashira K, Inou T, Hirooka Y, Yamada A, Maruoka Y, Kai H, et al. Impaired coronary blood flow response to acetylcholine in patients with coronary risk factors and proximal atherosclerotic lesions. J Clin Investig. 1993;91(1):29–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Ong P, Athanasiadis A, Borgulya G, Mahrholdt H, Kaski JC, Sechtem U. High prevalence of a pathological response to acetylcholine testing in patients with stable angina pectoris and unobstructed coronary arteries. The ACOVA Study (Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries). J Am Coll Cardiol. 2012;59(7):655–62.

    Article  CAS  PubMed  Google Scholar 

  106. Yeung AC, Vekshtein VI, Krantz DS, Vita JA, Ryan Jr TJ, Ganz P, et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med. 1991;325(22):1551–6.

    Article  CAS  PubMed  Google Scholar 

  107. Stillman AN, Moser DJ, Fiedorowicz J, Robinson HM, Haynes WG. Association of anxiety with resistance vessel dysfunction in human atherosclerosis. Psychosom Med. 2013;75(6):537–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Alvares GA, Quintana DS, Kemp AH, Van Zwieten A, Balleine BW, Hickie IB, et al. Reduced heart rate variability in social anxiety disorder: associations with gender and symptom severity. PLoS One. 2013;8(7):e70468.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Fanselow MS. Fear and anxiety take a double hit from vagal nerve stimulation. Biol Psychiatry. 2013;73(11):1043–4.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Ahs F, Sollers 3rd JJ, Furmark T, Fredrikson M, Thayer JF. High-frequency heart rate variability and cortico-striatal activity in men and women with social phobia. NeuroImage. 2009;47(3):815–20.

    Article  PubMed  Google Scholar 

  111. Friedman BH, Thayer JF. Autonomic balance revisited: panic anxiety and heart rate variability. J Psychosom Res. 1998;44(1):133–51.

    Article  CAS  PubMed  Google Scholar 

  112. Zimmermann-Viehoff F, Orth-Gomer K, Wang HX, Deter HC, Merswolken M, Ghadiyali Z, et al. Depressive symptoms and heart rate variability in younger women after an acute coronary event. Eur J Cardiovasc Prev Rehabil. 2010;17(5):509–13.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Penninx BW, Milaneschi Y, Lamers F, Vogelzangs N. Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile. BMC Med. 2013;11:129.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Licht CM, de Geus EJ, van Dyck R, Penninx BW. Association between anxiety disorders and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). Psychosom Med. 2009;71(5):508–18.

    Article  PubMed  Google Scholar 

  115. Gulli G, Cemin R, Pancera P, Menegatti G, Vassanelli C, Cevese A. Evidence of parasympathetic impairment in some patients with cardiac syndrome X. Cardiovasc Res. 2001;52(2):208–16.

    Article  CAS  PubMed  Google Scholar 

  116. Adamopoulos S, Rosano GM, Ponikowski P, Cerquetani E, Piepoli M, Panagiota F, et al. Impaired baroreflex sensitivity and sympathovagal balance in syndrome X. Am J Cardiol. 1998;82(7):862–8.

    Article  CAS  PubMed  Google Scholar 

  117. Spoladore R, Fisicaro A, Faccini A, Camici PG. Coronary microvascular dysfunction in primary cardiomyopathies. Heart. 2014;100(10):806–13.

    Article  CAS  PubMed  Google Scholar 

  118. Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, et al. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation. 2016;133(14):1341–50.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12.

    Article  PubMed  Google Scholar 

  120. Whalley B, Rees K, Davies P, Bennett P, Ebrahim S, Liu Z, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2011;8:CD002902.

    Google Scholar 

  121. Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev. 2011;9:CD008012.

    Google Scholar 

  122. Goodwin L, Ostuzzi G, Khan N, Hotopf MH, Moss-Morris R. Can we identify the active ingredients of behaviour change interventions for coronary heart disease patients? A systematic review and meta-analysis. PLoS One. 2016;11(4):e0153271.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  123. Tully PJ, Baumeister H. Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2015;5(12):e009128.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Kisely SR, Campbell LA, Yelland MJ, Paydar A. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev. 2012;13(6):CD004101.

    Google Scholar 

  125. Orth-Gomer K, Schneiderman N, Wang HX, Walldin C, Blom M, Jernberg T. Stress reduction prolongs life in women with coronary disease: the Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD). Circ Cardiovasc Qual Outcomes. 2009;2(1):25–32.

    Article  PubMed  Google Scholar 

  126. Orth-Gomer K, Deter HC. Sex and gender issues in cardiovascular research. Psychosom Med. 2015;77(9):1067–8.

    Article  PubMed  Google Scholar 

  127. Ouyang P, Wenger NK, Taylor D, Rich-Edwards JW, Steiner M, Shaw LJ, et al. Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientists. Biol Sex Differ. 2016;7:19.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paula M. C. Mommersteeg Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Mommersteeg, P.M.C., Widdershoven, J.W.M.G., Kop, W.J. (2017). Sex and Gender Differences in Psychosocial Risk Factors for Ischemic Heart Disease. In: Maas, A., Bairey Merz, C. (eds) Manual of Gynecardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-54960-6_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54960-6_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54959-0

  • Online ISBN: 978-3-319-54960-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics